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Neurology  (Expert Forum)
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What could this be?
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MedHelp Member's Question

What could this be?

by zelch, Feb 14, 2003 12:00AM
About 2 months ago, I developed what seemed to be weakness in my left leg after a period of lower back pain.  The weakness quickly spread to my other leg and both arms, I guess you could say proximal weakness.  I also developed fasciculations (visible twitching), mainly in my arms and legs, occasionally in other places.  My doctor ordered an lumbar MRI which showed some mild degeneration and a slight bulge but no herniated disk.  He sent me to a neurologist who performed an EMG on my left leg and in a few spots on my right leg, that was completely normal (nerve conduction study was also normal).  The exam was also normal,  this was the first week in January.  My symptoms seemed to improve a bit after that but not for long, they got worse again.  I should also mention that I have expierienced pain in my legs and arms, sometimes in my joints.  My hands and feet also ache occasionally.  Throughout this 8 week period, I have had a significant amount of lower back pain as well.  I am not sure what to make of all this, I am still concerned about ALS or MS or even Lyme disease.  There doesn't seem to be any serious loss of muscle strength, just extreme muscle fatigue.  Especially when going up stairs.  If you could provide some insight as to what I should do, and what this could be, I would be greatly appreciated.
Doctor's Answer

by CCF-Neuro-M.D.-JT, Feb 18, 2003 12:00AM
In the setting of a normal neuro exam and EMG, ALS would be unlikely as there should have been something seen on the exam or EMG. Doesn't sound like Lyme, and not sure about MS.  Although your symptoms aren't typical of MS, this disease can present in a number of ways and I do not know enough about your personal history or exam to make the call.  Routine laboratory tests that may be helpful include blood work to look at muscle enzymes such as CK and aldolase, inflammatory markers such as sed rate and C-reactive protein, thyroid studies, complete blood count and an electrolyte panel.  If rheumatological problems are suspected (depending on your full clinical history and exam) then an autoimmune panel may be helpful.  If symptoms get worse, return to the neurologist or consider a second opinion at a major academic hospital. Good luck.
Member Comments (12)

by Numb-in-FL, Feb 14, 2003 12:00AM
To: zelch - everyone
Zelch,



I felt like I was reading my own story.  I have experienced very similar circumstances.  My numbness and weakness began in my upper right arm and moved to my right hand.  Tried Chrio Adjustments and Massage therapy. Primary Care Physician (PCP) thought maybe Carpal Tunnel, but then symptoms worsened, added weakness in the right leg, and a sharp, electrical feeling in my back, arm, and (sometimes) leg when I tilt my chin to my chest.  Less weakness in legs now, but constant tingling, and real fatigue in my arm - especially my right one.  10 minutes of scrubbing, lifting etc and I am in severe pain and my arm just aches.    Pain meds help some, but do not take away the achiness.  Burning sensations in upper back and wrist.  I have always been quite active, and had a lot of stamina.   F, 35 YO, Non-Smoker, Social Drinker, Regular BP, other general stats OK.



Do you have any increased symptoms when you lean on your arms, or prop your leg up?  Mine occurs in the joint area up from the pressure.  When using the mouse its in my wrist, if i lean down on my desk with my arms, in my shoulder.



Brain MRI - radiologist report came back "unremarkable", but I have had my first visit to NeuroScience Lab here, the Nurse Practioner disagrees with the radiology report, and based on Neuro Exam, films and symptomalogy (sp?) is thinking MS.  



They drew blood (9 tubes) and I believe they will run blood tests for:



Something Viral,  Lyme,  B12 or B6 deficiency,  Lupus,   MS,  Thyroid.  



Conducting a VER (Visual Evoked Response) to determine the time it takes for my brain to register the object my eyes see.



Possible Cervical Spine MRI (to rule out pinched nerve)



I do have a lower herniated disc, but not having leg pain - or low back pain, only weakness, numb spots and some burning.



I would appreciate following along with your case, too.  To see if there are other similarities.  I will post more as I learn more.



Best of Luck and Healthy Days Ahead.

by zelch, Feb 14, 2003 12:00AM
Yes, my symptoms are very similar to yours.  I also have some numbness and tingling, mostly stiffness and pain in my legs.  Strangly enough, I am still able to lift the same amount with my legs (I tested myself).  So I don't think there is any true weakness there, but there is certainly fatigue, in some cases it's been extreme.  Putting my legs up does seem to make it worse, especially for long periods of time.  I did have a lower lumbar MRI which was unremarkable.  My doc also said lumbar MRI's can detect MS.  My neurological exam was also normal.  I think your disk herniation could explain some of your symptoms, but certainly not all of them.  Have you had an EMG yet?  Do you also have fasciculations (muscle twitching)?  



My joints also ache from time to time, especially in my right arm and knee (front and back of the knee).  The only symptom I can't relate to is the electrical sensations, but I do get occasional burning in my arms.  One possibility I have considered is Fibromyalgia.

by Numb-in-FL, Feb 14, 2003 12:00AM
Muscle fasciculations - I believe that is a YES answer.  I can be sitting and my arm or shoulders just toss themselves.  Last night was the first time it happened in my legs.



I definitely have decreased strength and capability in my arms.  My legs don't tire from walking, they seem ok, but go weak for moments... as if they were "weak knees" and give out - but again, only momentarily.



By the way, my symptoms have been going on about 2 months, too.  Before these symptoms began, the only other thing I have noticed is that I have taken several severe falls this year, and about 2 weeks before I noticed the numb spots, I was having severe itching spells, as if I had been bug bitten, first on an arm, then a leg, then it would go away for a few hours.  But no bug bite, no change in soaps, no change in detergent.



I feel like I am losing my capacity to function in many ways.



They have not ruled out carpal tunnel, but put it to the side in light of the other symptoms.



The neurologist seems to think that the herniated disc, because I can lift my legs with out any pain in my leg or back, is not playing a part in this.



THANKS and lets keep the ideas flowing.  I do appreciate it.  I have been trying to post an original question for about 3 weeks, and hadn't had any luck.   When I saw your post, it was so very close to my symptoms, I just had to reply.  



THANK YOU!



Mich

by carrots, Feb 15, 2003 12:00AM
I underwent surgery on the 12th of november 2002.The procedure performed was a L5/S1 posterior   lumbar interbody fusion with accompanying alar transverse fusion. The instrumentation utilised were BRANTIGAN CARBON

CAGES for the interbody fusion and posterior instrumentation was performed utilising bone screws and rods in the MOSS MIAMI SYSTEM.A bone graft was harvested from my left hip. I seem to have had a great recovery with almost no pain within 4 weeks of surgery