Q. How to halt demyelination?

Answered by
Dr. Anshul Varshney
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 06, 2016 and last reviewed on: Jan 10, 2020

Hi doctor,

This query is regarding my dad. He has been limping for a year now. He is a construction worker and about two years ago he accidentally fell down from the first floor. He reassures me that his left leg limping is not due to the fall. He had about 20 sessions of physical therapy. He went to a pain specialist who injected him with steroid injections, but that did not help. The pain specialist also performed an electro test to see the response reaction in both feet. The right one jumped and the left one did not. He said he barely felt any sensation in his left leg. His left leg is not responsive, and he cannot carry it around. We had an MRI and consulted a neurosurgeon. The neurosurgeon said that he is not to be operated on.

The result of his MRI is as follows. 47 years old with radiculopathy. Correlation is made with prior MRI of the thoracic spine. Findings are, mild spondylotic changes are seen within the cervical spine with disc desiccation multiple levels. C2-C3: There is a shallow central disc herniation impression on the thecal sac. C3-C4: No focal disc herniation or neurocompressive changes are seen. C4-C5: Shallow central disc herniation impresses on the thecal sac. C5-C6: There is central disc herniation with effacement of the ventral CSF. C6-C7: Shallow central disc herniation impresses on the thecal sac. C7-T1: No focal disc herniation or neurocompressive changes are seen. Vertebrae: The vertebral bodies demonstrate normal height and marrow signal characteristics. Spinal cord: There are multiple foci of abnormal T2 signal within the substance of the spinal cord, one at the C2 level and one at C4. It is unclear whether this reflects myelomalacia versus the possibility of a demyelinating process. Clinical correlation as well as evaluation of the intracranial compartment with MRI of the brain is recommended. Craniovertebral junction: The craniovertebral junction is unremarkable. Mild prominence of the nasopharyngeal soft tissues is incidentally noted. Please correlate with direct clinical examination. Impression is multiple foci of abnormal T2 signal within the substance of the spinal cord as described. These may be on the basis of myelomalacia however given the patient's age the possibility of a demyelinating process is not excluded. Clinical correlation as well as evaluation of the brain with MRI scanning is recommended. Mild spondylotic changes within the cervical spine with shallow central disc herniations at C2/C3, C3/C4, C4/C5 and C6/C7 levels. Slightly larger central disc herniation C5/C6 with effacement of the ventral CSF. Mild prominence of the nasopharyngeal soft tissue.

As I want an unbiased opinion, please consider only the results and not the possible diagnosis. My questions are, what are the possible causes of these? What are the outcomes in the future? Can anything be done to regenerate neural tissue and myelin? Finally, how many herniated discs does he actually have?

 

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Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

Hello,

Welcome to icliniq.com.

  • It seems that he has intervertebral disc compression that needs further evaluation.
  • Since there are suspected demyelinating changes in MRI, he would require further MRI brain to check for any demyelination in his brain.
  • His compression as per report is not that severe to cause him limping. So, we need to check for the brain, which might be causing the limping issues.
  • We also need to rule out possibility of any malignancy that might be causing the problems as there is abnormal signaling of the spine too, that could be a part of malignancy.
  • There are no medicines as such which can halt the demyelination. However, if demyelinating disease is found, we can try to halt the demyelination process, which includes steroids and interferons.
  • Regard to number of disc bulges, almost all the disc bulges but that can be seen with the age. Significant ones are at C5/C6.
  • The outcome would be based on his final diagnosis. This needs to be evaluated by proper examination of MRI brain and calcium levels.
  • So, my opinion for you is to get a MRI brain of him as soon as possible.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist



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Hi doctor, Thank you for the quick reply. I have attached the DICOM images, and also of the MRIs straight from the CD. My father also did get an EMG and I will attach the results. He consulted an orthopaedician and was informed that he has no issues. Maybe we have to get a second opinion. His PCP sent him to get blood work for TB, which came back negative. He also got two epidural injections Depo Medrol, in the back, but did not help. He then got the cervical MRI and the pain specialist looked at them saying he needs to go to a neurologist as the same thing that the neurosurgeon told him. My father has no neurological problems such as memory loss, deterioration, speech impairment, or anything unusual. He is healthy overall. So, I am not sure how it is possible that herniated disks from the neck can impair his lower extremity movement. I have attached his C/T/L-spine MRI and the EMG. Please help us.

Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

Hello,

Welcome back to icliniq.com.

  • I have studied the attached reports (attachment removed to protect patient identity) and my recommendations would be evaluation by his MRI brain.
  • Yes, he should see a neurologist and get an evaluation done for the same.
  • He would surely order an MRI brain for him. Revert with the report of MRI brain for better help.

Revert back with MRI brain to a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist


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