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Spine and Back Health

Cervical disc hernation

10/30/2008

Question:

In July I had pain in my neck and shoulder blade for 24 hrs. Then I developed severe chest pain, shortness of breath related to pain in chest (02 sats WNL), low grade fever (never exceeded 100.0), WBC 13.6, neutrophils 9.0, D-Dimer 278. I also have left sided tongue pain, left sided throat pain, chest pain which is more often on the left side and radiates down to the lower rib cage area, left sided neck, shoulder blade and upper arm pain. CT of chest ruled out PE and I was diagnosed with postviral pericarditis based on symptoms (did not have an Echo for 2 wks. after dx which only showed mild pericardial thickening). I was placed on Prednisone 40 mg. x 4 days and symptoms resolved for 1 wk. They returned along with fever. To make a long story short, I have been ruled out by rheumatology(neg. ANA, SSA, SSB, C3, C4, dsDNA, ENA, ANCA, Hep C), ruled out by ENT (have a paralzyed right vocal chord from thyroid surgery due to Graves 32 yrs. ago), infectious disease (negative BC, negative Histoplasmosis), oncology (although discovered gene for hemachromotosis).

10 days prior to symptoms developing I received the 3rd dose of Hep B vaccine series(my second round due to negative titers from first series received 18 yrs. ago).

Just received MRI results of Brain and cervical spine which show: Tiny anterior spur formation C5, C6, C7. No compression deformity or malalignment. The cervical cord is normal in signal and caliber. C4-C5 and C5-C6 show minimal 1 mm. disc bulges without signifi. spinal or neural foraminal stenosis, C6-C7 2 mm. broad based disc bulge present. No significant spinal stenosis. Mild left neural foraminal narrowing. Brain: Scattered punctate white matter signal abnormalities present. Tiny cystic-type areas less than 1 cm. present in left and right parotid gland of uncertain significance.

Could the cervical disc abnormalities cause the chest symptoms, tongue, throat symptoms I am having? Could nerve inflammation cause the low grade fevers and elevated WBC count? Could the Hepatitis B vaccine have anything to do with this?

Thank you so much for any input. Normally see my doctor once a year and am very tired of having weekly consults, CT scans, tests, etc. and am very anxious to receive an answer, do whatever I can to alleviate pain and get on with my life! Thank you again -

Answer:

Thank you for visiting NetWellness. On this site, we try to answer general questions about health but cannot diagnose, interpret testing results, or recommend treatment. 

You don't mention your age, which is important in deciphering your MRI results. The findings you've described here for the cervical spine would be considered normal findings in pretty much anyone over the age of 40 (or so), especially in a smoker, which also isn't specified in your question. I cannot tell you the cause of your symptoms without performing a thorough history and physical, but I will venture the opinion that there's almost no conceivable way your very, very mild cervical spine findings could be causing the symptoms you've described. I don't know enough about hepatitis to answer your other question.

In any case, you should insist that your doctors answer your questions in a way that you are able to understand before consenting to any treatment. If your physician is unable to help you understand these issues, you should get a second opinion.

Thank you for your question, and good luck.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University