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Does Myleomalacia Cause Gait, Spasticity And Bowel Incontinence?

Posted on Tue, 11 Feb 2014

Question: in 1998 an astrocytoma was found in my spinal cord at C5-6. I am a functioning incomplete quad, and over the years have fought back by using the benefits of physical therapy, a fusion at C5-6 in 2001, a lamenectomy at S1-5 to stabilize a cascade of back problems. I've also got age related arthritis at various levels of my spine. Most recently, an MRI of my C spine has turned up the feared myleomalacia, I believe below the original C5-6 site. I'm afraid this will cause a worsening of gait problems, spasticity, incontinence of bowel and bladder, etc., eventually to cause paralysis. Can anything be done? Do I start with a neurologist?

Answered by Dr. Sudhir Kumar (29 minutes later)

Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. First of all, I would like to reassure you that "myelomalacia" is not an active disease, it just represents the part of spinal cord damaged due to past astrocytoma and surgery. So, we do not expect any worsening in your gait, spasticity, bladder or bowel incontinence, etc at this moment. You could consult a neurologist to verify what I have said. I admire your courage and will power to fight this severe disease, and manage to live a good life for more than 15 years after a diagnosis of spinal cord astrocytoma! I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (21 minutes later)

Thanks for your kind support. My neurosurgeon was unable to remove the astrocytoma entirely because to do so would have created permanent, dramatic damage, most likely paralysis. I was advised that the tumor is very slow growing, so I should not be concerned about it growing back to a XXXXXXX level in my lifetime. Of course I do become concerned at times when my residual symptoms become more pronounced; I am a narrative painter and worry that my manual dexterity, already compromised by neuro issues, will become more limiting as time goes by. I also have severe osteoarthritis in my fingers. Are there any signs of decline I should be aware of?

Answered by Dr. Sudhir Kumar (11 minutes later)

Brief Answer: Thank you for getting back. Detailed Answer: Thank you for getting back and providing more information. I agree with your neurosurgeon's approach. His choice of safety during surgery was of paramount importance and his "conservative" approach has played a major role in you being able to maintain good functions at this date too. I would just urge you to remain positive and continue with your exercises/physiotherapy, etc. You should look at the usual signs of weakness or spasticity of limbs, and bladder and bowel incontinence, even though I feel that they are unlikely to develop after so many years. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (23 hours later)

Dr. XXXXXXX I truly appreciate your reassurance; there are times when my bravery fails me, especially after a hospital stay, and it can take some doing to buck up and get on with life. My discharge report said "MRI of the cervical spine showed postoperative changes with myelomalacia of the cervical spinal cord at C5-6." It's the reference to "postoperative" that raises the fear. A brain MRI taken on 12/19 had the following impression: "Scattered punctate nonspecific foci of T2/FLAIR hypersensitivity in the periventricular and subcortical white matter, although nonspecific microvascular disease suspected. No recent infarct." Following this I had an EEG, the results are forthcoming. Microvascular disease, should I have this, sets off my fear of problems arising in the future. MRIs of the T spine and L spine are neutral in content.

Answered by Dr. Sudhir Kumar (8 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: I have noted the MRI findings. As you said, the MRI spine shows only old changes and there is no need to worry about them. MRI brain shows small areas of ischemia which is often due to lack of blood flow to brain, and is quite common. They can also occur in people with migraine headaches, and sometimes, without any disease also. If you have risk factors for ischemia such as high BP, sugar or cholesterol, i would advise you to start aspirin tablets, otherwise, there is no need for that. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar