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Hi Doc! I'm a 33 year old mother of two. My medical history is long, so I'll try to abbreviate...

October, 2003-Suboccipital craniectomy, laminectomy of c1 and c2 for Arnold Chiari Malformation. Residual symptoms: downbeat nystagmus, tinnitis, mild imbalance, vertigo. (Chiari triggered by epidural with second son.)

August, 2004-Strabismis surgery to correct congenital fourth nerve palsy. Mild (unexpected) improvement with downbeat nystagmus.

June, 2005-Visual symptoms worsened. Although prescription glasses corrected to near 20/20, had difficulty focusing more than 20 feet away, unable to find things on shelves. Cranial and cervical MRI were normal, with slight possibility of cervical stenosis. Neurologist confirmed slight tendonitis and carpal tunnel, but no stenosis. No explanation found for visual disturbances.

June, 2005 to May, 2007-Vision deteriorated, symptoms forced me to quit working and eventually quit driving. Symptoms include downbeat nystagmus and newly developed sixth nerve palsy, which combine into an elliptical nystagmus on inward and outward gaze (dx Sept 06, no "good reason" found), photophobia, visual snow with larger flashes in spots, and loss of detail at more than a few feet. (I can't tell if someone's eyes are opened or closed, see facial expressions, or recognize my husband of twelve years in a group of people.) Stark black-on-white type gives me eyestrain headaches. Patterns appear to move.

Two months ago...I discovered a bloody discharge from breast. Cytology reports abnormal cells with proteinaceus debris. Suspected intraductal papilloma, major ductal dissection scheduled.

BUT...over the past few weeks, I've developed numbness in hands, major gait disturbance, severe difficulty ascending/descending steps (double-stepping with handrail only), stiffness, and aching after mild exertion. Getting up and down off the floor is becoming difficult. I generally feel like a stiff old lady. The anesthesiologist refused to administer general anesthesia until my neurosurgeon gives a cranial all-clear, and a spinal MRI is done and also gives an all clear. The spinal MRI shows (from what I gather from the nurse-I'm receiving a copy of the report in the mail) slight stenosis from c4-c6 with no major cord or nerve compression found. She mentioned another term I'm not familiar with, something -osis or -itis but she assured me it won't affect my surgery, and that it appears "almost normal and nothing to worry about".

Is this truly nothing to worry about? Should I get a second opinion? Do you have any inkling as to what could be causing ANY of this??? My specialists are at the Cleveland Clinic, and they are absolutely clueless. It's been mentioned that it could be a form of stress or depression, but wouldn't it resolve itself instead of gradually worsening over YEARS? I go to the gym, started going to church, and meditate regularly (as suggested by my NS) but it has no effect. HELP!!!!

Thanks for any information you can give me. By the way, I'll update and give the full report when I receive it. Have a Blessed Day!!

Silverwolf

Answers:


Here's the full radiological report:
Cervical Spine:
Patient has had a previous posterior fossa decompression and duraplasy. There is tonsilar ectopia present in this patient with history of Chiari I malformation. There is mild mass effect on the cervical medullary junction by the low lying cerebellar tonsils. No evidence for cervical spinal cord syrinx is seen. There is a mild spondylotic ridge formation at the level of c4-c5 and c5-c6 effacing the ventral subarachnoid space, however this does not lead to significant spinal stonisis or cord compression. Mild uncovertebral hypertrophy is present at the level of c4-c5 and c5-c6 leading to mild neural foramina narrowing especially at the level of c5-c6.
Post contrast admisitration, there is no abnormal enhancement of the cervical spinal cord or cervical vertebral bodies.

Thoracic Spine:
The thoracic spinal cord maintains normal shape and signal intensity. There is no evidence for significant disc protrusion, spinal stenosis or cord compression at any thoracic level present. Mild dextroscoliosis noted.

Lumbar Spine:
The lumbar spine alignment is within normal limits. The marrow signal intensity is intact. For the purpose of this dictation, the last lumbar type vertebral body will be numbered L5. Utilizing this dictation numbering system, conus medularis ends at the level of L1. There is no evidence for significant disc protrusion, spinal stenosis, or foraminal stenosis at any lumbar level. Mild facet arthritis of the lower lumbar spine is seen.


Does this help at all? My question is, if it's nothing to worry about now, will it continue to worsen and I'll have bigger problems later? Should I contact my neurosurgeon about the low-lying cerebellar tonsils, or is this normal post-Chiari decompression? Thanks!