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Could previous traumatic injury cause TM?

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    Could previous traumatic injury cause TM?

    I was "hit" over the course of weeks at age 31. A month before I starting "losing it", I had had one injury: I had slammed a wall when I returned a shot playing racquetball. My neck and head got the brunt of it, but that was all.
    I was at the beach when I started stinging in my feet and lower legs. I mentioned it and was asked if I'd been stung by jellyfish, but it wasn't that kind of stinging. When I returned home a week later, I could not feel my lower legs at all and the stinging was higher. I did trip and fall at the start of the trip in Hilton Head, but it seemed pretty inconseqential.
    Anyway, I finally went to my orthopod, who referred me to a neurologist. The neuro thought I had Guillaume Barre and a host of other things. She finally ordered an MRI. The films were lost and it took an extra two days before she saw me.
    I was sent immediately to a neurosurgeon when she got the films back. He delayed surgery with another patient for me to get across the city to his office within 30 minutes. C 6/7 had ruptured and the one below was bulging. By this time, I was not feeling anything from underarms down. I had loss of movement, weakness where I still had movement.
    I had emergency surgery and since then, I have loss of sensation (like major novacaine), weakness and where I feel, it's like my skin has been ripped off. On the back of my neck, it always feels as though something is crawling on it. The weird pain is excruciating. I was weaning off Neurontin due to side effects, but I'm going back on it because I cannot stand it without it.
    When I was in the hospital, paraproteins were found in my blood. I was told I had hairy cell leukemia, but I didn't.
    I was sent to an oncologist who told me I had Multiple Myeloma. A spinal tap had been done by my neuro and the same paraproteins were in my spinal fluid. I had two types. The bone marrow biopsy the onco performed did not show malignancy, but many cells were bi-nucleated.
    Anyway, I've been told on and off I have MM. Then, I'm told I don't, but have MGUS. The last bone marrow aspiration I had at Vanderbilt a year ago did not show MM, although in the neuro unit I'd been in while hospitalized in 2003, they were sure I had MM.
    My current doc asks how my "MS" is doing. I keep telling him I don't have MS unless he knows something I don't. I had seen a specialist in 1995 at University of Alabama at Birmingham, Dr. Whittaker, and at the time, he said I did not have MS.
    After the surgery for the spinal cord, I have had stinging, buzzing, numbness, burning, no sensation and loss of function in various areas. The cord was definitely squeezed and damaged pre-surgery. The paraproteins have the doctors (and definitely me) totally confused about what happened and any significance.
    At the time of the MRI in 1993, I had been asked if I had been in a car wreck or a diving accident. I was asked if any waves had "slammed" me when I had been body surfing at the beach. None of those things had happened. A month before, I had taken a hit against a wall playing racquetball and I also tripped and fell at the beach. That was it. I'm still not sure what has caused anything, but life has been different since 1993.
    For mobility, I use a wheelchair or for really short distances (in my apartment), a trough walker. I fall a lot because I cannot tell where my legs are or my body in relation to the rest of the world. (I've had broken bones and surgery as a result of trying to walk unassisted and I've been told, "Don't!" by my docs. They say I'll break a hip if I keep trying.)
    I know this is long, but Dr. Wise or SCI Nurse, if you're reading this, have any clues as to what happened to me or what is happening to me? I still don't know what happened definitively other than a cord injury. I worry whatever it was could happen again because I don't know how this happened.
    I had CP from birth, but it was mild and I had a very active life. I had worked as a broadcast journalist and a writer pre-injury. I worked out daily at the time this happened to me and fortunately, was in the best shape of my life before the SCI.
    "That" is what happened, but I still don't know what "that" is.
    Help!

    #2
    Dr. Wise and SCI Nurse,
    I guess I did not ask the questions I have in the above post. I am wondering if slamming a wall playing racquetball a month before the surgery could have caused the SCI? (I was hurt, in major pain. No x-rays or anything. The doc gave me muscle relaxers and put me to bed for three days.) Could tripping and falling a couple of weeks before the surgery have caused it? (I did not seem to be hurt.) Can an earlier (either the racquetball slam or the trip/fall) trauma happen and take that long to fully appear? What role, if any, do paraproteins play in an injury like I had? Could the cerebral palsy be compounding what happened to me in 1993? (Until six months ago, I was told CP was a very stable condition.)
    You guys are among the best in the country, possibly the world. I'm hoping you have insight.
    Depending upon the specialty of the physician I've seen, they each have different ideas about what happened and why. It's been called everything from idiopathic to MS to MM to a recent hypothesis that the paraproteins have caused and are adding to the pain and loss of function in addition to what happened to my cord. I was also told CP causes problems as we age.
    Any information you have will be greatly appreciated.
    MaryEllen

    Comment


      #3
      LaMemChose, I moved your question into its own thread because I think that your question is very important and interesting. Let me try to answer it as best as I can.

      Transverse myelitis is by definition a diagnosis by exclusion. The words "transverse myelitis" refers to damage to white matter that goes across rather than up and down the spinal cord (longitudinal). The term implies that there has been damage to one segment of the spinal cord. If there were trauma, of course the diagnosis of traumatic spinal cord injury.

      There are some who believe that most transverse myelitis results from loss of blood flow. While the condition is often associated with virus or auto-immune disease (such as systemic lupus erythematosus), the mechanism by which these may lead to transverse myelitis is believed to be vascular, related to local inflammation and occlusion of the vasculature. Likewise, emboli (clots and fragments of cartilage) may occlude blood vessels.

      Your history of mild cerebral palsy probably is unrelated. Many people have cerebral palsy but I don't think that there is an increased incidence of transverse myelitis in people with cerebral palsy. Yes, cerebral palsy should be a "stable condition" in the sense that it should not be progressive in adults.

      Paraproteins are abnormal proteins in the urine or blood, due to monoclonal gammopathy or gamma-immunoglobulin light chains produced by clonal proliferations of plasma cells and shows up as a narrow band of proteins of similar molecular weight on protein electrophoresis. Paraproteinemia may be associated with multiple myeloma which may cause transverse myelitis. If you had multiple myeloma, the diagnosis would have been established by now and so I would guess that you don't have it.

      Multiple sclerosis (MS) is an unlikely explanation of what you have. If you had MS, you would be having recurrent episodes involving other parts of your brain and spinal cord. The fact that you don't describe such episodes suggests that you do not have MS. I suspect that you don't have systemic lupus erythematosus either because, given your detailed history, you would have mentioned other symptoms.

      So, in my opinion, you very likely had an incomplete spinal cord injury from a C6/7 disc. The neurological changes that you describe sound like that of an incomplete spinal cord injury with recovery and residual posterior column deficits (not knowing the position of your legs). You were young to have such a significant disc herniation at age 31. By the way, compression of the spinal cord causes ischemia.

      Wise.

      Comment


        #4
        Dr. Wise Young,
        Thank you for your reply. I have been so frustrated and scared since 1993. Because I never knew what happened "for sure", I've always been terrified whatever happened could/would happen again.
        I was also tested for Lupus, some type of MD (when this first began in 1993), Sickle Cell Anemia (I learned it can rarely happen to Caucasian people, too.) with a variety of spinal taps, bone marrow biopsies, x-rays, MRIs, evoked potentials, blood work, blood work, blood work (the vampires!), bone scans, etc. I'm "overdue" for an onco visit by half a year, but going every year is very upsetting. For now, I'm choosing not to go.
        As for my legs? I don't seem to have any muscle from knee down in my left leg. I have a quad muscle on that leg upper, but little in the way of hamstring. The right leg has muscle, but I cannot tell where my leg is. I feel novacained to the touch ... nothing there and I have a constant sensation of stinging/electric/foot gone to sleep only it's my body anywhere from underarms down in soooo many areas.
        As for bladder and bowel control? That's hit or miss. I have accidents, but it's just what I do. I guess we all do. With my bladder, I have a constant slow leak. If I am on the toilet, I can "push" (from somewhere) and urine exits. I "push" to urinate. I have a BM daily. (I was having massive diarrhea, but I recently bumped my fiber intake and now, for the first time in years, I no longer have diarrhea with need for Imodium most days. SCI Nurse wrote to someone here about increasing fiber to "gel" stool. It works.)
        Thank you Dr. Wise. I appreciate your insight, knowledge and response.
        MaryEllen

        Comment


          #5
          LaMemChose, I have similar bladder problems to you, how do you cope? Do you cath? Are ypu on any medication?
          Now all that's left of me is what I pretend to be....

          Comment


            #6
            This is the exact question I have had for the last 3 years

            Glad I came across this post... I was hit by a drunk driver in June of 03 and it led to a spinal fusion of L4-L5 - 6 months into recovery of this surgery... I was again hit by another inattentive driver (on her cell phone) - who rearended me at a speed of at least 45 mph -

            while not much damage to the vehicle (a Jimmy) there was a rather traumatic whiplash effect to my body and an immediate numbness on my right side from the right hip/pelvic area to the mid bottom of my right foot - to date this is still true - I now walk with a much worse limp and (foot drag from time to time) than I ever did before I had the surgery from the first accident -

            In any event (an the timinig is interesting) 3 weeks after the second accident, I experienced Vertigo (1st time in my life!) for a period of 4 days - sending me to the ER - at which point my PCP (Doc) suggested I have an MRI cuz she thought maybe I had an inner ear problem causing the vertigo-

            Next thing I know - she's calling me back saying "if it's not MS, I don't know what it is!" - Hence time for the neuro - he says yes, its MS after my 2nd visit and prescribes Avonex

            ....But since I cant walk or think right anymore - I lose my job (while a single mom at 43 years old - with no family to speak of) I also lose my insurance - now on public aid - see a new neuro - who says its not MS and that starts the last 3 years of seeing 3 neuros and now 4 MRI's later... to finally say (and this is now back to the original neuro who 1st diagnosed me in 03') that YES, it is MS (that finally occured just this last Sept 25th)...

            I have had a BURNING DESIRE to find someone who has been under enormous stresses while enduring physical traumas (particularly car accidents) back to back and then ending up with a diagnosis of MS - does trauma trigger MS - Is this a likely scenario especially where there is no family history or background of the disease?

            Dr. Wise Young have you or anyone else heard of a possible connection? If so... please, please tell me where I can learn more... thanks a bunch!!!
            Last edited by missinglynx; 4 Oct 2006, 7:15 PM.

            Comment


              #7
              Dear Dr. Wise Young: How do I reach you with my question, relative to this post? Im new on this site and was hoping to find some answers... please advise, thanks much!

              Comment


                #8
                Missing, MS is considered an autoimmune disorder. In SCotland where a huge cluster of cases are reported theories have been put forward that it may be a virus that is earth borne. I have never heard of MS from trauma or stress.

                Have you had any lumbar punctures (spinal taps) that are "off" to back up the MRI? Whiplash can also cause traumatic brain injuries that can mimic some symptoms of several conditions.
                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


                  #9
                  Thanks for responding. Yep, had the spinal tap - didnt show anything - 4 MRI's later - lesions appeared in the corpus callosum - thats why they're now confirming the diagnosis as MS - Interesting that you should mention whiplash as I definitely suffered this in the last accident - the same accident that made me numb on my right side... I have read of several incidents where someone had a whiplash type injury and shortly thereafter received a diagnosis of MS... anyone else hear of this? thanks again...

                  Comment


                    #10
                    Originally posted by missinglynx
                    Dear Dr. Wise Young: How do I reach you with my question, relative to this post? Im new on this site and was hoping to find some answers... please advise, thanks much!
                    lynx, I am sorry but I have been on an airplane for over 15 hours and was catching up on some sleep. I do look at most posts on this site and try to answer as quickly as possible.

                    The questions of trauma association with multiple sclerosis has been brought up repeatedly over the decades and there is controversy about the linkage. Of course, there are many people who have MS who have had accidents. Some people think that this is coincidental. I am not sure whether the association has yielded any difference in the way one would treat the traumatic injury or the MS.

                    Your description of MRI findings in the corpus callosum does strongly support the diagnosis of MS. Association with whiplash does not necessarily mean that it caused the multiple sclerosis. There have been several recent attempts to find out whether trauma can exacerbate the progress of multiple sclerosis (abstracts below)

                    Wise.
                    • Poser CM (2000). Trauma to the central nervous system may result in formation or enlargement of multiple sclerosis plaques. Arch Neurol 57: 1074-7, discussion 1078. Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA. cposer@caregroup.harvard.edu. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10891994
                    • Kivioja J, Ozenci V, Rinaldi L, Kouwenhoven M, Lindgren U and Link H (2001). Systemic immune response in whiplash injury and ankle sprain: elevated IL-6 and IL-10. Clin Immunol 101: 106-12. Whiplash injury and whiplash-associated disorders (WAD) are significant problems of modern society. Numerous attempts have been made to characterize the nature of whiplash injury. Whether the immune system is involved during the disease process is not known. In a prospective study, using enzyme-linked immunospot (ELISPOT) assays, we examined numbers of blood mononuclear cells (MNC) secreting pro- (IFN-gamma, TNF-alpha, IL-6) and anti-inflammatory (IL-10) cytokines in patients with WAD and, for reference, patients with ankle sprain and multiple sclerosis and healthy subjects. An immune response reflected by elevated numbers of TNF-alpha- and IL-10-secreting blood MNC was observed in patients with WAD examined within 3 days compared to 14 days after the whiplash injury. The patients with WAD examined within 3 days after the injury had also higher numbers of IL-6 and IL-10 secreting blood MNC compared to healthy subjects. The alterations of cytokine profiles observed in WAD were also observed in patients with ankle sprain when examined within 3 days after trauma. In contrast, there were no differences for cytokine profiles between patients with WAD examined 14 days after the whiplash injury and healthy subjects. Relatively minor trauma like WAD and ankle sprain are associated with a systemic dysregulation in numbers of cells secreting pro- as well as anti-inflammatory cytokines. Karolinska Institutet, Division of Orthopedics, Huddinge University Hospital, Stockholm, Sweden. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11580233
                    Last edited by Wise Young; 12 Oct 2006, 8:03 AM.

                    Comment


                      #11
                      This is a very interesting thread for me too, as I've had a similar situation.

                      In early 2004 I was in Toronto, Canada studying to be an apprentice costume designer. The situation was pure hell, very stressfull, and not very healthy living conditions. I lived in the work area, meaning I was exposed to cloth dust, areosol glue, had no heat to speak of, and slept on an air mattress for the two odd months I was there. My food intake was sporadic and not exactly planned, and again, the situation for other reasons was pure hell. Very stressfull. I cried myself to sleep most nights.

                      I arrived in Toronto on January 10th, I believe, and left on February 28 or so. Sometime in there, I forget exactly when, I had three accidents. The first was pretty simple. I slipped and fell on ice - but all seemed fine. I fell on my butt, I had a bruise, no apparent harm done. The second I tripped over the air mattress and fell landing on my already-bad-knee on the tile floor. The third was a bit later and a couple of days before I left Toronto completely. I was in a gym (we worked out regularly) and sat down at the back extension machine. Someone had locked it open with all the weights on, so when I pulled the pin, it crushed me down with the full 125 pounds on it. There was no sounds of crunching, no high speed impact, and no immediate obvious issues. My thoughts were that nothing seemed to be broken and except for some pain (obviously) I'd have obvious issues if I'd really hurt myself, right?

                      Right. :P

                      Fast forward about two days, my back still bothers me some but it seems to have cleared up completely, and all seems fine. However, I've been kicked out of the place I was staying by the boss/woman I was there to apprentice with, and I spent the next few hours packing, carrying my crap out to a van taxi, and literally fleeing for a hotel. The next day my husband and mom arrived to retrieve me and my stuff, and we came back to Georgia.

                      The stress seemed only to peak as we were leaving Canada, and taper off, until it was more or less gone. About a week later I woke up, and my back REALLY hurt, incredibly bad, worst back pain I've ever had - but I'm not a stranger to back pain at all, far from it. I've hurt my back in various ways more times than I can count.

                      So after about two months of my back being in severe pain, I go see a chiropractor - and things seem to look up. The first visit he took x-rays and that showed some bone damage. It looked like there were pieces of bone (although he said it could be just calcium deposits as well) anterior to the T12, L1, L2, and L4 vertebrae. My pain eased a lot under his care, but various other things began happening.

                      Within a month or two, I started having to use a cane to walk, because of the pain. Very shortly after that I began falling, a lot. Repeatedly. I tried to get out of a car once, and while I was absolutely positive that I put my foot out onto the pavement, it never moved, and I dove face first onto the pavement as though I were just trying to jump out like a fish.

                      Due to the repeated art shows I was attenting and presenting at at the time, it was adivsed that I get a wheelchair and use it. I did. I saw an ENT with the doctors thinking tha perhaps it was some strange inner ear problem. He said no, he thought it seemed more like MS. I saw an orthopaedist who advised me to STAY in said wheelchair until we learned what was causing the problem. MS was bandied about at the time, and I was sent to a neurologist. The neurologist said MS right off the bat, and treated me with muscle relaxers and told me to basically live as well as I could.

                      I had MRIs, EMGs (OH MY GOD THAT WAS HORRIBLE!!!!!! Worse than torture!) and gave my body weight in blood samples for bloodwork. There were tests after tests after tests and more tests for desert. Nothing ever came back conclusive, nothing ever showed positive. My bloodwork has always, this entire time, shown inflamation of some type, but no one can figure out what from.

                      I have a lot of classic MS symptoms, but without the cycles that go with having MS. I have a lot of back pain, and a weakness and numbness in the legs. I can only describe the feeling of having been in a swimming pool or hot tub relaxing for many many hours and then getting out only to feel heavy and as though you can't move your legs, except that I really can't. I'm not paralyzed, but I do have intermittent levels of paraperesia and parenthesia (did I spell that right?) I also have presented something similar to Uhthoff's symptom, and have constant temperature regulation issues. While my feet (or any part of my legs, but mainly my feet) will feel normal temperature to anyone touching them, to me they often feel like a block of ice, and are so cold they hurt. This same happens occaisionally (but about 99% less often) with my hands, spots on my back, or my calves. I get fatigued, and after walking around my house for a bit (like putting stuff away) if I do not sit down, I WILL fall down. I get stabbing pains in my hips, knees, lower back, and middle back. I get restless leg syndrome, and at night when I lay down, no matter what I did during the day, my back "screams" in the manner most people describe as relaxing muscles, except that it's absolutely positively the most excrutiating pain I've ever felt.

                      I use a chair out of th ehouse for safety sake, and I often, even in the house, need one or two forearm crutches in order to not fall when I get teh stabbing pains that leaves me breathless, dizzy, and with 'dead leg'. Or 'dead legs'.

                      The MRI's showed that my spinal cord wasn't severed, or even visibly damaged - yet I have a lot of symptoms of it having been so. No one has ever mentioned TM to me in a diagnosis fashion, however I see a huge similarity to the above posters info.

                      I'm sorry to have run on for so long, but the possibilty of a physical trauma combined with an emotional trauma sparking MS or similar intrigues me. Especially as it seems to be an extremly abnormal case of MS if it *IS* MS. I saw Khurram Bashir at Kirkland Clinic in Birmingham Alabama right before Christmas last year and he said he was pretty sure I didn't have MS, however it was possible that my diagnosis in that regard could change.

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