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Neurology (Expert Forum)
Polyneuropathy without identified cause
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Polyneuropathy without identified cause
by Bridget1, Mar 21, 2004 12:00AM
I'm a 36 y/o cauc female w/mult. symptoms but no unifying diagnosis. PMH incl. L5-S1 HNP and primary hypothyroidism (now euthyroid). s/s began 15 mo ago w/occas. "charley horses" of R calf at noc. Over next several mo, developed signif. fatigue and RLE paresthesias/pain (previously ['98] paresthesias in only LLE which responded to epid. steroids/rest) w/LBP/sciatica not responsive to phys. therapy/epid. steroids. MRI w/some narrowing/possible nerve compression-not enough to explain symptoms. LBP/sciatica resolved but paresthesias now in BLE. Cluster of new symptoms (3/03) seem temporally-related per neuro MD (includes new bilat ulnar paresthesias, 2 episodes of visual blurring lasting <24 hrs, LE sense of vibration/"wetness"/ heaviness/weakness, tripping over feet, myokymia in LEs, shock-like stabs in extrem./face/back). Now w/more new symptoms (transient episodes of chin/tongue numbness w/decr. taste, myokymia also in L face/UEs/back, burning band-like sensation in extremities/back, arm/leg intention tremor, arms heavy/weak/ decr. coord., feels like walking on thick material in shoes). Sometimes w/decr. hand fine motor skills. Have seen 2 neuro/1 rheum along w/extensive testing (brain/C-spine/L-spine MRI, EMG, somatosensory evoked potentials, serology all in fall '03) with no explanation. 1st brain MRI w/2 focal punctate areas w/incr. Flair signal in periatrial distrib-nonspecific-artifact? 2d MRI read normal for age. Tried Neurontin-d/c'd-excessive sedation. Now on Mirapex (RLS?) but no relief after almost 1 mo. MDs waiting for etiology to declare itself. Seeking insight.
Doctor's Answer
by CCF-Neuro-M.D.-CS, Mar 24, 2004 12:00AM
Your case is very complex, and it sounds like you have had a good evaluation. This does not sound like a peripheral neuropathy. Some of the symptoms could be consistent with RLS. Other disorders which may have been excluded include connective tissue diseases, B12 deficiency, or non-specific inflammatory disorders. What I would recommend is having a second opinion at a large academic medical center. Then can perhaps review what testing has been done and maybe recommend a few more. Good luck.
If you have risk factors you might want to get cjhecked for mercury intoxication. Risk factors: amalgam fillings, heavy fish-eater, possible home or work exposure.
Bloods often don't pick it up - check the net on mercury + chelators + urine test. Possible sx of mercury intox are incredibly varied, and all of yours could fit in.
Just a shot in the dark. I hope they figure it out for you.
-dave