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Report from the Neurosurgeon!

Posted Nov 20 2009 1:08pm
Report from the Neurosurgeon!

 


Sorry it's been a while since I posted but here is the report that was given to my primary care doctor from Dr. Spence:

PHYSICAL EXAMINATION:

This area was a lot of nothing of importance. Here are the only negative things I saw:

1. Has no gag reflux

2. Has no palatal sensation

3. Has diminished corneal reflex on the right

4. Romberg Positive -  

DEFINITION PROVIDED FROM WIKIPEDIA FYI
A Positive Romberg test suggests that ataxia is sensory in nature, i.e. depending on loss of proprioception
DEFINITION PROVIDED FROM WIKIPEDIA FYI
Ataxia (from Greekα- [used as a negative prefix] + -τάξις [order], meaning "lack of order") is a neurological sign and symptom consisting of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of parts of the nervous system that coordinate movement, such as the cerebellum. Several possible causes exist for these patterns of neurological dysfunction. The term "dystaxia" is rarely used as a synonym.


RESULTS REVIEWED:

Its says: I reviewed an MRI of the cervical spine, which demonstrates multilevel disk degeneration at the C3-C4, C4-C5, C5-C6, and C6-C7 levels with cord compression and neroforminal stenosis. She also has a Chiari malformation with tonsillar eectopia to the level of superior portion of C1.


DIAGNOSIS

1. Chiari 1 Malformation

2. Cervical Spondylosis w myelopathy, C3-C4, C4-C5, C5-C6, C6-C7 w neuroforminal stenosis 

3. Headaches related to Chiari Malformation

4. Bilateral upper extremity and lower extremity numbness and tingling secondary to spinal cord dysfunction from craniocervical junction compression as well as cord compression causing myelopathy.

DEFINITION PROVIDED FROM WIKIPEDIA FYI

Myelopathy refers to pathology of the spinal cord. [ 1 ] When due to trauma, it is known as spinal cord injury. When inflammatory, it is known as myelitis

Spondylosis is a term referring to degenerative arthrosis of the joints between the centra of the spinal vertebrae and/or neural foraminae. In this condition the interfacetal joints are not involved. If severe, it may cause pressure on nerve roots with subsequent sensory and/or motor disturbances, such as pain, paresthesia, or muscle weakness in the limbs.


PLAN

1. Discussion of risks, benefits, and alternatives to suboccipital decompression.

2. Discussion of risks, benefits, and alternatives to anterior cervical diskectomy with interbody fusion of the cervical spine for decompression of the spinal cord.


DISCUSSION

Mrs. Sherril has a complicated story. She has basically both Chiari malformation, which causes craniocervical compression, and cranial nerve symptoms and she has a cervical cord compression causing myelopathy. She essentially has a tandem lesion of the cord and a craniocervical junction problem causing the constellation of symptoms that she has been able to describe issues with her head, ear, her throat, her neck, walking, hearing, and other areas. I have discussed in detain the attendant issues. I have demonstrated the imaging studies. I answered a lot of questions that she and her husband have prepared. They would like to go home and think about their options and come back to see us in 2 weeks time and we will make some final determinations how to best to proceed.
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