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Neurology (Expert Forum)
Left Leg Weakness
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Left Leg Weakness
by Mark in Alaska, Jun 19, 2006 12:00AM
Over the past three years I have been experiencing diminished strenght in my left leg with burning pain on the outside of my thigh stopping at the knee and some inside thigh pain. I am a type II diabetic with 1ac's in the mid 6 range.
I cannot do a straight leg raise and have no strenght performing a "kicking" motion. I was an avid hiker and 3 to 8 miles with significant elevation gains have been part of my exercise routine since 1999.
In the last 8 months, I have lost the ability to walk more than 100 yards without leg weakness and pain, this is getting progressivly worse. Walking uphill seems to cause more problems. The discomfort comes after I exert my leg, a deep burn and ache.
I have had numerous tests including an MRI of my low back(L-3-4 disc desiccation, small centarl protrusion with evidence of an annual tear, l4-5, loss of disc space, central protrusion and small annual tear, l-5-s1 loss of disc space diffuse bulge w/o nerve root displacement from a 1998 injury).
A CT scan of my pelvic area, total bone scan, xray of my hip, EMG do not indicate any problems. I even had a ingunial hernia repair with the thought it was pressing against my femoral nerve and a laproscopic examination of my abdomen. I had a series of 3 epidural injections at the L4-5 level in Feb of 2006 w/o positive results.
I have the doctors in my community stumped and am being treated with nerve medications and narcotics. Can you shed any insight of what my next steps should be?
Thank you
I cannot do a straight leg raise and have no strenght performing a "kicking" motion. I was an avid hiker and 3 to 8 miles with significant elevation gains have been part of my exercise routine since 1999.
In the last 8 months, I have lost the ability to walk more than 100 yards without leg weakness and pain, this is getting progressivly worse. Walking uphill seems to cause more problems. The discomfort comes after I exert my leg, a deep burn and ache.
I have had numerous tests including an MRI of my low back(L-3-4 disc desiccation, small centarl protrusion with evidence of an annual tear, l4-5, loss of disc space, central protrusion and small annual tear, l-5-s1 loss of disc space diffuse bulge w/o nerve root displacement from a 1998 injury).
A CT scan of my pelvic area, total bone scan, xray of my hip, EMG do not indicate any problems. I even had a ingunial hernia repair with the thought it was pressing against my femoral nerve and a laproscopic examination of my abdomen. I had a series of 3 epidural injections at the L4-5 level in Feb of 2006 w/o positive results.
I have the doctors in my community stumped and am being treated with nerve medications and narcotics. Can you shed any insight of what my next steps should be?
Thank you
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jun 22, 2006 12:00AM
I cannot give you a clinical diagnosis over the internet unfortunately, as this site is purely educational
A pinched nerve or compressed nerve seems unlikely with your normal test results as above. Further things ot consider, escpecially as you re diabetic are a possible small stroke, or more likely a diabetic peripheral nerve complicaition. The neurological exam by a phsycian shoud be able to seperate between stroke or peripheral nerve
In diabetes, the peripheral nerve can be affected in a variety of ways - caused by diabetic related impairment of blood supply to the small peripheral nerves. There can be a peripheral sensory neuropathy, (you may be describign this as your inability to walk), a painful muscle conditon called amyotrophy, infarction of a single or multiple nerves (may be the cause of your weak quadrcupes muscle - supplied by the obturator nerve). Sensory loss on the outer thigh is usually from compression of the lateral cutaneous nerve of the thigh (also called 'meralgia paresthetica'), a quite common neuropathy usually from compression from tight clothes, weight los or gain etc.
For diabetc neuropathy, the treatment is good diabetci control to prevent further complications, and symptomatic treatent with nerve pain medications such as gabapentin or pregabalin.
Good luck
Poor blood supply to the legs ina diabetic can also affect the ability to walk (irrespective of a peripheral nerve problem).
A pinched nerve or compressed nerve seems unlikely with your normal test results as above. Further things ot consider, escpecially as you re diabetic are a possible small stroke, or more likely a diabetic peripheral nerve complicaition. The neurological exam by a phsycian shoud be able to seperate between stroke or peripheral nerve
In diabetes, the peripheral nerve can be affected in a variety of ways - caused by diabetic related impairment of blood supply to the small peripheral nerves. There can be a peripheral sensory neuropathy, (you may be describign this as your inability to walk), a painful muscle conditon called amyotrophy, infarction of a single or multiple nerves (may be the cause of your weak quadrcupes muscle - supplied by the obturator nerve). Sensory loss on the outer thigh is usually from compression of the lateral cutaneous nerve of the thigh (also called 'meralgia paresthetica'), a quite common neuropathy usually from compression from tight clothes, weight los or gain etc.
For diabetc neuropathy, the treatment is good diabetci control to prevent further complications, and symptomatic treatent with nerve pain medications such as gabapentin or pregabalin.
Good luck
Poor blood supply to the legs ina diabetic can also affect the ability to walk (irrespective of a peripheral nerve problem).
Also an MRI of my hip came back unremarkable.
Would I be suspect for diabetic complications with low 1AC's and a 3 year history with the disease? (I have glucose tests every year since 1995 and my elevated BG did not show up until 2003)
My bad does gine me a fit. Sore, stiff and spasms are common.
Thoughts?
My neurologist tells me it was (or is) a neurological stroke.I am in pain, and can't seem to find help.
I am open to any suggestions.