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Neurology (Expert Forum)
upper motor neuron signs- Desperate!
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upper motor neuron signs- Desperate!
by promethius, Jun 26, 2004 12:00AM
I have objective signs on exam of spastic legs, clonus in legs, increased muscle tone all over, and hyperreflexia. They are not really weak. Subjectively, the legs spasm, feel tight, tire easily, get sore, twitch, and feel strange to walk. This started no more than 2 weeks ago (though the inc. muscle tone was there 6 weeks ago) I also have parasthesias all over the body - arms, legs, face - tingling, burning, and numbness (started 6 weeks ago). Both brain and cervical and thoracic MRIs are normal. Symptoms seem to be progressing rapidly- my arms in the last day or two feel heavy and are hard to left and bend. During the night, the symtpoms are at their worst- i feel like i can't move very well, and hard to open mouth and open and close hands.
THE QUESTION IS: CAN THIS BE ANYTHING OTHER THAN SOMETHING SERIOUS AND PROGRESSIVE that will lead to paralysis and death? I know these are upper motor neuron signs, which I can't seem to find a benign cause for. I have also been worked up for B-12, which is at the high end of normal, and thyroid. SEd rate and white cell count have alsobeen normal so far. I think temp. is going up some now though to 99.4 basal. ANA is negative, as is RF and anti SS and DS DNA. I suspect an EMG is next, but i would still like to know from an outside source what some of the possible causes of upper motor neuron signs (along with the sensory signs). ALS usually doesn't give sensory signs that I know of. (I am a 43 year old female with a 10 year history of extreme fatigue, some elelvated body temp,and nightime myoclonus). Any info. greatly appreciated!
THE QUESTION IS: CAN THIS BE ANYTHING OTHER THAN SOMETHING SERIOUS AND PROGRESSIVE that will lead to paralysis and death? I know these are upper motor neuron signs, which I can't seem to find a benign cause for. I have also been worked up for B-12, which is at the high end of normal, and thyroid. SEd rate and white cell count have alsobeen normal so far. I think temp. is going up some now though to 99.4 basal. ANA is negative, as is RF and anti SS and DS DNA. I suspect an EMG is next, but i would still like to know from an outside source what some of the possible causes of upper motor neuron signs (along with the sensory signs). ALS usually doesn't give sensory signs that I know of. (I am a 43 year old female with a 10 year history of extreme fatigue, some elelvated body temp,and nightime myoclonus). Any info. greatly appreciated!
Doctor's Answer
by CCF-Neuro-M.D.-CS, Jun 30, 2004 12:00AM
Unfortunately, without speaking with you, and examining you I cannot determine if you have a progressive disorder. The majority of your symptoms seem to be within the arms and legs. Therefore a spnal MRI to exclude structural or inflmmatory changes is necessary. The other blood work to look for inflammation within the central nervous system is also useful. An EMG will be helpful to complete your evaluation, and then perhaps a spinal tap. The spinal fluid should be examined for inflammation and abnormal anti-bodies. If this is truely progressing over weeks, then perhaps an admission to the hospital to expedite the evaluation would be reasonable.
These symptoms due not sound like ALS or a similar disorder primary lateral sclerosis. In addition to the B12 level I would also consider checking a methyl malonic acid level and folate level. These can occasionally be abnormal with a normal B12 level. If you cannot receive answers with your current docotr, then a second opinion at a academic center would be reasonable. Wish I could be of more help, good luck.
These symptoms due not sound like ALS or a similar disorder primary lateral sclerosis. In addition to the B12 level I would also consider checking a methyl malonic acid level and folate level. These can occasionally be abnormal with a normal B12 level. If you cannot receive answers with your current docotr, then a second opinion at a academic center would be reasonable. Wish I could be of more help, good luck.
Your symptoms and mine are almost identical except I have had two MRI and EMG's, all of which were normal. I also have a hypersensitive nervous system. Please view the following posts from: Neurological symptoms due to stress or disease? - jrsoma 6/9/2004
A: neurological symptoms due to stress or disease? - CCF-Neuro-M.D.-CS 6/12/2004
I think you will find that you aren't the only one who is baffled by these confusing and worrying symptoms. I sometimes walk like I am drunk and stutter and stammer. The nights are the worse for the pain and tightness. We are wondering if our symptoms may be a result of a viral infection, allergies or some similar problem. I would like to correspond with you personally if you are interested.
***@****
Good luck and take care,
The Canadian
tim
Some people at least have an idea why they are having these symptoms, either due to surgery, a car accident, stroke or whatever. I don't have any clinical evidence, but suspect it is either my immune system and the time of my life (menopause) when I first became afflicted. The tingling in my lips and tongue and sometimes the scalp of my head is a new one this year. I can't convince anybody how this all makes me feel and the first thing they suspect is that you are depressed. I would rather endure the pain and stiffness, jolts and other weird symptoms then be doped up and in a fog, dizzier then normal in more ways then one!!! I know that some mild antidepressants are now being used to help in the treatment of pain, but I think more attention should be directed on finding the cause. Since I had foot drop in the fall of 2001, the sole of my foot has always been tender and sore. My fingers are numb and sore and at times it feels like needles are being stuck in and out of them. It is never ending so you don't get much relief. If your mother was in an accident previously I would hope that they request some new X-Rays or other types of tests to rule out those possibilities.
Good luck and please keep us updated. I usually check in this forum a few times a week and I am continually amazed at how many people like ourselves are still searching for answers.
Happy Canada Day and the Fourth of July for the USA.