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Neurology (Expert Forum)
Peripheral Neuropathy or not
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
Peripheral Neuropathy or not
by wjb, Feb 16, 2000 12:00AM
I had cervical neck surgery on 12/3/98 to repair a ruptured disk. Fusion (no hardware) at C6-C7 was performed. Left arm and triceps damage resulted from pressure on nerve. The surgery instantly relieved my pain and I feel it was a success. One notable complication from the surgery was my laryngeal nerve was stretched resulting in paralyzed right vocal fold. I could not speak above a whisper for 10 weeks. While still recovering and still suffering with a paralyzed vocal fold I had an emergency appendectomy in February 1999. A few weeks latter while recovering from both surgeries I noticed my right arm and hand would go numb while walking. This sensation quickly settled into my feet and has predominantly been there since then. Sensations include soreness in ankles and feet, pins and needles, numbness, and burning sensation. Occasionally these symptoms are in all extremities (hands and feet). My neurologist suggested Peripheral Neuropathy (PN)…but did not fully commit to this diagnosis. EMG performed and was negative. To rule out other causes my family doctor ordered a B-12 blood test and it was 188 pg/ml (expected range: 187—1059 mg/ml). He started me on B-12 injections and after a few months my B-12 blood level was 869 pg/ml. I can say I have improved since my B-12 injections. But I also was improving slowly prior to the B-12 therapy. My question: Do you think I have PN? Could the nerve damage that occurred to my left arm and laryngeal nerve cause or be related to the PN. Prior to surgery I had terrible posture (for years) and post surgery my posture has been corrected. Obviously my spinal canal has shifted (for the better) and could this be temporarily placing undo pressure on my spine thus causing PN. Finally, What about the B-12? It certainly was low and would be suspect. Thanks for your help.
Doctor's Answer
by CCF Neuro[P] MD, RPS, Feb 16, 2000 12:00AM
Dear WJB:
Low levels of vitamin B12 can cause a neuropathy. Your level was in the low range and this is one of the likely explanations for your problems. Certainly damage to the spinal column at C6 and C7 can cause a lower extremity problem, but usually it is spasticity (tight muscles) and the new onset R sided arm problems should not have been okay for awhile and then flaired. The EMG being normal is comforting that axonal loss or demyelination has occured. I think the logical explanation is the vitamin B12.
Sincerely,
CCF Neuro MD
Low levels of vitamin B12 can cause a neuropathy. Your level was in the low range and this is one of the likely explanations for your problems. Certainly damage to the spinal column at C6 and C7 can cause a lower extremity problem, but usually it is spasticity (tight muscles) and the new onset R sided arm problems should not have been okay for awhile and then flaired. The EMG being normal is comforting that axonal loss or demyelination has occured. I think the logical explanation is the vitamin B12.
Sincerely,
CCF Neuro MD
Thank you
PN is a peripheral neuropathy and not a central disorder. The EMG is used to detect peripheral disorders of nerves and muscle. MS is a central disorder of demyelination and does not affect the periperal nervous system myelination. An EMG would show an upper motor neuron disease of unclear origin.
I hope this helps.
CCF Neuro MD
Have you ever heard of Grover's disease ever being associated with neuropathy and MG? I would be thankful for any information you have to offer.
Thank you
Could you please tell me something about Grover's disease (?) I am not aware of this entity being associated with MG or neuropathy.
CCF Neuro MD
This is the only thing that I found on it. I developed this rash last year, which was a year into my neurological symptoms. It was just bx'd and dx'd last week.
Any thoughts on this would be helpful as my neurologist feels another autoimmune