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    #16
    Has a SSEP (somatosensory evoked potential) been discussed as a diagnostic tool?

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #17
      Originally posted by melissa76
      I totally agree. I am not too sure if mentally it is the best thing as she has a young family. I want her to go she does not. Although she will if told by a professional that it is best. She has no problems with her bowels or bladder, none. I will let you know how we get on. thank you

      Melissa, I am a spinal cord injury researcher. Four parts of your description strongly argue against a spinal stroke.

      1. "She has no problems with her bowels or bladder, none." In my opinion, this statement alone throws the spinal cord stroke diagnosis out the window. Let me explain why. A spinal stroke that causes injury to the thoracic spinal cord and that causes paralysis in the legs must have affected the long tracts. Your partner should have problems with bladder control. The fact that she did not have any problem with her bladder at any time indicates that she did not have spinal cord injury.

      2. The above is consistent with the absence of any MRI findings in her spinal cord. A stroke usually causes a rather big increase in MRI intensity at the infarct site. If none can be seen, there is unlikely to be a stroke.

      3. You are not describing any of the other symptoms of spinal cord injury, symptoms that are usually apparent by this time, including spasticity (if there is no spasticity, there should be substantial atrophy).

      4. You don't describe a sensory level in the belly, butt, or other parts of the anatomy. A sensory level is where there is sensation above and no sensation below a given level. A spinal cord injury should cause a prominent sensory level and most people would describe such a level.

      I suspect that your partner did not have a spinal cord injury. It sounds like it was more like nerve compression or perhaps even peripheral neuropathy. By the way, a drop in blood pressure normally would not cause a spinal cord infarct, without severe brain damage. The brain is much more sensitive to reduced blood flow than the spinal cord. So, if she has had no brain damage, it is very unlikely that the episode of hypotension had any effect on her spinal cord.

      I don't know what she has. My guess, based on the limited history that you have given including the fact that she has cancer and may be receiving chemotherapy, is that the cancer or chemotherapy may have caused a peripheral neuropathy that was aggravated by the hypotension. The way that you would find out is to do a neurological examination and to look for reflexes. The deep tendon reflexes should be depressed with peripheral neuropathy but increased with spinal cord injury. Electrophysiological study of the peripheral nerve should show decreased conduction velocity in the peripheral nerves and should be able to separate out sensory or motor neuropathy, if there is a difference.

      The differential diagnosis should be cauda equina injury, diabetes, and Guillian-Barre or a viral-induced peripheral neuropathy.

      Wise.

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        #18
        Hi Sue:

        Can you elaborate on regaining the ability to feel pain? Did it come back all at once? Is it normal? The same all over? How long did it take? and your hot and cold?

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          #19
          Originally posted by luckydog
          Hi Sue:

          Can you elaborate on regaining the ability to feel pain? Did it come back all at once? Is it normal? The same all over? How long did it take? and your hot and cold?
          Most of it came back slowly, in patches, over the years I took 4-AP. The first pain that came back was I lost my neurogenic pain in my feet but realized I had arthritis in my toes which my doc confirmed. Hot and cold is still patchy but left leg is more sensitive. The artery that was effected entered the right side of my cord. You can probably find more by searching the site for 4-AP, 4-aminopyridine or Fampridine and my name. Oh, some regular pain did reappear around my 2nd anniversary before I started 4-AP.
          Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

          Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

          Comment


            #20
            My brother is 21 years old and suffered an incident 12 days ago. Inital symptoms were chest pain and numbness in both arms. He was taken to the ER via ambulance. Upon arrival he was able to walk and communicate infomation to the to the paramedics. While sitting in the ER he stated that his chest pain has subsided both still could not feel both arms. Within five hours, he was unable to feel both legs and began having difficulty breathing. MRI was negative and neuro specialsit diagnosed him with Gullain Barre syndrome. He was sent to Vanderbilt for additional tests. GBS was moved down on the list due to no trigger and symptoms were in reverse order. A second MRI was performed and showed a blockage. Since then he has had three plasma exchange treatments and has showed improvement. He has been able to move his shoulder, communicate w/ trach, increased sensation in limbs, and feeling burning sensation in legs and butt. A dye tests was performed and no blockage was found, but docs were only able to view "sections" and the body could have expelled the blockage. His breathing has greatly improved but still the aid of a vetalator. The latest finding was a small hole in his heat that did not close and they feel this may have been a cause of the stroke. Any suggestions wether or not this is a stroke or GBS?

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              #21
              Hi Bhiggins:
              I am sorry to hear about your brother. I am not an expert, but this sounds like a spinal stroke based on the information provided. I hope your brother seems much recovery over the next year. Information about spinal strokes are hard to come by, but you will find many people with knowledge here on Carecure.

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                #22
                is necrotic ( dead tissue ) the same as scar tissue? If one's spinal cord is necrotic in spots doesn't that mean that all cell bodies are dead? In this case what could be done?! Ischemia/infarction I assume kills cell bodies quicker and worse than a regular sci.

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                  #23
                  Hi Cdurfree99, I do not have enough scientific knowledge to answer your questions specifically, but people who suffer ischemia/infarction have a good chance at recovery.

                  Comment


                    #24
                    how about 10 years after complete t12 paraplegia?

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                      #25
                      I wish; at least there is always the chance for a cure or reincarnation.

                      Comment


                        #26
                        Originally posted by cdurfee99 View Post
                        is necrotic ( dead tissue ) the same as scar tissue? If one's spinal cord is necrotic in spots doesn't that mean that all cell bodies are dead? In this case what could be done?! Ischemia/infarction I assume kills cell bodies quicker and worse than a regular sci.
                        Necrotic = rotting. It is not the same as scar tissue, which is a complex structure primarily made of collegen. Necrotic tissue will generally be phagocytized by white cells in your body and eventually replaced with scar.

                        Why would you think that ischemia or infarction would damage CNS tissue worse than crushing, bruising, pinching or cutting? That is actually not founded in science. There is more likelyhood of return in an ischemic or infarcted cord, esp. if the injury is incomplete or if early return occurs. In addition, much of the damage done in traumatic spinal cord injury is actually ischemia. Cutting of the cord is very rare, but swelling or compression from fractured bone can easily cut off the blood supply to the cord.

                        (KLD)
                        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                        Comment


                          #27
                          Originally posted by SCI-Nurse View Post

                          Why would you think that ischemia or infarction would damage CNS tissue worse than crushing, bruising, pinching or cutting? That is actually not founded in science. There is more likelyhood of return in an ischemic or infarcted cord, esp. if the injury is incomplete or if early return occurs. In addition, much of the damage done in traumatic spinal cord injury is actually ischemia. Cutting of the cord is very rare, but swelling or compression from fractured bone can easily cut off the blood supply to the cord.

                          (KLD)
                          Yea, that's what I thought KLD. Or at least what every neurologist and neurosurgeon told me. Then I found out why stroke will be excluded from the China SCINet and the NASCINet trials. Might ask Wise to explain. I think Q Therapeutics will help spinal stroke victims better than the umbilical cord/lithium mix. Or at least I understand what their trials will use and what it has done in many studies.
                          Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

                          Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

                          Comment


                            #28
                            newbie looking for post spinal stroke sci therapy advice

                            Greetings, first time poster here.
                            My wife was diagnosed at Brigham and Womens Boston recently with a spinal stroke. It took 12 days of a "million dollar workup" in their Neuro ICU and step down unit to come to that conclusion with GBS being the first suspicion and everything from VD to AVM eliminated. They were eventually confident that one or more of the 5 MRI's showed an infarction (I believe at T12).
                            Sypmtoms included paralysis of ankles and feet with cold and sharp sensory loss in those as well as various places on her legs and behind. Lack of control voiding. Significant weakness in certain leg motions. They were quite challenged with the case and had her on grand rounds and everything. In any case, there is nothing to be done to treat the condition except to go for rehab in an appropriate facility. We chose a suburban rehab hospital which had a decent neuro reputation. Problem is they want to discharge her to home therapy (eventually followed by outpatient). But I can't believe after just 2.5 weeks, essentially 12 fulltime days of therapy, that they've done all they can. Clearly at home will not be anything like being in the facility. What are other people's experiences in this regard? She has made significant progress and is able to move one foot pretty significantly and the other less so. Limited walking with braces, walker and assitance. Also tried removing catheter and using flomax and may be able to manage that. Not being an expert I don't have much ammunition to argue the point, but can't believe an SCI victim should only get 12 days of inpatient therapy.

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                              #29
                              Hi Setanta:
                              I am very sorry to hear about your wife.
                              I too had a spinal stroke. After moving from the hospital to inpatient rehab, they sent me home pretty quickly. I think three weeks. My Dr. strongly felt that people progress more quickly in their home environments. Being forced to do everything yourself is a lot of exercise/work when you have SCI. I don’t know if her philosophy was right or wrong, but it worked out for me. I did outpatient rehab once a week and worked out in my own home. Of course, I still believe more would have been better.
                              Good luck. You might want to post in the NEW SCI forum, you will probably get more responses there.

                              Comment


                                #30
                                Thanks lucky dog

                                I really appreciate you sharing your experience and advice. We're feeling thrown into the deep end of the pool with this event and people like yourself and this forum really make a difference.

                                Much thanks and the best to you and your recovery.

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