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Neurology (Expert Forum)
arm/leg pain
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
arm/leg pain
by stss, May 22, 2005 12:00AM
For almost 4 months, I've had sharp, burning pain and unpleasant shivery sensations starting at my butt and going down both outer/back thighs. It's unbearable to sit -- my entire sitting area burns, and there's a gnawing pain almost in my pelvic area. My legs feel heavy and shaky. Two months ago, I also started having burning pain and hypersensitivity in my neck and shoulders, as well as from both elbows to my fingers (esp. the pinky and ring fingers). My finger movements are shaky and jerky, and it's difficult to hold them straight. My arms feel weaker. I also started having some discomfort -- jerking, twitching, clicking -- in my jaw area. When I talk, it feels like after I've had a filling -- a bit tingly and stiff. I've had urinalysis, blood tests (CBC, CPK, thyroid, calcium, blood sugar, ANA, ESR, RF, B12, folate, syphillis, HIV), spinal x-rays, and a lumbar/cervical/brain MRI. All normal except CPK, which was slightly elevated (206). The neurologist said she doesn't think I have a neurological problem because I hadn't lost my reflexes (she tried to convince me it was muscle pain). But she agreed to test me for Lyme (at my insistence -- she said it's unlikely since I don't have meningitis) and send me for an EMG. I'm a female, age 30, in excellent health prior to this -- no history of illness or injuries.
Questions:
1. Given all the negative test results, what possibilities remain? Is my neurologist right, or is Lyme a possibility? Are there other infectious diseases that can cause these problems?
(Please see below ...)
Questions:
1. Given all the negative test results, what possibilities remain? Is my neurologist right, or is Lyme a possibility? Are there other infectious diseases that can cause these problems?
(Please see below ...)
Doctor's Answer
by CCF-Neuro-M.D.-PW, May 25, 2005 12:00AM
The localzation of your symptoms to one area of the nervous system is difficult. An abnormality inside the spinal cord in the neck, such as with a syrinx (hollow cavity within the spinal cord) or tumor, can give you that pattern of sensory abnormality - in a cape distribution over the neck and shoulders, and proximal lower extremities. This would be seen on an MRI though, and you seem to hve had this done
Although not a typical distribution, a small fiber neuropathy (disease of the very small sensory nerves) can give similar type symptoms - the causes are usually diabetes or pre-diabetes, or amyloid. A much rarer cause might be a sensory ganglionopathy of the ganglion sensory relay station beside the spinal cord - this is unlikely though and an EMG may be helpfeul in ruling this out. Otherwise an EMG is unlikely to be helpful in the setting of pain symptoms only. Other causes of radiculoneuropathy (nerve roots) shoudl be looked for as they are doing - Lyme, diabetes, viral infections. If everything is still negative the only other ivestigation that might help woul be a skin or nerve biopsy looking for inflammation and/or nerve structure changes
Good luck
Although not a typical distribution, a small fiber neuropathy (disease of the very small sensory nerves) can give similar type symptoms - the causes are usually diabetes or pre-diabetes, or amyloid. A much rarer cause might be a sensory ganglionopathy of the ganglion sensory relay station beside the spinal cord - this is unlikely though and an EMG may be helpfeul in ruling this out. Otherwise an EMG is unlikely to be helpful in the setting of pain symptoms only. Other causes of radiculoneuropathy (nerve roots) shoudl be looked for as they are doing - Lyme, diabetes, viral infections. If everything is still negative the only other ivestigation that might help woul be a skin or nerve biopsy looking for inflammation and/or nerve structure changes
Good luck
2. If I get a normal EMG, does this rule out a nerve problem? Or should I insist on further testing (e.g., spinal tap)?
3. Would the Lyme test I had detect the European versions of Lyme? (I spent time hiking and gardening in Europe last summer.)
Thank you!!!