Current working hypothesis: Dynamic cord compression mistaken for FND
Christoff Trüter
Spousal caregiver
Over the years, along with various doctors, we have considered many hypotheses regarding my wife's medical condition, ranging from Parkinson's, Wilson's disease, Multiple Sclerosis (MS), hepatic encephalopathy, B12 deficiencies, CMT (Charcot-Marie-Tooth), and even, briefly, FND, until we realised how speculative such a diagnosis truly is (in essence, no diagnosis, MUS in sheep clothing).
Along the way, we collected extensive medical data: blood tests, MRIs (showing mild but progressing cervical stenosis over a period of 2 years), CT scans, recorded biokinetic data, and several operations, revealing conditions such as endometriosis (nodules removed) and nephrolithiasis (kidney stones).
Viewed in isolation, her blood tests mostly hover near reference ranges, however, over seven years they reveal subtle chronic inflammation and possibly unidentified autoimmune dysfunction.
Her progressing cervical stenosis, though deemed mild, has only been assessed using static imaging and should not be ignored.
Life is not lived statically, but dynamically, constantly in movement. Why, then, do we believe it is enough to view the spine only statically? What appears mild could behave very differently under movement, for example, how the spine responds to flexion and extension, which can be seen on a dynamic MRI.
A dynamic MRI captures images while a body part is in motion or under stress, allowing real-time assessment of structure and function rather than just static anatomy.
What makes this more intriguing is that my wife's symptoms can be mechanically triggered. For example, moving her neck in certain ways causes loss of dexterity in her fingers, and spinning her arms triggers facial asymmetry (the corner of her mouth pulling 30–45°). This was initially considered possibly MS-related, but when McDonald criteria were not met, it was dismissed as functional, yet it is clearly mechanical in nature.
Could her symptoms result from dynamic cord compression, causing spinal inflammation during daily life?
- Intermittent symptoms: Appear only in certain positions, so exams may seem normal.
- Variable severity: Symptoms may seem to fluctuate, mimicking FND patterns.
- Negative static imaging: Mild stenosis may seem insufficient to explain deficits when its dynamic nature is ignored.
- Overlooked mechanical triggers: Movement-induced symptoms can appear unpredictable if not assessed correctly.
- Subtle neurological signs: Position-dependent weakness or tremor may resemble and be mistaken for functional signs.
The next step is to find someone willing and able to perform a dynamic MRI.
