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Neurology (Expert Forum)
HELP! Parasthesias, weakness, fatigue, fasciculations, imbalance since Aug. '06
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HELP! Parasthesias, weakness, fatigue, fasciculations, imbalance since Aug. '06
by 396SS, Jan 20, 2007 12:00AM
Aug '06, finishing degree, under stress. Sitting at computer, big toe going numb, burning, over weeks progressed to other foot, all toes & in months progressed to feet, calves, hands, wrists, forearms. Walking far made foot drag/numb
Hx: 31 yo F Scoliosis 21 deg. w/ spina bifida occulta in L5 and stenosis at L? - neck and back pain common. Was told degenerative disc disease by one Dr., another disagreed. Dry mouth starting Spring '06 - very uncomfortable. Insomnia/anxiety - Zoloft 25mg daily and Ativan 2mg to sleep (for about 1.5 years) but I am definitely not imagining this pain. MVP - mild with PVCs/Chest pain
Constant low blood pressure and low temp. - nurses always ask if I feel ok. 4 yrs ago had virus w/ high fever. As fever inc., so did vertigo sensation & tinnitus when changing gaze in any position. MRI & bloodwork neg. then - dizziness lasted 3/4 months and would send shock sensations w/ "electric" sounding tinnitus when changing gaze, finally subsided. ABR normal, ENG normal. Fam Hx: diabetes, Grave's disease, undiag. neuromuscular dis, rheumatoid arthr.
Now, calves tight, fasciculations all over, jaws weak/tight, fatigued, extremities weak, parasthesias, tremor, imbal
Neuro's workup now:
Labs - all norm, except increased IgG slightly
VEP - norm ABR - norm NCV - norm
MRI - one non-enhancing lesion at splenium of corpus callosum, "could be MS plaque" Compared 4 yo MRI w/ new - same lesion appears - missed on old MRI.
Neuro stumped - referring to rheumatologist for fibromyalgia or get spinal tap or 6 mo MRI? SCARED of what's wrong with me!
So tired
Hx: 31 yo F Scoliosis 21 deg. w/ spina bifida occulta in L5 and stenosis at L? - neck and back pain common. Was told degenerative disc disease by one Dr., another disagreed. Dry mouth starting Spring '06 - very uncomfortable. Insomnia/anxiety - Zoloft 25mg daily and Ativan 2mg to sleep (for about 1.5 years) but I am definitely not imagining this pain. MVP - mild with PVCs/Chest pain
Constant low blood pressure and low temp. - nurses always ask if I feel ok. 4 yrs ago had virus w/ high fever. As fever inc., so did vertigo sensation & tinnitus when changing gaze in any position. MRI & bloodwork neg. then - dizziness lasted 3/4 months and would send shock sensations w/ "electric" sounding tinnitus when changing gaze, finally subsided. ABR normal, ENG normal. Fam Hx: diabetes, Grave's disease, undiag. neuromuscular dis, rheumatoid arthr.
Now, calves tight, fasciculations all over, jaws weak/tight, fatigued, extremities weak, parasthesias, tremor, imbal
Neuro's workup now:
Labs - all norm, except increased IgG slightly
VEP - norm ABR - norm NCV - norm
MRI - one non-enhancing lesion at splenium of corpus callosum, "could be MS plaque" Compared 4 yo MRI w/ new - same lesion appears - missed on old MRI.
Neuro stumped - referring to rheumatologist for fibromyalgia or get spinal tap or 6 mo MRI? SCARED of what's wrong with me!
So tired
Doctor's Answer
by CCF-Neuro-M.D.-SH, Feb 11, 2007 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 that you describe are non-specific, and can be seen in a number of different problems. Given your story of multiple complaints in multiple different areas of the nervous system (without evidence of problems despite fairly extensive testing), my first thought is depression. Depression results in the amplification of minor pains and can even produce pain (that feels just like real pain) that would not otherwise be there. Depression also causes insomnia and fatigue. Some anti-depressants are better for pain than others (at least in clinical experience-no good trials) such as wellbutrin, effexor and possibly cymbalta. I would suggest that you discuss these options with a psychiatrist. That being said, I would recommend continuing to search for other causes as you start a trial on wellbutrin, etc. Many of the symptoms that you describe are found in patients with multiple sclerosis, but from all the symptoms that you describe I doubt that one questionable spot on your MRI could explain everything. I did not hear about a MRI of the cervical spine (I would suggest one with contrast if you have not had one), and/or a lumbar puncture (to look for inflammation, IgG index, Tourtelotte panel, oligoclonal bands, NMO antibody). I would also recommend an EMG given your history of weakness, numbness/tingling in your calves and fasiculations. An SSEP (somatosensory evoked potential) would be able to assess the role that the curvature of your spine may be playing.
I hope this has been helpful.
The symptoms that you describe are non-specific, and can be seen in a number of different problems. Given your story of multiple complaints in multiple different areas of the nervous system (without evidence of problems despite fairly extensive testing), my first thought is depression. Depression results in the amplification of minor pains and can even produce pain (that feels just like real pain) that would not otherwise be there. Depression also causes insomnia and fatigue. Some anti-depressants are better for pain than others (at least in clinical experience-no good trials) such as wellbutrin, effexor and possibly cymbalta. I would suggest that you discuss these options with a psychiatrist. That being said, I would recommend continuing to search for other causes as you start a trial on wellbutrin, etc. Many of the symptoms that you describe are found in patients with multiple sclerosis, but from all the symptoms that you describe I doubt that one questionable spot on your MRI could explain everything. I did not hear about a MRI of the cervical spine (I would suggest one with contrast if you have not had one), and/or a lumbar puncture (to look for inflammation, IgG index, Tourtelotte panel, oligoclonal bands, NMO antibody). I would also recommend an EMG given your history of weakness, numbness/tingling in your calves and fasiculations. An SSEP (somatosensory evoked potential) would be able to assess the role that the curvature of your spine may be playing.
I hope this has been helpful.
You should embark on a massive research project, specifically with your auto immune system and go to a facility that can do some in depth testing...
Yes, a spinal tap would be my highest priorty at this point also.
Good Luck!
I was wondering when you last had your EMG/NCV? If it has been more than, say, 4 months ago, you might want to do it again. My neurologist says that it doesn't take a long time for results to evolve (or devolve), and he also said that sometimes they don't read the results accurately -- scary though. I would get this somewhat painful test done at a place other than where you had it last just to make sure you are getting another opinion. My first EMG came back normal and then months later came back abnormal in the NCV part, showing slowing (peripheral neuropathy).
Hang in there. You aren't alone!
Good Luck, as there are a whole lot of us with many unexplained problems...