Q. I have minor tingle in my right second toe with moderate to severe stenosis of spine. Please help.

Answered by
Dr. Aida Quka
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 03, 2020 and last reviewed on: Jun 26, 2020

Hello doctor,

I am 58 years old. I have some very minor tingle in my right second toe. I am very healthy with no medicines and no other symptoms. It started with unilateral tinnitus. MRI of the spine showed moderate to severe stenosis spine. I do exercise, and running, and my neurologist says this might be normal. I had a concussion when I was 17 and spent a day in the hospital.

My MRI brain is obviously abnormal with white matter. What is the likelihood of MS? I had an MRI in 2015 and said chronic microvascular changes. MRI of a couple of weeks ago said no tumor on auditory nerves. Please explain.

Dr. Aida Quka

Neurology
#

Hello,

Welcome to icliniq.com.

I understand your concern and would explain that your MRI findings (head and spine) fulfill the radiological criteria of MS (multiple sclerosis). There are many old lesions in the head and spine and there is a new lesion in the left parietal lobe, which explains the tingling in the right toes. Although you have no past medical history for paralysis or limb numbness and weakness, these brain lesions are compatible with MS. I recommend discussing with your neurologist about that. As there is a new lesion (with light contrast enhancement), steroids would help to relieve the tingling in the right toes.

Regarding the mild spinal canal stenosis, it does not explain the spinal cord lesions in the upper levels which are probably related to MS. I recommend performing a spinal tap in order to examine your cerebrospinal fluid and visual evoked potentials.

I hope this helps.


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Thank you doctor,

Yesterday I surfed for 1.5 hours and then ran 3.5 miles in the heat (not very fast though). I really have very few symptoms as stated some very minor tingling in the right foot, and minor tingling in the thumb. My current neurologist stated that many people of my age have white matter and even a cord lesion that remain stable. I am not looking for an out and since this is all new just making sure. Is he correct in saying that there are people who have similar MRIs? I am a nurse anesthetist so I do understand medicine.

Dr. Aida Quka

Neurology
#

Hello,

Welcome back to icliniq.com.

Your doctor is right on the fact that there are many normal persons who have white matter lesions. Anyway, the lesions in the spinal cord and in the corpus callosus, when coupled with the other lesions and especially that in the parietal lobe which has mild contrast enhancement fulfill the MS MC. Donald radiological criteria. You can check on the internet too.

In normal persons, the white matter changes are not enhanced by contrast. So, in my opinion, your radiological findings are suggestive of MS. You should also know that MS patients with sensory problems have milder symptomatology.

Coming to this point, I would recommend repeating the brain MRI after a year in order to see the progression of these lesions. You can take no treatment for the moment and wait and see, as your symptoms are minimal.


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Hi doctor,

Thank you for your kind help.

Dr. Aida Quka

Neurology
#

Hi,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.


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