Dr. Hitesh Kumar
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
For two weeks now I have had bad low back pain followed by pain and tingling in my legs. Not both legs at the same time, but it switches sides. I went to my doctor and he did an x-ray, which was unremarkable. Rest alleviates the pain. Today, I woke up with a heavy feeling in my left leg and pain that radiates from my left buttocks to my left leg. The piriformis stretch seems to alleviate the pain a bit. Also, I noticed that I have to pee more yesterday and today, and sometimes even a few drops of urine leak. I was reading about cauda equina syndrome and freaked myself out. I called my doctor and he prescribed some steroids. I am supposed to leave on vacation tomorrow and am very concerned. I am still able to go to work and do housework with this pain. I am also able to control the stream of urine and stop any time I need to. Bowel habits are unchanged. No saddle anesthesia so far. I am able to walk on my toes and my heels, albeit my left leg does hurt a bit after attempting the heel raises 10 times or so. Can this be cauda equina syndrome? My doctor did not feel like I needed any imaging done at this point. I did a UTI (urinary tract infection) test at home and it was positive for leukocytes and negative for nitrites.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and understand your concern.
As you mentioned, lower back pain and radicular pain in the left leg with intermittent tingling can be radicular pain. Regarding urinary symptoms, you mentioned increased frequency. But you have full control over urine. All these symptoms are not fully fitting for cauda equina syndrome. But the possibility can be lumbosacral radicular pain, maybe PIVD (prolapsed, herniated, or extruded intervertebral disc), or something else. You can plan for an MRI (magnetic resonance imaging) of the lumbosacral region (contrast if required).
I hope I have answered your question. Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I wanted to ask how soon I should get the MRI (magnetic resonance imaging).
Thank you.
Hello,
Welcome back to icliniq.com.
It is better that your symptoms get better. It would be better if evaluation be feasible so that treatment decisions can be taken better. You can decide based on symptom improvement and the availability of investigations around your place.
I hope this response helps you.
Regards.
Patient's Query
Hello doctor,
My lower back pain seems to have subsided. I still have a dull ache in my left buttocks spreading down my leg. Still some tingling in buttocks and legs, without anesthesia. The doctor suggested Prednisone (Deltasone). Started taking it this morning.
Thank you.
Hello,
Welcome back to icliniq.com.
It is better that your symptoms have got better. It would be better if evaluation be feasible, so that treatment decision can be taken better way. You can decide based on symptom improvement and availability of investigations around your place.
I hope the response helps you.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
Yes, I have scheduled an MRI (magnetic resonance imaging) a week from today. In your expert opinion, do you not think that cauda equina syndrome is very likely?
Thank you.
Hello,
Welcome back to icliniq.com.
Your current symptoms are not fitting in all symptoms of cauda equina yet. But seem to be of radicular pain.
I hope this response helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I have another question regarding it. What would indicate a cauda equina?
Thank you.
Hello,
Welcome to icliniq.com.
Bladder incontinence or stool incontinence is also associated with lower back pain in symptoms of cauda equina.
I hope this answers your question.
Patient's Query
Hello doctor,
Thank you for the reply.
How can you tell the difference between sciatica numbness and saddle anesthesia? Also, today I have used the bathroom twice and I feel slight pressure above the anus. Can that have something to do with the back pain?
Thank you.
Hello,
Welcome back to icliniq.com.
Saddle anesthesia is a loss of sensations in the buttocks or perineal area or inner thigh area. But sciatica numbness is commonly radicular pain (current-like sensation or stretching or heaviness in leg from buttock to back or outer side of thigh and calf region) with or without paresthesia (tingling or burning or pins and needle sensation in the foot).
I hope I have answered your question. Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
Thank you for the reply.
I have another question. How can one test for saddle anesthesia?
Thank you.
Hello,
Welcome back to icliniq.com.
The answer to your question is clinical examination.
Regards.
Patient's Query
Hello doctor,
So I was on a long flight yesterday. Today, my back pain is gone. However, today I have the worst sciatica in my right buttocks, it is making my right leg heavy and if I try to tiptoe there is some weakness. I have an MRI (magnetic resonance imaging) scheduled for Friday. Should I go to the ER (emergency room)? This numbness or heaviness or weakness in the right leg is scaring me. I can walk fine, jump on one leg etc., but if I try to tip toe I notice it is weaker than the other leg. I am in a foreign country and absolutely terrified and my doctor does not work today.
Thank you for all the answers.
Hello,
Welcome back to icliniq.com.
I read your query and understand your concern.If you have worsening symptoms, there is no harm in going to the ER (emergency room). Cannot say if it is really weak or if you are not able to exert full power due to the pain itself. It may be erroneous to conclude on chat conversation on emergency or urgent or severe symptoms. In chat conversation, the examination part is not feasible. By chatting, we can discuss possibilities.
I hope I have answered your question. Let me know if I can assist you further.
Regards.
Patient's Query
HeIlo doctor,
Thank you for the reply.
I have moved my MRI (magnetic resonance imaging) to tomorrow morning and will go in then. I am in another country and healthcare here is subpar. I am just scared that I will wake up paralyzed. I am most scared of cauda equina. Can you have that without bladder symptoms?
Thank you.
Hello,
Welcome back to icliniq.com.
Cauda equina is a syndromic entity. It can be due to many etiologies. PIVD (prolapsed, herniated, or extruded intervertebral disc) or another lesion at the spine, if compressing nerve roots, which supply the leg, may cause pain in the leg. PIVD or another lesion, If compressing the nerve roots which are supplying the bladder & rectal area, may cause urinary and stool symptoms. So symptoms are based on which nerve roots are affected. The underlying reason or etiology can be any. You have symptoms of leg pain going down. Till now, you did not have symptoms of bladder incontinence. You can try medication like - starting from Gabapentin (Neurontin) 100 mg thrice daily. Consult your specialist doctor, discuss with them, and take the medicines with their consent. Please revert with MRI (magnetic resonance imaging) spine report, will think about further course
I hope I have answered your question. Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
I have received the MRI results. The report reads the following:
Minor S scoliosis.
The height between vertebrae is preserved.
6 mm hemangioma in L1.
IV discs with preserved dimensions.
L4-L5 annular bulging IV disc.
L5-S1 annular bulging of V disc with a smaller concentric fissure of annulus fibrosus.
Conus medularis ends at the level of L1.
I apologize if the translation is less than ideal, the report was in some other language. The doctor here says that he did not see any indication of the discs pressing on any nerves or spinal cord, as these changes are minimal. He believes it is a muscle spasm pressing on a nerve somewhere. What is your opinion?
Hello,
Welcome back to icliniq.com.
Your symptom is mainly pain in your lower back radiating to the left buttock and left leg, which seems radicular pain. MRI if not showing significant PIVD, is fine. Sometimes there can be dynamic compression on a nerve root while standing, walking, or bending, but not visible in MRI (as MRI is done in a laying position). Also, the possibility can be due to spasms of paraspinal muscles leading to pressure on the rootlet as your doctor speculated.
Thank you.
Treatment plan
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Neurology
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