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Neurology (Expert Forum)
hand clawing and right side muscle weakness
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hand clawing and right side muscle weakness
by jc80, Apr 08, 2007 12:00AM
26 yo female. For the last 3 years I've had progressive hand clawing in my right hand. I am right handed. It started in my pinky and has included my ring finger now. I have decreased muscle mass on my hand,wrist,forearm. Tried several dr's, many don't know or don't believe me. Most recent dr noticed decreased strength in my right ankle as well, I cannont flex my right foot for very long or very high. Other problems maybe related or not: chronic constipation, decreased feeling but not numbness in right finger tips and toes. Sometimes I feel "cold splashes of water" like a spray bottle of cold water on my legs. Sometimes on front of thighs, sometimes on back. Not pins and needles, but just brief feeling of cold water spray. I have a slight right hand tremor. I also get leg muscle pain sometimes, and sometimes I have leg problems that are not painful. I describe that as "walking through water" where its exerting and difficult to walk foward, usually lasts entire day when it happens.
Neurologist says I have hyper-reflexes. My most troubling problem is the hand weakness and clawing and tremor as I am right handed and interferes w/ my job. He ordered MRI of head and neck that was normal. EMG was normal. No family hx of neuro probs except great-grandmother had parkinsons at old age and both her brothers had it at a young age. Great aunt has MS. Does anyone have any idea what this could be?
Neurologist says I have hyper-reflexes. My most troubling problem is the hand weakness and clawing and tremor as I am right handed and interferes w/ my job. He ordered MRI of head and neck that was normal. EMG was normal. No family hx of neuro probs except great-grandmother had parkinsons at old age and both her brothers had it at a young age. Great aunt has MS. Does anyone have any idea what this could be?
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 and you have had some good tests already to evaluate for the most obvious potential causes. Several diseases/categories that I did not see represented are seizures/epilepsy, vasculitis and Wilson's disease.
There is a category of epilepsy called Rasmussen's encephalitis that is more common in children, but can have adult onset as well. This disorder causes focal seizures that affect one side of the body and at first the symptoms can be strange with twitches/tremor, weakness, and sensation changes that can evolve into more recognizable seizures, speech problems and problems thinking/memory. In the later stages this condition will show up on the MRI and white matter changes afecting one side only and atrophy of one side of the brain (the left in your case would give you right body symptoms), but early on in the disease the MRI is often interpreted as normal. I would suggest an EEG of the brain (brain wave test) to look for seizure activity that is sleep deprived (to make sure you sleep during part of the test-this makes the test more sensitive).
Another possibility is vasculitis (or inflammation of the blood vessels in the brain). This could be caused by many different things, and we often do not find a cause. Many patients with advanced vasculitis have strokes that show up on their MRI, but it may be negative early on. To look for vasculitis a cerebral angiogram should be done (it is like a heart cath, but they will squirt dye into the arteries of your brain to look for narrowing, etc).
Finally Wilson's disease is a disorder of Copper metabolism that allows copper to build up in many different organs, including the brain. These patients often present with depression/psych disturbances and are found to have tremor and ataxia. Testing for this rare disorder involves a simple blood test for ceruloplasmin and copper as well as liver function tests.
It is very frusterating to patients with disabling problems to go through many tests and have them come back 'normal'. Many times after you have exhausted the tests that your doctor knows or cares to order, it is time to go to major academic center and to have your case reviewed by an expert in the field that can provide further guidance.
I hope this has been helpful.
The symptoms that you describe are non-specific and you have had some good tests already to evaluate for the most obvious potential causes. Several diseases/categories that I did not see represented are seizures/epilepsy, vasculitis and Wilson's disease.
There is a category of epilepsy called Rasmussen's encephalitis that is more common in children, but can have adult onset as well. This disorder causes focal seizures that affect one side of the body and at first the symptoms can be strange with twitches/tremor, weakness, and sensation changes that can evolve into more recognizable seizures, speech problems and problems thinking/memory. In the later stages this condition will show up on the MRI and white matter changes afecting one side only and atrophy of one side of the brain (the left in your case would give you right body symptoms), but early on in the disease the MRI is often interpreted as normal. I would suggest an EEG of the brain (brain wave test) to look for seizure activity that is sleep deprived (to make sure you sleep during part of the test-this makes the test more sensitive).
Another possibility is vasculitis (or inflammation of the blood vessels in the brain). This could be caused by many different things, and we often do not find a cause. Many patients with advanced vasculitis have strokes that show up on their MRI, but it may be negative early on. To look for vasculitis a cerebral angiogram should be done (it is like a heart cath, but they will squirt dye into the arteries of your brain to look for narrowing, etc).
Finally Wilson's disease is a disorder of Copper metabolism that allows copper to build up in many different organs, including the brain. These patients often present with depression/psych disturbances and are found to have tremor and ataxia. Testing for this rare disorder involves a simple blood test for ceruloplasmin and copper as well as liver function tests.
It is very frusterating to patients with disabling problems to go through many tests and have them come back 'normal'. Many times after you have exhausted the tests that your doctor knows or cares to order, it is time to go to major academic center and to have your case reviewed by an expert in the field that can provide further guidance.
I hope this has been helpful.
The important thing to remember: just because a dr. discounts you or doesnt know an answer, does not mean nothing is wrong; it means they don't know the answer or the symptoms. You must be your own advocate. Good luck!!
From a diagnosis standpoint - its certainly odd what you describe, however do not take a normal MRI to necessarily mean just that. In my experience sometimes things are missed, it happened to me last year. A pineal gland tumor was seen on CAT scan and not reported, brain MRI was reported as clear but I had no contrast, then when my symptoms worsened, they did a repeat MRI again no contrast, they saw the tumor and it was reported, then they did a recheck of me and added contrast to the MRI, 6mths later and once again they saw the tumor (not grown thankfully) but with the contrast they also saw that one of my carotid arteries (fairly essential for good brain function :-) was twisted. My EMGs have also been normal, but I have definitive heart, lung and adrenal disease, that has shown in bloodwork and formal testing. For a time I had some what I called a sensation of cold air conditioning on my scalp and when my adrenals are really bad, I seem to walk through mud, its hard to walk and stay upright and I am completely and utterly fatigued.
Have you seen a rheumatologist? They are often good at tracking down other reasons like Lupus or immunological probs that can cause things like you describe. You could also request a muscle biopsy and make sure they take a really good look at your bloodwork. The rheumatologist I saw was helpful but did not come up with anything new ideas, but one Dr did wonder if I had inclusion body myositis (there is a milder version called polymyositis) from the history and the test results he reviewed, which you may want to look up. I have so far refused a muscle biopsy, its only useful really if you have acute symptoms, but bloodwork for muscle enzyme levels can help establish if its a useful idea or not. If they are elevated (mine were but then dropped back to normal) by the time a muscle biopsy was suggested. I am seeking my third opinion in NY in two wks time and its 17mths since my acute symptoms.
I hope that helps, and please don't give up, its miserable when you have no answers and are suffering.
GL and maybe those are some new ideas to consider.
Fiona