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Neurology (Expert Forum)
Tingling and Numbness with Rapid Paralysis
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Tingling and Numbness with Rapid Paralysis
by DesperateFamily, Feb 15, 2006 12:00AM
My mother is 66 years old. She is a smoker with very high cholesterol. In November 2005 she began experiencing tingling in her left big toe and two fingers of her right hand. The tingling got rapidly worse. By Thanksgiving (3 weeks after first tingling) the tingling and muscle weakness had progressed up both legs and she was forced to use a walker. By Christmas, she was wheelchair bound and only able to make it from her chair to the toilet. By mid January she had absolutely no use of her legs or trunk area and had lost the use of her left arm. She still has complete feeling in all extremities but no muscle control and severe tingling(tingling even occurs in her trunk stomach area). She also has no pain just says that she feels extremely weak. She also says that she can actually feel the weakness coming up her body(a little more each day). We’ve had her to many doctors and even spent a week at the Mayo Clinic - Jacksonville(St Lukes) but still have no diagnosis. To date, the only thing that has come back abnormal is her B12 levels, EMG and nerve conduction study. Doctors also frequently comment on the fact that she has no reflexes left. The doctors finally started her on B12 injections three days ago(shots for 3 days and then once a month). As of yesterday, she had lost most of the use of her one remaining limb(her right arm). She is no longer able to feed herself, cough, sneeze or take a deep breath. Do you think that there is anyway a B12 deficiency could cause this severe or rapid progression? If so, could she expect to make a full recovery now that she is taking B12 injections? If not, do you have any suggestions for how we should proceed? As info the Mayo clinic has ruled out the following; GBS, Cancer, large blood vessel pressing against spine, problems in her spinal fluid or a genetic disease.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Feb 21, 2006 12:00AM
I cannot give you a formal clinical opinion as this forum is purely educational
Your mother obviously has a serious and progressive condition involving the peripheral nerves (as noted by the loss of reflexes)
B12 deficiency occurs very slowly over time, so it would be unusual to evolve so fast. It can cause pretty severe disability if untreated but the presentation with multifocal motor weakness is atypical. With B12 treatment some of the deficits may be reversible, depending on the severity and duration of nerve damage
Other things that come to mind are CIDP (chronic inflammatory demyelinating polyneuropathy, the chronic form of GBS) which causes predominantly motor weakness, is diagnosed by EMG/NCS, spinal fluid analysis and/or nerve biopsy.
Also, mononeuritis multiplex can rapidly affect one then multple nerves and has a variety of causes including vasculitis, diabetes, Lyme among others. Tests include various blood tests and/or a muscle or nerve biopsy.
Treatment is available for both conditions and consists of various forms of immunosuppression (ie steroids, cytoxan) as the dmaage is thought to be caused by the bodys own immune system.
One might also consider a paraneoplastic syndrome (as she is older and a smoker there may be an underlying cancer) or polymyositis (absent reflexes go against this but could occur in profound muscle weakness) or a rapid onset ALS type disease (caused by ALS itself or sometimes viruses like West Nile).
Ask your doctors whether these diagnosis have been considered.
Good luck
Your mother obviously has a serious and progressive condition involving the peripheral nerves (as noted by the loss of reflexes)
B12 deficiency occurs very slowly over time, so it would be unusual to evolve so fast. It can cause pretty severe disability if untreated but the presentation with multifocal motor weakness is atypical. With B12 treatment some of the deficits may be reversible, depending on the severity and duration of nerve damage
Other things that come to mind are CIDP (chronic inflammatory demyelinating polyneuropathy, the chronic form of GBS) which causes predominantly motor weakness, is diagnosed by EMG/NCS, spinal fluid analysis and/or nerve biopsy.
Also, mononeuritis multiplex can rapidly affect one then multple nerves and has a variety of causes including vasculitis, diabetes, Lyme among others. Tests include various blood tests and/or a muscle or nerve biopsy.
Treatment is available for both conditions and consists of various forms of immunosuppression (ie steroids, cytoxan) as the dmaage is thought to be caused by the bodys own immune system.
One might also consider a paraneoplastic syndrome (as she is older and a smoker there may be an underlying cancer) or polymyositis (absent reflexes go against this but could occur in profound muscle weakness) or a rapid onset ALS type disease (caused by ALS itself or sometimes viruses like West Nile).
Ask your doctors whether these diagnosis have been considered.
Good luck
Member Comments (41)
by abcsoup, Feb 15, 2006 12:00AM
Did the doctors say anything about ALS (Lou Gherig's disease)?
by flyin2006, Feb 15, 2006 12:00AM
Have your mother's doctors completed their testing?
by DesperateFamily, Feb 15, 2006 12:00AM
ALS has been ruled out. My parents have one final appt with the Doctors at Mayo Clinic this Friday to determine if there is anything else they can do.
by DesperateFamily, Feb 15, 2006 12:00AM
To: flyinnurse
My parents have one final appt with doctors at Mayo clinic this Friday. Currently, there are no pending tests.
by flyin2006, Feb 15, 2006 12:00AM
First thing that comes to mind is Myasthenia gravis. Did the doctors rule it out? I know this must be very scary for you and your family.
by fcar, Feb 15, 2006 12:00AM
Has your mom had any MRI's done??? What about thyroid testing. Some people dont know to ask for the T4 and the T levels (not sure exactly ) of the trhyoid gland. Some doctors only take a basic thryoid test and do not check the T levels of the thyroid. When the test is taken for just the regular thryoid test it can come back negative, but the T levels can come back showing a thryoid problem. I only know this because my sister had lots of problems they told her that her thryoid level was fine. She later went to an Endorcrinolgist who gave her further testing for thryoid specific blood work and it came back postive. She is now on medication and doing well. See if your mom had this done. Throid problems can cause havoc on a body.
by DesperateFamily, Feb 15, 2006 12:00AM
To: fcar
My mother has had many MRI's done especially to her spine. She has also had a brain scan, cat scan and bone scan. All results were normal. I will ask my father to mention the thyroid on Friday.
by DesperateFamily, Feb 15, 2006 12:00AM
To: flyinnurse
Myasthenia Gravis was ruled out and honestly the symptoms associated with that disease do not sound like my mothers. In fact, the disease that most describes her symptoms in guillain barre but Mayo says they tested her for that twice and both times it was neg. We are to the point now where we would like them to treat her for it just in case the tests were wrong. Have you ever heard of anyone having GBS but not testing positive for it? We are also going to ask the doctors to consider exploratory surgery to look at her spine just in case the many mri's and cat scans missed something. At the rate she is declining we are afraid she only has weeks left unless something is done quickly.
by flyin2006, Feb 16, 2006 12:00AM
Oh one more thing... ask yourself ( or her ) ..did she have any surgical procedures in the few weeks proceeding all the neuro symptoms? Did she cut herself working outside, maybe in the garden or on the house? Did she have any mild illnesses, like a the flu, gastrointestinal illness? Anything you can find to relay to her doctors is helpful.
by DesperateFamily, Feb 16, 2006 12:00AM
To: flyinnurse
We are trying to get an appointment at Shands(university of Florida) which is close to where she lives but have not been accepted yet. Someone also mentioned Acute Transverse Myelitis as a possible cause. Do you know anything about this disorder?
by flyin2006, Feb 16, 2006 12:00AM
I don't know that I would wait for an acceptance. I think I would just probably show up on their doorstep!! As for Acute Transverse Myelitis, I have no idea. Whatever it is, it sure has progressed rather quickly. Have the B-12 shots helped yet? And don't forget to dissect her history ( even bug bites ) the few weeks before this all began. That is very important. ( See above ) Hang in there.
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