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Dr. Chip
Dr. Chip, Doctor (MD)
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Experience:  Over 20 yrs of Family Practice
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A recent SSEP test showed "a significant delay in central conduction

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A recent SSEP test showed "a significant delay in central conduction time with left posterior tibial nerve stimulation". The radiologist recommended looking for a structural lesion within the spinal cord. As it happens, an MRI of the cervical spine last October showed a small 4x7 mm STIR hyperintensive/intermediate T1 lesion in the C5 vertebral body. Could this really be causing all of this pain that radiates across my shoulder, down my spine and leg? ...
Hi--was there any more investigation to determine exactly what the T1 lesion was and did you have an MRI of the rest of your spine?
Customer: replied 3 years ago.

I saw an ortho surgeon at the time who dismissed it -- said it looked normal to him. I've run the gamut of doctors since then, but the short story is I'm seeing a new ortho surgeon who started by focusing on my lumbar spine because he does one section at a time. The lumbar MRI shows 3 bulging discs and 1 with minor herniation, none of which he says can be causing this much pain in so many places. Tomorrow I'm going for a thoracic MRI for the first time and we'll look at that. If that doesn't produce results, we're working back up to the cervical spine for a new MRI of that lesion. Not to be facetious, but I probably wouldn't be around to write this email anymore if that cervical lesion were a malignancy (anyway, I've had a bone scan and no cancer). So the question remains, is it really possible that little lesion could be causing all of this radiating pain?

Just for a little more clarity, where all is your pain?
Customer: replied 3 years ago.

Both sides of my neck, radiating across both shoulders (but more on the left side), and straight down my entire spine to the lumbar area. My hands and feet go numb at night, never in the day, after I lie flat on my back to go to sleep. In fact, it happens when the pillow presses against my neck.

Sorry for all the questions but do you have other medical conditions and has your primary care physician done other tests--especially blood work--to get at a cause here?
Customer: replied 3 years ago.

Since this has been going on for about 1-1/2 years now, I've run the gamut of tests. All kinds of blood work (no Lyme disease or other odd diseases), no cancer, no lupus, basically nothing except bulging and herniated discs and that little lesion.


A rheumatologist says I have fibromyalgia but none of the medications for it work (Neurontin, Gabapentin, Lyrica).


Customer: replied 3 years ago.

No other known medical conditions. Blood work showed only a B12 deficiency last year that was corrected wtih supplements. Oh, and I have very low blood pressure, 90/60, which no one seems to think is a problem.

Well, even if the meds didn't work this does sound like fibromyalgia although that's basically a diagnosis of exclusion--made with other things are ruled out. To answer your first question, no, none of this except maybe the pain across your shoulders and upper back would be from the T1 lesion. The SSEP results could be explained by the disk problems in the lumbar spine. I would, however, if it hasn't been checked, check you for heavy metal (lead and mercury) toxicity before I decided on the fibromyalgia dianosis.
Customer: replied 3 years ago.

I was checked for lead and mercury and other poisonings and no issues there. Maybe more than one thing is going on --- the lumbar disk problems and the cervical could be unrelated. How should I pursue this lesion? Should I get another mri? or a different test? I'm not really satisfied with a year-old diagnosis of "looks fine to me".

That just about only leaves fibro and I know how frustrating this must be for you. You need a PET scan to look more closely at the thoracic lesion.
Customer: replied 3 years ago.

Is PET basically a 3-D view of the lesion? Should I have a combined PET/CT scan?

Clausterphobia is a challenge, but I'll live through it if it rules the lesion in or out as a source of the pain.


It's a more refined and defined kind of ct scan but better than an MRI for looking closely at a lesion like this Please hang in there and let me know how it goes
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Customer: replied 3 years ago.

Okay, I'll pursue it. Thanks for your recommendation and I will let you know how it ends up.

Take care til then
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