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Undiagnosed Symptoms (Expert Forum)
Extreme fatigue, memory problems, and clumsiness
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Undiagnosed Symptoms forum are answered by Dr. Kevin Pho. Topics covered include breathing difficulties, feeling cold, cough, diarrhea, dizziness, fainting, fever, indigestion, itching, nausea, numbness, pain (chronic), paralysis, rash, sweating, swelling, urination problems, and vomiting.
Extreme fatigue, memory problems, and clumsiness
by gromit12, Apr 17, 2007 12:00AM
I’ve been having unexplained symptoms for over a year. Took antidepressants from March 05-June 06 (Zoloft 50mg, then Celexa10mg, then Lexapro 5mg) but I stopped taking them due to side effects (slurred speech,memory problems,constant drowsy sleepy groggy sedated feeling,difficult time waking up,clumsiness). I didn’t have any of these symptoms before the antidepressants. The symptoms were very frequent when I was on the antidepressants but now they have subsided and happen when I’m fatigued,tired, or waking up. Waking up did not used to be difficult for me. Symptoms: clumsiness,dizziness with sudden head movements,can’t get a good grip/drop things,(it’s like my hands have a mind of their own/there is some kind of disconnect),memory/concentration problems (brain fog),can’t wake up, unrefreshing sleep,very fatigued, come home from work exhausted,increase in severity,duration,& frequency of migraine headaches. I take Maxalt 10 mg for migraines which doesn’t always work. I take no other medications. I go to bed at 9 or 10 & get up at 5:30. I sleep in until about 7 on the weekends. I used to have some insomnia but this hardly happens now. I’m so tired I usually fall right asleep & don’t wake up in the middle of the night. My maternal grandmother had chronic progressive MS. Occasional heart palps which increase w/stress. Nocturnal Polysomnogram: Sleep efficiency was 69.1%Stage 1 sleep 7.1% Stage 2 sleep 55.3% Stage 3 sleep 8.7% Stage 4 sleep 0% REM sleep 28.9% Total sleep time 329 minutes Non REM sleep was 240.5 minutes REM sleep time was 95 minutes Latency to persistent sleep was 17 minutes Latency to REM sleep was 162 minutes Multiple Sleep Latency Test-I could not fall asleep at all during any of the nap periods although I was tired and yawning throughout the day. I’m 43 female,about 50 lbs overweight,and don’t smoke or drink. All negative—MRI,spinal MRI,blood tests,visual evoked potentials,EEG. B12 & iron were low but not deficient. What might be causing my symptoms?
Doctor's Answer
by Kevin Pho, MD, Apr 18, 2007 12:00AM
, Apr 18, 2007 12:00AM
You have had a comprehensive evaluation for your symptoms. I agree with the testing thus far, including the imaging tests and neurological studies.
Further testing can include looking at the blood count, metabolic panel, liver panel, thyroid function, ANA level (looking for rheumatologic disease), rheumatoid factor (looking for rheumatoid arthritis), and a test for mononucleosis.
With the dizziness, I agree with the neurological workup. The MRI was negative. You can consider looking at the carotid arteries with an MRI or ultrasound. This should be discussed in conjunction with a neurologist, or a second neurological opinion.
If the tests continue to be non-revealing, I would consider a referral to a rheumatologist - which various diseases in this area can lead to your symptoms. As mentioned above, an ANA and rheumatoid factor would be a reasonable place to start.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Further testing can include looking at the blood count, metabolic panel, liver panel, thyroid function, ANA level (looking for rheumatologic disease), rheumatoid factor (looking for rheumatoid arthritis), and a test for mononucleosis.
With the dizziness, I agree with the neurological workup. The MRI was negative. You can consider looking at the carotid arteries with an MRI or ultrasound. This should be discussed in conjunction with a neurologist, or a second neurological opinion.
If the tests continue to be non-revealing, I would consider a referral to a rheumatologist - which various diseases in this area can lead to your symptoms. As mentioned above, an ANA and rheumatoid factor would be a reasonable place to start.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Hi,
If all of your tests are negative, then I would consider speaking with your physician(s) about CFS.
Good luck !