Sunday 26 November 2006

I've got the ill communications...

My parents are visiting this weekend. Amongst other things, my dad brought up a copy of the neurologist's report on me that he was copied in on (you might remember that I saw this guy back in early October). I hadn't actually seen this yet, so naturally I was curious.

Here it is in full:


"Thank you very much for referring this pleasant young gentleman who had an episode of transverse myelitis in 2005. This has left him with residual symptoms. He is a right-handed IT consultant. In June 2005, he woke up and noticed parathesia [pins & needles] in the right arm, which slowly spread out to involve the whole arm, trunk, thigh and knee and then went over to the left side, which involved the hand. Initially there was an improvement, but that was incomplete, and he has residual symptoms. These appeared to be more prominent recently and in part that might be explained by him continuing to perform strenuous exercise.

You saw him and noticed that he had an examination consistent with myelitis. You obtained an MRI scan, which indeed showed an inflammatory lesion in the cervical spinal cord as well as some subtle changes in the brain including some enlargement of the posterior body and occipital horns of the lateral ventricles with a slightly corpus phallic appearance. There was possibly some signal change in that area.

He continues to have primarily sensory problems in the arms and legs, but as I mentioned, he is very active. He was originally training for triathlon and he continues to play football, runs and swims. He can still do all of this, but not at the same intensity and he gets tired more readily. He denies any difficulty with eyesight. His past medical history is notable for campylobater food poisoning with severe diarrhoea lasting for about 2 or 3 weeks with major weight loss from which he never recovered. At the time of his infection, in the period following it, shortly he denied any neurological symptoms. Since 1995/6 he has low back pain and is seeing an osteopath and exercise appears to help.

Family history is notable for his mother having some heart problems. There is also a history of glaucoma in his mother. He has brothers who are all about 6 foot tall, but not necessarily as thin, as in fact, he lost weight after the campylobacter infection. They also all wear glasses. There is questionable Marfan's feature, which potentially could explain the low back pain.

He takes no medication. He has no known drug allergies and has had no pets. He does not smoke and drinks about 15 units a week. His walking distance is practically unlimited.

More recently he reports night sweats in the last few months. He also reports L'Hermitte's phenomenon.

On examination visual acuity was 6/5 in both eyes corrected. Cranial nerves and brain stem were normal. Power was potentially only very slightly reduced in the left ankle dorsi flexion and he had some slight difficulty, mostly subjective, hopping more than 10 times on the left foot. His gait was normal. The reflexes were ever so slightly brisker on the left. He had decreased vibration in both lower extremities, mostly on the right and slightly decreased pin prick on the right leg. He denies bladder or bowel problems, memory or mood disturbances currently. He does report some fatigue.

EDSS 2.0. [this is a scoring system to guage suitability for interferon treatment. >2.0 is needed to be considered suitable]

I think he has transverse myelitis and that the symptoms are only the residual symptoms from that event, with no current evidence of dissemination in space or time to fulfil the criteria for multiple sclerosis. He knows, however, the implications of his condition. It is difficult to assess the risk of this recurrence becoming multiple sclerosis, given the only very subtle changes in the brain MRI.

I advised him to continue leading a normal life, which he appears to be doing anyway. He is somewhat concerned as to why he has residual symptoms that tend to be even more prominent, but I think it is reassuring that he does not have any new neurological problems since the event in 2005.

I am obtaining a number of blood tests. This will include ganglioside antibodies, which can be triggered by campylobacter infection, but the significance for of that for spinal cord rather than peripheral demyelination is unclear."


What are you supposed to make of that then, do you think?

I've had the blood tests back, and they were "negative or normal", which is good and rules some of the more unusual things out. This leaves me in the same boat as I was before --- we wait to see if this turns out to be something more than a solitary episode.

My dad takes this as being good news, and I suppose it is. Well, it's not worse news, anyway.


  1. It must be horrible not knowing what's up and having to simply wait. Glad that there are positive noises being made, though.

    Also, it must be nice still to be seen as a 'pleasant young gentleman'. I still get called things like that from time to time. I wonder how old we'll get before people stop?

  2. Reading between the lines, it sounds alright. It almost seems as though he thinks there may be some tie-in to the old illness of yours. There's mention of running a test related to it I believe. And the fact that symptoms have not substantially progressed beyond the initial complaint is also promising. Still, not having a definite answer must be maddening, and I'm sorry you're having to go through it!

  3. I wish I could understand that, however I'd take heart from your dad thinking it's good news since presumably he does.

    Not knowing what the problem is is very frustrating though, I know.

    Incidentally, my GP described me as a "young lady" in my referral last month. No pleasant, mind, but I was happy with young.

  4. I'm with your dad on this.

    Also is "pleasant young gentleman" a medical opinion founded on science, do you think?

  5. I hadn't heard of Marfan's feature before this. The things you learn in Blogworld. I'm impressed that you might share it with Osama bin Laden. He was jawdroppingly gorgeous, back in his youth. (I presume MI5's file on me just got a lot thicker.)

    So the Campylobacter thing could be a trigger? How strange.

    Sorry to hear about your occipital horns and that whole corpus phallic thing. I don't know what I'm on about as is probably obvious.

    It all sounds a lot better than "This luscious young scoundrel is riddled with pox", or however he might be inclined put it. I'm with your dad, it must be good.

  6. it's okay lizzy - I don't know what pretty much any of it means either. My dad explained some, we looked some up on wikipedia and elsewhere, and I told him what L'Hermitte's Phenomenon was. Neurologists know a lot, of course, but basically in the grand scheme of things they know very little about the brain indeed. Some of these things have great names though, don't they? Occipital horns? brilliant!

    It's quite strange reading this stuff about your own brain and nervous system though, I have to say.


  7. Well, gratitude for small mercies you don't have the archnoid digits thing they talk about on the Marfan syndrome Wikipedia page. I think I would have struggled to shake hands with someone blighted by that condition, pleasat young gentleman or not...


    It's no worse, which is good.

  8. Here's my take: it's an extremely thorough history and physical report which can be used as a baseline for the future. You already know where you stand...this is just a report which will allow for comparison.

  9. young man, now listen. enjoy things...

    you know me, you know what i went through about 7 years ago! I still recall the desk full of pharmacy drugs i received for my xmas/birthday gift on my return! cheeky buggers.

    prior to that, i had a worse turn.

    just remind yourself now and again, things are peachy. and use the chances given to you to do good things. and count yourself lucky for great friends.

    finally, please tell me you OCR'd that report and didn't sit there typing it in.