Caudate Lesion / Office Test

[Sharqua]

This is my first time posting here, though I've lurked for some time.

I have a complex case -- TBI (car accident concussion as a teenager plus multiple cracks to the chin as a child)... combined with gluten intolerance but no positive diagnosis of Celiac because I got myself off gluten too quickly to be tested accurately. In the past I had numerous brain-related difficulties associated with gluten intolerance, most of which have gone away.

Two weeks ago I had an MRI due to short-term memory difficulties (new symptom). It showed a left caudate nucleus lesion with involvement in the structures nearby. My family doctor put me on Lexapro (SSRI) and sent me to a neurologist. (As an aside, the Lexapro is helping.)

I'm a little curious about one of the tests the neurologist conducted, and what it meant.

He tested my reflexes normally, then touched a vibrating fork to both of my big toes. No problem there. His next action, however, was to run the tip of the fork up the bottom of my RIGHT foot several times. Possibly testing reaction? I am HYPER ticklish on the bottoms of my feet. He did this until I lost control. I think I kicked him, because he stopped. His next action, however, was to do the same thing to my LEFT foot. It didn't tickle at all, and in fact he left me sitting there baffled as to why I'd be uncontrollably ticklish on one foot and not ticklish at all on the other.

Is this some kind of a neurology thing where the overwhelmed brain doesn't react the same on the opposite side? Am I just plain not ticklish on the one side? Or could this have been the left side of my brain reacting inappropriately and in fact I shouldn't actually be ticklish on the bottoms of my feet at all?

Thanks for whatever light you can shed on this subject.

-Donna

[sau773a]

It sounds like your best bet would be to go back to the neurologist or family doctor to ask what was tested, and were the results as expected. With your history, it's possible that your reaction was expected. Although, it does sound curious that your sensitivity would be so different from one foot to the other. That would be easy enough to test on your own, to see if it was just that day or situation that brought the reaction, or if it's the way you always are.
As far as the test, having had many neuro exams in the past few years, I can say that stimulating the feet is a pretty standard practice. I asked a therapist about it once, and she told me lots of reasons why, and it made sense. Like you, I'm ticklish on my feet, and though I don't think I've ever kicked anybody, a thorough exam will leave me with a serious case of the giggles.:)
Sharon

[Sharqua]

Thanks!

I finally figured out what it was. He was testing for something called "Babinski's Reflex" which is a sign of nerve damage.

It still doesn't explain why I didn't feel the same "tickle" on one side as the other, but at least now I understand what he was looking for.

Very interesting!

Thanks for the feedback and have a great day!

-Donna

[NG_F]

This is my first time posting here, though I've lurked for some time.

I have a complex case -- TBI (car accident concussion as a teenager plus multiple cracks to the chin as a child)... combined with gluten intolerance but no positive diagnosis of Celiac because I got myself off gluten too quickly to be tested accurately. In the past I had numerous brain-related difficulties associated with gluten intolerance, most of which have gone away.

Two weeks ago I had an MRI due to short-term memory difficulties (new symptom). It showed a left caudate nucleus lesion with involvement in the structures nearby. My family doctor put me on Lexapro (SSRI) and sent me to a neurologist. (As an aside, the Lexapro is helping.)



-Donna

Hello Donna, what were the other structures involved? and is the scan showing hypointense signal in the Caudate on T2 gradient echo imaging?

This would be indicative of hemosiderin deposition from possible diffuse axonal injury. I would think this is an extremely rare area for shear forces as it is encased in the centre of the brain-the basal ganglia.

It is more common in microbleeds,TIA's and lacunar infarcts from a history of hypertension.

Have you ever had hypertension? A CT scan would rule out any calcification.

How is the Lexapro helping you out sofar? Are you taking any other meds for your cognition and short term memory?

I've had 4 concussions in the last 15 years and I have recently had an MRI showing hypointensity with blooming on the gradient echo and SWI(succeptability weighted imaging) at the head of the left caudate with a more mild succeptability in the globus pallidus bilaterally.

I'm worried as my MRI in Dec/99 after my last concussion was clear even on gradient echo axial sequence and now it shows with these hemosiderin deposits,especially the blooming which is usually from microbleeds. I dont have a history of hypertension but might have been slightly hypertensive while entering a rapid detox for benzodiazepine's in which blood pressure can rise significantly,although I was controlled with Neurontin,phenobarbitol and clonidine for high blood pressure.

Thanks in advance for any additional info