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Neurology (Expert Forum)
Sore legs, unsteady gait
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Sore legs, unsteady gait
by wobblyboots, Apr 06, 2007 12:00AM
Hi,
I am a 47-year-old male. About three months ago I started getting heart palpitations. A day or so later I began to get a very strangetingling sensation right through the thighs. After another day I developed a flu which went within a few days. The sensation in my legs made it impossible to sit down for long. My hands and legs started "falling asleep" very easily and I then became very dizzy and unbalanced. At times my legs felt like they just wouldn't support me and that sensation has continued. I have real problems keeping balance, get intense tingling at the top of the spine and very sore knees and ankles. I've had mild soreness of both eyes and symptoms get worse when I get tired. At times the sensations are so bad I can barely sit on a chair or I can't walk. Sometimes I also get a very unpleasant "brain fog" when I find it hard to speak or think clearly. My GP ran tests for anemia, EDR, thyroid, diabetes and all were normal. A halter monitor showed atrial and ventricular ectopics but an examination by the cardilogist said my heart was fine. Blood pressure also ok. The neurologist ruled out "any underlying neurological condition such as MS" and told me he was so sure it wasn't MS he wouldn't order an MRI at this stage because there were no clues at all on examination. He maintains I am highly stressed and also hyperventilating. But these symptoms are so pronounced I have trouble accepting that diagnosis. My GP is also sceptical and thinks MS may be the cuplrit. All of these symptoms come and go throughout the day at various levels of intensity. Heat does not seem to effect them and there are times when I feel almost normal - exercise helps a little. I've started a new job but am having real trouble hiding the symptoms from my boss and doing it properly. Could stress actually cause such dramatic symptoms over such a long period of time or should I see another neurologist? Anything you can offer would be really appreciated - this is wearing me down terribly. Thank-you so much.
I am a 47-year-old male. About three months ago I started getting heart palpitations. A day or so later I began to get a very strangetingling sensation right through the thighs. After another day I developed a flu which went within a few days. The sensation in my legs made it impossible to sit down for long. My hands and legs started "falling asleep" very easily and I then became very dizzy and unbalanced. At times my legs felt like they just wouldn't support me and that sensation has continued. I have real problems keeping balance, get intense tingling at the top of the spine and very sore knees and ankles. I've had mild soreness of both eyes and symptoms get worse when I get tired. At times the sensations are so bad I can barely sit on a chair or I can't walk. Sometimes I also get a very unpleasant "brain fog" when I find it hard to speak or think clearly. My GP ran tests for anemia, EDR, thyroid, diabetes and all were normal. A halter monitor showed atrial and ventricular ectopics but an examination by the cardilogist said my heart was fine. Blood pressure also ok. The neurologist ruled out "any underlying neurological condition such as MS" and told me he was so sure it wasn't MS he wouldn't order an MRI at this stage because there were no clues at all on examination. He maintains I am highly stressed and also hyperventilating. But these symptoms are so pronounced I have trouble accepting that diagnosis. My GP is also sceptical and thinks MS may be the cuplrit. All of these symptoms come and go throughout the day at various levels of intensity. Heat does not seem to effect them and there are times when I feel almost normal - exercise helps a little. I've started a new job but am having real trouble hiding the symptoms from my boss and doing it properly. Could stress actually cause such dramatic symptoms over such a long period of time or should I see another neurologist? Anything you can offer would be really appreciated - this is wearing me down terribly. Thank-you so much.
Doctor's Answer
by Forum-M.D.-SH, Apr 24, 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, but could be symptoms of multiple sclerosis (MS). MS causes inflammation and damage to certain areas of the covering/insulation (myelin) in the wiring (axons/white matter) of the brain and spinal cord. When a particular area is affected then the symptoms coresponding to that area of the brain are felt by the person, these symptoms may be numbness/tingling, weaknes, blurred vision, problems thinking, dizziness/vertigo, etc or may be nothing at all (many MS lesions occur and the patient is unaware until the MRI is done. One characteristic (at least early on) is that MS lesions tend to come on subacutely over 2-3 days and then last for 1-4 weeks then improve spontaneously (many times they disappear entirely). In some cases when the symptoms are very severe, then MS patients can take IV steroids for several days to shorten the time of the symptoms. That being said there are many diseases that mimic MS, such as lyme disease, vitamin deficiencies, PML, white matter strokes/vasculitis, etc. It is also true that stress and a disorder call conversion disorder (a psychological diagnosis) can also lead to these type symptoms. The problem with diagnosing stress is that there is not tests for this, only clinical impression and exclusion of other diseases. It sounds like you have had the basic blood work done. I would stronlgy suggest that you get an MRI of the brain and cervical spine with contrast. If this is negative, it will be unlikely that you have MS and you can move ahead with psychological treatments. If the MRI demonstrates MS then you can move ahead with disease modifying therapy (Rebif, copaxone, steroids, etc). The one thing that is clear is that the spells need to stop and you require additional testing to know which path to go down. If the MRI is negative and MS is still suspected then a lumbar puncture looking for inflammation (IgG index, oligoclonal bands) and visual evoked potentials might be helpful. I would suggest that you take your case to a neurologist that specializes in MS (such as at a MS center) and allow then to order/interpret your MRI and set up further care.
I hope this has been helpful.
The symptoms that you describe are non-specific, but could be symptoms of multiple sclerosis (MS). MS causes inflammation and damage to certain areas of the covering/insulation (myelin) in the wiring (axons/white matter) of the brain and spinal cord. When a particular area is affected then the symptoms coresponding to that area of the brain are felt by the person, these symptoms may be numbness/tingling, weaknes, blurred vision, problems thinking, dizziness/vertigo, etc or may be nothing at all (many MS lesions occur and the patient is unaware until the MRI is done. One characteristic (at least early on) is that MS lesions tend to come on subacutely over 2-3 days and then last for 1-4 weeks then improve spontaneously (many times they disappear entirely). In some cases when the symptoms are very severe, then MS patients can take IV steroids for several days to shorten the time of the symptoms. That being said there are many diseases that mimic MS, such as lyme disease, vitamin deficiencies, PML, white matter strokes/vasculitis, etc. It is also true that stress and a disorder call conversion disorder (a psychological diagnosis) can also lead to these type symptoms. The problem with diagnosing stress is that there is not tests for this, only clinical impression and exclusion of other diseases. It sounds like you have had the basic blood work done. I would stronlgy suggest that you get an MRI of the brain and cervical spine with contrast. If this is negative, it will be unlikely that you have MS and you can move ahead with psychological treatments. If the MRI demonstrates MS then you can move ahead with disease modifying therapy (Rebif, copaxone, steroids, etc). The one thing that is clear is that the spells need to stop and you require additional testing to know which path to go down. If the MRI is negative and MS is still suspected then a lumbar puncture looking for inflammation (IgG index, oligoclonal bands) and visual evoked potentials might be helpful. I would suggest that you take your case to a neurologist that specializes in MS (such as at a MS center) and allow then to order/interpret your MRI and set up further care.
I hope this has been helpful.
Thanks for your thoughts. I really appreciate it. The worst thing about this is that I keep wondering if I'm going crazy! I've been very healthy all my life and was a regular gym goer and swimmer until this happened. I certainly didn't feel stressed -- until now. Of course not knowing exactly what it is doesn't help either. I should have mentioned that they sent me for a CT scan of the brain and spine which showed up clean. It wasn't looking for MS clues, rather ruling out tumours, strokes, herniated discs and the like. But you're right about the anti-depressants. I said I won't take them until I know everything else had been ruled out. Even then I'd rather exercise than take them. Your problems sound horrific but I'm really glad you were able to get them sorted out. I'll give the exercise and breathing thing a month or two but if this keeps up I'll take your advice and be demanding an MRI and a second opinion. I've also started seeing an osteopath who thinks he can do some good ... we'll see I guess. I obviously hope the neurologist is right of course, but I just can't seem to accept that stress alone could give me such severe symptoms. Anyway, thanks again for your help and interest. It's really nice to know people do care.
Cheers!
You may want to read my posting regarding the "pain in my legs I can barely walk" I feel like the tinman at times due to the strange sensations in my legs (mainly my thighs) along with pain in both knees and ankles. I was in a wheelchair for 7 months due to this and was told I have a post viral syndrome which was precipitated by a flu like upper respiratory virus, and a low B12 level. The numbness, tingling and stiffness coupled with weakness are very difficult to work with. I think you may have a mild case of this.