Lhermitte's & Cervical Spine Lesions

[Emrs08]

Hi everyone. I am a 26 year old Caucasian female. I have been experiencing Lhermitte's sign for a few months. Every time I bend my chin down I feel tingling from my waist to my feet. At first, I went to a chiropractor thinking it might have been related to my spine being misaligned. After awhile, I saw no improvement and started researching what I was experiencing. This is when I came across the name and started worrying about MS. I waited a few more weeks and finally called my PCP. She immediately wrote it off as tight muscles in my neck, but that just didn't seem right to me so I asked for an MRI because I was worried about MS and she said yes. Well, here we are a week and a half later and they discovered 3 small lesions on my cervical spinal cord. Here are the results:

There are three tiny 2-3mm high T2 signal lesions in the midline of the cord posterior columns at C2 and C3-4 levels without contrast enhancement. The differential diagnosis includes early demyelination, subacute combined degeneration (suggest
correlation with vitamin B12 levels), and rare viral myelitis.

Suggest obtaining a brain MRI with IV contrast, MS protocol, to evaluate for other lesions that would be typical for demyelination.

I am going in for a brain MRI next Wednesday, then being referred to a neurologist. Lhermitte's sign is my only symptom that I'm aware of. I've had a few sharp pains in the back of my head and over my ear in the last week or so, but just assumed it was a tension headache. I get achy "growing pain" feelings in my legs sometimes as well as pins and needles in my feet when I initially get out of bed. But I just figured those were normal things. I've had no bloodwork done at all.

I know this could be related to a couple of different things, vitamin B12 deficiency being one of them. I do not follow a vegan or vegetarian diet. I eat very healthy. I get most of my carbs from fruit and whole grains and eat a lot of protein and vegetables. I had a baby almost 9 months ago and had gestational diabetes while pregnant. It was diet controlled so I did not take any medicine to control my blood sugar. I passed the 2 hour GTT 6 months post partum. As I mentioned, I eat very healthy and always have. I am 5'4" and fluctuate between 105-110 lbs.

I took a prenatal vitamin all throughout pregnancy and a women's multivitamin after. I live in sunny California where I get lots of vitamin D!! I'm just worried and discouraged. Any thoughts? This has all come on very suddenly.

Oh and I was very, very, VERY mildly anemic during pregnancy. (Common, I know.) I also get lots of canker sores... so I've thought maybe celiacs??

Just seems like MS is most common when you have Lhermitte's and lesions on your cervical spine.

The only other things are I've always gotten dizzy and lightheaded easily and been extremely clumsy. I run into walls all the time. BUT I've always been clumsy. My entire life!

Just don't know what to think and the doctors don't want to discuss anything until they do further tests and the wait is killing me.

[Snoopy]

Just seems like MS is most common when you have Lhermitte's and lesions on your cervical spine. I get achy "growing pain" feelings in my legs

Both the Lhermitte's sign and the achy growing pains can be due to cervical spinal cord lesions, in Multiple Sclerosis. I know waiting can be very difficult but have patience, it's important to receive the correct diagnosis. Not everything you mentioned would be due to MS, it's possible to have more than health issue going on.

[jimmylegs]

hi here's one thing to look at:
Effects of Zinc Treatment in Patients with Recurrent Aphthous Stomatitis (canker sores)
https://www.jstage.jst.go.jp/article/dm ... 1/_article
i used to have those, and i had zinc tested and was deficient. fixed the zinc issue, and no more canker sores has been just one of the benefits
there are studies documenting steady zinc decline during pregnancy, even while supplementing. day to day dietary choices can help individuals build zinc, maintain, or deplete over time. building small humans is just one of those things that uses up a lot of it!

if your docs will test zinc, if you want to be unlike an ms patient and most like healthy controls, you can ensure that your level is near the top of the normal range.

if low zinc is in the picture it could affect b12 absorption. your docs will hopefully run a b12 test just to rule it out as a factor if nothing else. ppl can end up with b12 issues from other causes than veg or vegan diets. the normal range is pretty bad, aim for at least 500 pg/ml.
interestingly, low zinc can affect iron as well. if you do find a zinc issue, it will be worth boosting both zinc and iron intakes together, emphasizing dense/rich food sources before supplements.

either way, there will probably be some health optimization work you can take on, while you go through the process with the docs most ppl don't adhere to guidelines, and i mean in the 99% neighbourhood. the stat only gets better, nowhere near perfect adherence to MINIMUM intakes, in professionals who know what they are doing. strange but true!

[Emrs08]

Thank you for your responses!!

Snoopy - Yes, I will definitely be patient. I want every test possible to explore every scenario. What do you mean by more than health issue going on?

Jimmylegs - I will definitely request a zinc test. I'm pretty sure they will test for b12 deficiency because they mentioned it as a differential diagnosis on my MRI. If not, I'll request one. Should I wait to start any zinc or iron supplements or increasing them in my diet until I've had the bloodwork done?

[Snoopy]

Snoopy - Yes, I will definitely be patient. I want every test possible to explore every scenario. What do you mean by more than health issue going on?

Well Emrs08 proofreading is a wonderful think but something I apparently didn't do I meant to say you can have more than one health issue going on. Things like Anemia and Canker Sores is not something MS would cause.

[jimmylegs]

hi emrs
b12 deficiency is an established one to rule out as part of the ms dx process for sure.
serum zinc is not a status quo request for an msddx, so you might want to ask for it strictly in the context of the recurrent canker sores.
i would suggest going in and just asking for an updated serum ferritin to check on the anemia, and a serum zinc to start, see if they go for it.

re supplementing or waiting, imho the most informative scenario would be:
no supplements right away BUT serum zinc and serum ferritin are successfully requested and tested in the immediate future.
this would provide clean baseline info, with no supplement contamination masking any issues with the your current pre-supplement status quo.
my 2cents, just a good idea to be able to make informed decisions on how to proceed, with some solid data.

if the doc says no to your verbal request for a zinc test, you can always be prepared with some science to give the doc in support of your request.
convincing abstracts will involve studies with lots of patients and controls, or multiple studies included in a meta analysis. statistical power and so forth. case studies are fairly useless when it comes to making a solid argument that something could feasibly apply to you as well.

here's an example of a good abstract, with extra detail from the full text to underline the point:

Bao, Z. X., Yang, X. W., Shi, J., & Liu, L. X. (2016). Serum zinc levels in 368 patients with oral mucosal diseases: A preliminary study. Medicina oral, patologia oral y cirugia bucal, 21(3), e335.

Abstract
Background
The aim of this study was to assess the serum zinc levels in patients with common oral mucosal diseases by comparing these to healthy controls.
Material and Methods
A total of 368 patients, which consisted of 156 recurrent aphthous stomatitis (RAS) patients, 57 oral lichen planus (OLP) patients, 55 burning mouth syndrome (BMS) patients, 54 atrophic glossitis (AG) patients, 46 xerostomia patients, and 115 sex-and age-matched healthy control subjects were enrolled in this study. Serum zinc levels were measured in all participants. Statistical analysis was performed using a one-way ANOVA, t-test, and Chi-square test.
Results
The mean serum zinc level in the healthy control group was significantly higher than the levels of all other groups (p < 0.001). No individual in the healthy control group had a serum zinc level less than the minimum normal value. However, up to 24.7% (13/54) of patients with AG presented with zinc deficiency, while 21.2% (33/156) of patients with RAS, 16.4% (9/55) of patients with BMS, 15.2% (7/46) of patients with xerostomia, and 14.0% (8/57) of patients with OLP were zinc deficient. Altogether, the zinc deficiency rate was 19.02% (70/368) in the oral mucosal diseases (OMD) group (all patients with OMD). The difference between the OMD and healthy control group was significant (p <0.001). Gender differences in serum zinc levels were also present, although not statistically significant.
Conclusions
Zinc deficiency may be involved in the pathogenesis of common oral mucosal diseases. Zinc supplementation may be a useful treatment for oral mucosal diseases, but this requires further investigation; the optimal serum level of zinc, for the prevention and treatment of oral mucosal diseases, remains to be determined.

from Table 3. The basic parameters, zinc levels, and zinc deficiency in each group
Group..........Zinc level (Mean±SD, μmol/L)
Control.........16.47±2.10
RAS.............12.90±2.55
(recurrent
aphthous
stomatitis)

so, the canker sore (RAS) group had the lowest mean serum zinc of the whole study, and the control group had the highest mean serum zinc of the whole study. meanwhile both means were well inside the 'normal' range.
here's a full text link: http://www.medicinaoral.com/pubmed/medo ... 3_p335.pdf

now as for 'what is 'normal' '
'normal' ranges are set up differently depending what lab you go to.
11.5-18.5 umol/l (75-120 µg/dl) is perfect by any stretch, but it's definitely way better than some of the lab to lab variation i've seen out there.
sources/entities using 11.5-18.5 umol/l (75-120 µg/dl):
american medical association: http://bit.ly/1PdSF5K
manual of scientific style: http://bit.ly/2iPL9Ww
council for continuing pharma ed: http://bit.ly/2k60inE

lol worst reference ever, they'd be dead
http://emedicine.medscape.com/article/2172316-overview
Zinc: 70-100 µmol/L
units matter, medscape!

heeheehee 'wonderful think' we've all been there

[Snoopy]

heeheehee 'wonderful think' we've all been there

Well crap! I did it again Good grief!

[Emrs08]

My b12 was 741. I'm waiting on the rest of the blood tests. They want a lumbar and thoracic spine MRI as well. Brain was clear. Then they will do a LP. She also tested vitamin e and d and some other things that I haven't gotten back yet. I'm feeling discouraged now because I was hoping it was a b12 deficiency.

[jimmylegs]

741 is great no matter what units. it's good news! i hope you get your vit e, vit d and other results soon, including zinc and ferritin