Q. I experience sexual dysfunction with reduced sensitivity in penis and erratic BM. Kindly help.

Answered by
Dr. Rahul Patil
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Oct 05, 2020

Hello doctor,

I have saddle anesthesia, sexual dysfunction, erratic bowel movements, and episodes. I have a slow onset of reduced sensitivity in the penis, head, and mid-low shaft. I have a slow start of stomach gurgling and inconsistent stools and bowel movements.

I am currently Fluconazole and Robaxin.

#

Hi,

Welcome to icliniq.com.

I have gone through your history and MRI (attachment removed to protect patient identity). But I am sorry to say that the clinical history is insufficient to comment or reach a diagnosis. Also, the MRI investigation are inadequate to help me get a diagnosis. I want a detailed history and MRI brain and whole spine screening MRI. Also, I would like to have all your blood investigation reports, which you have mentioned. With all this investigation, I would prefer a video call with you to get maximum detail points from your clinical history, which would help me reach a diagnosis.

I hope this helps.


Investigations to be done:

MRI brain with screening of whole spine. Blood investigation for MS. Blood investigation for pituitary hormone study.

Regarding follow up:

Follow up after one day.

Thank you doctor,

I have done an MRI brain. It came back normal. According to the radiologist, no lesions or abnormalities. I do not know what amp means. I have not done a total spine MRI.

#

Hi,

Welcome back to icliniq.com.

Good to hear that your MRI (magnetic resonance imaging) brain shows no abnormality (attachment removed to protect patient identity). But I also want to know about the MRI spine.

Since your neurologist or physician has put MS (multiple sclerosis) as his first differential diagnosis, I would like to rule it out.

A normal MRI brain does not rule out MS. (We need multiple periodic MRI of the brain and spine. Lesion in MRI are predominantly appreciated when there are relapse of the clinical problems).

1) As your MRI brain is normal. So now, we can go ahead with CSF (cerebrospinal fluid) examination for MS.

2) Also, need a complete eye examination (in MS, eye problems are seen).

3) Do a visual evoke potential (VEP) study of both eyes.

4) You need to watch for your clinical symptoms (I mean do you have complaints, symptoms, which later improve and then again have symptoms, usually two attacks of relapse or year).

5) Symptoms can be in any form,

Eye symptoms:- nystagmus, double vision, temporary vision loss, or blurring.

Bowel:- constipation, diarrhea, loose motion.

Sexual dysfunction.

Urinary problems.

Weakness in upper limb or lower limbs.

Sensory changes.

CNS - disorientation, confusion, memory loss.

6) Diagnosis of MS depends on a combination of clinical history lab investigation (CSF study) MRI study.

7) However, I would still keep other spinal pathology in a different diagnosis (like spinal AVM).

8) Please follow up with the CSF study for MS and MRI spine (please do a contrast study of spine if possible).

9) Do spinal MRI before doing CSF study (as in a few spinal pathology CSF study is contraindicated).


The Probable causes:

MS (multiple sclerosis). Spinal AVM (ateriovenous malformations). Spinal pathology.

Investigations to be done:

1) VEP (visual evoked potential). 2) MRI spine. 3) CSF (cerebrospinal fluid) study for MS. 4) Ophthalmologist opinion.

Differential diagnosis:

MS. Spinal AVM.

Regarding follow up:

Follow up with above investigation.


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