Patient: Hello Dr. Shi! I am very touched by your reply. Thank you for your attention in your busy schedule. I am a patient of Tiffa. The weakness of the limbs is continuously aggravated. Two years ago, I felt weakness in my left leg without pain, and my arm was sore wherever I put it when I slept. After a period of time, even the bicycle can not ride, have been to a number of hospitals, including Shenyang Medical University to do a comprehensive examination, including CT, MRI, etc., but no results, can not be diagnosed. After returning home, I did not take any treatment measures. Four months ago, my condition became more and more serious, and I developed weakness in my limbs and difficulty in getting up and lying down. Patient: Hello, Dr. Shi! My hands are sometimes trespassing, I have bowel movements once every six to ten days, and I have not wanted to eat vegetables for the past three to four months. In addition to the two previous cases, I have no other abnormal feelings for the time being. Now I’ll send you the results of the film I took in December 2007 at Shenyang Medical University and ask you to take a look at it for me. Thank you very much! 1.XRA Inspection site: Spine. Inspection item: Lumbar spine front and side view film. Description: Physiological curvature of lumbar vertebrae is natural, each vertebra is in line, lumbar 1-5 vertebrae can be seen obvious osteophytic changes, the rest of the bone is good, and there is no abnormality in the soft tissues around the vertebrae. Impression diagnosis: lumbar degeneration. MR examination site: plain scan. Inspection item: thoracic spine. Description: MRI scan of thoracic spine Thoracic spine is paracentral, physiologic curvature exists. t4-5 disc bulge, corresponding level of spinal canal stenosis, compression of the dural sac. t4-8 medullary cavity outer fat thickening, the remaining vertebral body and accessory structures do not show obvious abnormality. Impression and diagnosis: Consider: 1, T4-5 disc bulge; 2, T4-8 medullary cavity posterolateral fat thickening. Recommendation: Combine with clinical. 3. MR examination site: plain scan. Inspection item: cervical spine. Description: MRI scan of the cervical spine. cervical vertebrae are paracentral, physiological curvature is present. c3-4 intervertebral disc is bulging to the right posteriorly, with pressure on the dural sac and mild compression and deformation of the spinal cord; the edge of the C4-7 vertebrae is osteophytic. The remaining vertebrae and cervical spine accessory structures showed no obvious abnormality. Impression diagnosis: Consider: C3-4 intervertebral disc bulging to the right posteriorly. 4. MR examination site: plain scan. Examination item: lumbar spine. Description: MRI scan of lumbar spine The lumbar spine is smooth and physiological curvature is present. the L3-S1 intervertebral discs are bulging to the periphery to varying degrees, with L3/4 and L4/5 being the most important ones, and the dural sacs are deformed by the compression. The ligamentum flavum was not significantly hypertrophied. The rest of the vertebral body and lumbar spinal accessory structures showed no obvious abnormalities. Impression diagnosis: L3-S1 disc bulge. 5. 5. MR examination site: plain scan. Examination item: head. Description: Cranial and MRI scans Bilateral cerebrum, cerebellar hemispheres and brainstem are symmetrical with normal gray-white matter contrast and no abnormal signal foci. The ventricles, cerebral fissures and sulci were symmetrical, normal in size and morphology, and the midline structures were centered. The pituitary gland was normal in size, morphology and signal. No abnormalities were seen in the cranial structures. The mucosal thickening of the right maxillary sinus showed isotropic T1 long T2 signal. Impression Diagnosis: 1. Cranial MRI plain scan did not show any obvious abnormality. 2. Right maxillary sinus mucosal thickening. 6. MR Examination site: plain scan. Examination item: head. Description: cranial MRI scan Bilateral cerebrum, cerebellar hemispheres and brainstem are symmetrical with normal gray and white matter contrast and no abnormal signal foci. The ventricles, cerebral pools, cerebral fissures and cerebral sulci are symmetrical with normal size and morphology, and the midline structure is centered. The pituitary gland was normal in size, morphology and signal. The mucosal thickening of the right maxillary sinus showed isotropic T1 long T2 signal. Impression diagnosis: right maxillary sinus mucosal hypertrophy. Suggestion: Please combine with clinical. Finally, the medical university suspected that I am cerebellar atrophy and cerebral pole death, but my memory has been very good and my mind is clear. Please help me analyze what kind of disease I have! Thank you again for your selfless help! Thank you! Patient: Hello, Dr. Shi! My left leg and foot have been swollen for more than a month, my left arm is uncomfortable, sore but not painful wherever I put it, my right leg and right arm are lighter, my limbs are weak and I have difficulty moving. Hands and feet not stiff, difficulty in getting up and lying down, but walks a little better, not in small steps, but needs assistance when walking, and can walk a few steps if unassisted, but very slowly. No tremor when hands are not moving, no loss of sense of smell; sometimes screams in bed. Thank you so much! Thank you very much! Patient: Hello, Dr. Shi! I don’t have muscle atrophy. Dr. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: Have you had your spinal cord examined? Do you have any tremor? Do you have any sensory abnormalities? If the disease lasts for two years, the possibility of inflammation is rare, but I think the possibility of spinal cord lesion is high. Please upload the tests you have done to me. Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: Hello, after reading your examination results, my impression is that your whole spine is not very good, and the osteophytes and herniated intervertebral discs are not light. Therefore, I think your disease is related to the compression of the spinal cord, especially the cervical cord, which can cause weakness of the limbs and abnormalities of the bowels. But there are also some unexplained symptoms. For example, you have no obvious sensory impairment. (Sometimes, however, subjective sensations do not always correspond to objective tests.) It is recommended that you go to the hospital and ask your doctor to do a detailed neurological physical examination (no cost), mainly for sensation. Also consider peripheral neuropathy, diabetes can also cause. It is recommended to go to the hospital for electromyography to understand the condition of peripheral nerves. For treatment, control blood sugar and regular intramuscular vitamin B1 and B12 injections. There is also consideration of myasthenia gravis, which is unlikely and can be ruled out by electromyography. Tumors can also cause paraneoplastic syndromes, with the above symptoms, which need to be examined and ruled out. As for cerebral lesions, head MR does not suggest a lesion and is not considered at this time. Cerebellar atrophy does not manifest like this, mainly ataxia, unsteady walking and incoordination. Finally, Parkinson’s syndrome has to be considered, so can I ask if you have weakness or dexterity and mobility? Any stiffness in the hands and feet, difficulty getting started, walking in small steps? Tremor when hands are not moving, worse when agitated, disappears when sleeping. Any loss of smell, sleep is screaming? (However, your cranial MR does not suggest a lesion in the basal ganglia.) Shi Haisan, Department of Neurology, Guangzhou Brain Hospital Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: I am very interested in your disease, and it would be nice if I could do a neurological physical examination for you in person. Do you have muscular dystrophy? Shi Haisan, Department of Neurology, Guangzhou Brain Hospital: Hi, I discussed your condition with my professor, and she also initially considered cervical medulla. We all think that we need to do a systematic neurological physical examination, because many symptoms are not expressed by the patient and can only be found out by physical examination. You have been to so many hospitals and what is their opinion? As a neurologist, the general requirement to see the patient to see the patient, do a body check to determine the condition of the disease, the paper alone may be misdiagnosed, miss the diagnosis. This is especially true for difficult cases. If it is a problem of cervical medulla, it is recommended to use drugs to improve circulation and neurotrophic drugs. If necessary, a “cervical collar” should be worn to avoid strenuous activities. In severe cases, surgery is recommended. Thank you.