Very Concerned

[DKK7]

I would appreciate having the opinion of you on this forum involving my symptoms and test results.

I am a father of two school aged boys and am frightened of what my outcome could be.

In October 2020, while playing football with the boys I took a pretty hard fall and ended up with a disc herniation at L4-L5. I received a steroid injection at that time. Since then, little to no pain.

Approximately a year later I noticed that my left large toe would move on its own while at rest. I didn’t think much of it, but did inform my PCP at my annual physical. He discounted it as some irritation as a result of the herniated disc.

My job requires several days in the office and in June of 2022 I began to have difficulty writing and forming words. Letters became smaller. My wife is a nurse and had me to have it checked out when she noticed that the symptoms weren’t improving months later.

Primary doctor sent me to a neurologist for an EMG of the right hand. His report basically said that everything looked good and that I needed to have an MRI on my neck. This MRI revealed no damage and I was referred to another neurologist for further evaluation. However, this appointment was 10 weeks out. During this wait time my twitching in my left foot moved up to my left calf and became very active.

Unsatisfied, I called a large hospital in my area and asked for an appointment and they had just received a cancellation and put me on the schedule for the following day. This neurologist has been practicing almost 40 years and performed his evaluation.

He undoubtedly was more focused on the calf fasciculations and told me that I likely have damage at the S1 area causing these. He ordered an MRI of my lumbar spine. He said that I likely injured my right shoulder at the same time that I fell and herniated the disc causing the hand issue.

The MRI results are below:

L4-5: Large circumferential posterior disc extrusion of the L4-L5 intervertebral disc and extends a 5 mm inferiorly along the posterior margin of the L5 vertebral body. There is associated bilateral neuroforaminal encroachment. Mild bilateral facet
arthropathy is noted at this level.
L5-S1: No central canal or neuroforaminal stenosis.

His response is that he still feels this is related to my back, but to be safe ordered an EMG of my legs. These results were abnormal. Report attached. The neurologist that performed the EMG was vocal about the fact that my L4-L5 herniated disc would not typically cause fasciculations in all the areas of my calf that were present. She also said that my upper limbs need the EMG test.

My neurologist is saying that even with the abnormal EMG that he still feels that it is back related, but to be safe he wants me to see a neuromuscular specialist. This appointment is scheduled for November 30.

I have confirmed atrophy and weakness in the lower legs as well.

Waiting over 4 months for this next appointment has my anxiety at its peak. Please help to make sense of the results and his opinion.

Sorry for the long post. Wanted to be thorough.

 

[lgelb]

It is not uncommon to hear "this disk isn't related to this symptom" but for there to be other damage that is obscured by the "large extrusion" or just not visible on the MRI (they are not all-seeing).

The fact that you had a fall makes it more difficult to connect X with Y; there is all kinds of tissue/tendon/ligament damage that you can't always see, that may take a while to manifest. And of course a steroid injection reduces inflammation only temporarily.

Not sure what level of weakness/atrophy has been confirmed in the lower legs? But a bilateral onset more often arises from spinal damage than ALS.

If I understand it, you had difficulty with reading/writing; has this been persistent? Same question re the wayward toe.

 

[DKK7]

Thanks for your reply.

The atrophy was noted by the EMG performing neurologist. No specific data was given. However, my own measurements indicate a little over a half of an inch reduction in my left calf as compared to my right calf. The neuro also pointed out that atrophy exists in the left ankle and foot.

The toe basically twitches non-stop while at rest. This has been persistent for at least a year, maybe longer. This was my very first symptom, but I just assumed it was nothing serious.

I have had no issues with reading, only performing fine motor tasks with my right hand (such as writing). This began about a year ago and hasn't improved at all. I see no signs of atrophy in the hand. I might add that I have mild shoulder pain that I feel may be attributing to the issue with the hand (maybe wishful thinking).

My main concern has been the abnormal EMG results from the legs. Mostly, how that my referring neurologist and the EMG performing neurologist don't seem to be of the same opinion as it relates to my back. My referring neurologist has stuck to his opinion that the back is causing the fasciculations, atrophy, EMG abnormalities, etc. The neuro that performed the EMG doesn't feel the back is the issue at all and recommended having an EMG on both arms.

I truly appreciate this forum!