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Neurology (Expert Forum)
West Nile Positive Worried about ALS
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West Nile Positive Worried about ALS
by jbedell, Nov 05, 2006 12:00AM
In spring I ran fever with eye strain, headache & numb tingling under my right cheek. In August I developed a twitch under my right eye & muscle tics & spasms all over my body (mostly in my thighs and chest).
I finally went to the doctor in mid-august with numb face & cramping muscle fatigue. Did an MRI which came back clean & bloodwork which turned up nothing except for an IGG positive test for West Nile. The IGM was negative.
Convinced it was the West Nile, my doctor sent me to a neurologist who ran an EMG and NCT on my legs which showed no abnormalities. He, too, figured West Nile or some virus of the CNS.
Slight numbness & tics all over my body (but was almost always present in my left shoulder and the right side of my face) until October, when all symptoms abated. After a week, the skin on my stomach & back was sensitive like it was sunburned. Then my left shoulder got really wonky (like it was asleep) with easy fatigue.
A week or so later, I got numbness in my lower & upper lips in the middle of my mouth up to the tip of my nose. I started having trouble saying some letter combinations because of dry mouth and thick tongue. This persists.
Dr. gave me lexapro for anxiety. First dose caused cramping first night & I noticed my voice was hoarse. I took only one dose.Since then I've had tremors all over constantly with muscle fatigue in left shoulder & forearm. Left thumb feels weak b/c of forearm fatigue. Shoulders & thighs feel weak b/c of constant tremors.
My question: Could the West Nile virus cause all of this? I'm terrified it's ALS related.
I finally went to the doctor in mid-august with numb face & cramping muscle fatigue. Did an MRI which came back clean & bloodwork which turned up nothing except for an IGG positive test for West Nile. The IGM was negative.
Convinced it was the West Nile, my doctor sent me to a neurologist who ran an EMG and NCT on my legs which showed no abnormalities. He, too, figured West Nile or some virus of the CNS.
Slight numbness & tics all over my body (but was almost always present in my left shoulder and the right side of my face) until October, when all symptoms abated. After a week, the skin on my stomach & back was sensitive like it was sunburned. Then my left shoulder got really wonky (like it was asleep) with easy fatigue.
A week or so later, I got numbness in my lower & upper lips in the middle of my mouth up to the tip of my nose. I started having trouble saying some letter combinations because of dry mouth and thick tongue. This persists.
Dr. gave me lexapro for anxiety. First dose caused cramping first night & I noticed my voice was hoarse. I took only one dose.Since then I've had tremors all over constantly with muscle fatigue in left shoulder & forearm. Left thumb feels weak b/c of forearm fatigue. Shoulders & thighs feel weak b/c of constant tremors.
My question: Could the West Nile virus cause all of this? I'm terrified it's ALS related.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Nov 14, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms you describe are not specific for any single disorder. There are several things that make me doubt West Nile Virus (WNV) as the cause. First, your serology (IGG positve for WNV) indicates exposure at some time in the past, and not an acute/current exposure (which would be IgM positive). Many people are exposed to WNV and do not develop any symptoms (80%). Of the people who develop symptoms, the most common is west nile fever assocaited with fever, fatigue, rash and lasts from 2-3 days up to several weeks. Rarely (1 person in 150) will develop more severe "neuro-invasive" disease in the form of west nile encephalitis (inflammation of the brain), west nile meningitis (inflammation of the covering of the brain) and/or west nile poliomyelitis (inflammation of the spinal cord). What does not make sense for west nile neuro-invasive disease is that your MRI (usually abnormal in WNV encephalitis) and EMG (usually abnormal in WNV poliomyelitis) were reported as normal. If you have not had a lumbar puncture then you should have one (usually abnormal in WNV meningitis). Your cerebrospinal fluid (CSF) can be sent for west nile serology and PCR for West nile DNA products. The most common CSF abnormalities are elevated WBC (mostly lymphocytes) and elevated protein. Your symptoms sound mostly sensory and sound more like lyme disease than WNV to me. Lyme patients can have abnormal brain SPECT scans that explain their symptoms even when their MRIs are normal/non-specific. I would ask your doctor about lyme, even if your tests are normal. Your symptoms do not sound like ALS. In summary, I would recommend a lumbar puncture, Brain SPECT scan and a repeat EMG (6 months form your first).
I hope this has been helpful.
The symptoms you describe are not specific for any single disorder. There are several things that make me doubt West Nile Virus (WNV) as the cause. First, your serology (IGG positve for WNV) indicates exposure at some time in the past, and not an acute/current exposure (which would be IgM positive). Many people are exposed to WNV and do not develop any symptoms (80%). Of the people who develop symptoms, the most common is west nile fever assocaited with fever, fatigue, rash and lasts from 2-3 days up to several weeks. Rarely (1 person in 150) will develop more severe "neuro-invasive" disease in the form of west nile encephalitis (inflammation of the brain), west nile meningitis (inflammation of the covering of the brain) and/or west nile poliomyelitis (inflammation of the spinal cord). What does not make sense for west nile neuro-invasive disease is that your MRI (usually abnormal in WNV encephalitis) and EMG (usually abnormal in WNV poliomyelitis) were reported as normal. If you have not had a lumbar puncture then you should have one (usually abnormal in WNV meningitis). Your cerebrospinal fluid (CSF) can be sent for west nile serology and PCR for West nile DNA products. The most common CSF abnormalities are elevated WBC (mostly lymphocytes) and elevated protein. Your symptoms sound mostly sensory and sound more like lyme disease than WNV to me. Lyme patients can have abnormal brain SPECT scans that explain their symptoms even when their MRIs are normal/non-specific. I would ask your doctor about lyme, even if your tests are normal. Your symptoms do not sound like ALS. In summary, I would recommend a lumbar puncture, Brain SPECT scan and a repeat EMG (6 months form your first).
I hope this has been helpful.
He told me today that clean tests on these areas would absolutely rule out ALS.
He seems to think all my symptoms are anxiety-driven (even in my speech issues) now.
For the physician answering these posts:
1) Can I be confident in my neurologist's opinion that clean EMGs on my legs in August and clean EMGs on the pending left arm/bulbar muscles signal no ALS even with some perceived difficulty speaking?
2)Could the West Nile IGG positive test have anything to do with the symptoms I've listed here and above?
Please help. I'm terribly afraid of the possibility of ALS.
I would have your doctor check your thyroid, vitamin B12, check you for Sjogren's, Lyme. But best of all, try to relax about ALS, you most likely don't have it -- trust your doctors.
Musculoskeletal System
Joint pain