Another could it be.

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Jscantonwine

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I want to thank you for taking your time to read this. I appreciate you taking time out to look at another could this be post. I am looking for that I don't need to be here response. :)

Bit of background. I am female and 34 years old.

In December I hurt my lower back which resulted in surgery in Feb. Since then I have had some on going issues with my legs, a little bit of nerve pain, etc., weakness and gait issues but not bad enough that I thought it might be anything else.

July 15th I started PT 2x a week for the right leg strength and gait issues. PT noted very weak hip abductors and we started with work on those, along with general weakness on the right and very mild ankle clonus.

Between here and July 23rd PT and I noticed weakness in the left leg, and no progress in the right leg.

July 23rd I noticed a "twitching" in my toes that would disrupt my ability to drive.

PT and I discussed, kept with normal routine. Made notes about the leg weakness spreading to the left.

July 29th I had leg spasms while sitting in my left leg.

July 30th I woke to bilateral leg spasms while walking and sitting.

August 4th I was asked to stay home from work, as we were getting to a point it was unsafe for me to get coming.

August 11th I saw my Neurosurgeon as I thought this may have something to do with my first surgery, and it turns out it does not.

My legs don't work how I want them to. I have to think about walking, at times have had a complete shut down (best way I can think of to put it) where I am walking and I just stop like my legs have forgotten what to do. I've fallen due to this. Stairs are doable with help from someone else. Me or someone else has to lift my leg into the car.
When I am just standing still I feel like I am trying to balance on a board. My hips will pull back and my upper body forward.

This has happened very quickly. I have had no injuries, accidents, or falls (besides what is noted) before this started. I have no sensory defects that are new, the ones I have are from my L5 nerve root compression.

I have two MRIs scheduled to look for compression, though besides the legs (which could be showing signs on spinal cord compression or damage) I have none of the normal signs that I have a very bad disc higher up. I am of course worried that it won't be spinal cord compression as that seems to be the best outcome right now.

I copied in my notes from yesterdays visit. I know I am early, I have had no EMG.

I did discuss with Justine that due to the current symptoms she is having, Dr. Wellman would like to check a cervical and thoracic MRI to make sure we do not have any cord compression. The MRI of the lumbar spine does show a small disk fragment on the right side that may or may not be contributing to some of the pain symptoms she is having, but certainly not the extreme neurologic symptoms in her legs at this time. If the MRIs are negative, we will send her to Neurology for further workup. Also did order her some baclofen to see if this can help with any of her spasms. We will call her with MRI results once reviewed.

Justine is a known patient to our office, who underwent a right-sided L4-L5 microdiskectomy on 2/172020. At her 6-week appointment she did have decreased pain with some occasional tingling and twinges into the right and left lower extremity, but overall was doing okay. She did call the office at the end of June and physical therapy script was provided. She began noticing a heaviness to the right leg along with spasms in the right foot around 7/24. The severe spasm started around the 7/30. Since that time they have progressed enough that she was taken off work. She is able to walk; however toes are pointed inward and she has constant tremor or spasm while walking. She has a very abnormal gait currently. If she forward flexes, she could calm the symptoms down or if she lies flat her legs will relax somewhat. She does have an MRI from the end of July for our review.

Neurological: She is alert and oriented to person, place, and time. She displays tremor (bilateral legs). No cranial nerve deficit or sensory deficit. Coordination and gait abnormal.
Reflex Scores:
Tricep reflexes are 2+ on the right side and 2+ on the left side.
Bicep reflexes are 2+ on the right side and 2+ on the left side.
Brachioradialis reflexes are 2+ on the right side and 2+ on the left side.
Patellar reflexes are 4+ on the right side and 4+ on the left side.
Achilles reflexes are 4+ on the right side and 4+ on the left side.
Clonus: unable to assess due to the constant spasms

So there you have it. Since I am in the waiting game at the moment my brain is spinning, at least it is when the Baclofen wears off.

Thank you again.
 

KarenNWendyn

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Could it be? Very unlikely. See the neurologist.
 

Jscantonwine

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I will be after the I get the next two MRI's if they are clear. I hope they aren't clear.
Thanks for the response.
 
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