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Neurology (Expert Forum)
Acute onset sensory symptoms
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Acute onset sensory symptoms
by Anya9821, Jun 22, 2009 09:07AM
I am a 38 yo female. 5-6 wks ago I developed twitching of eyelid. 3 wks ago I noticed tingling in my legs -- lasting several seconds at varying locations along my buttocks, posterior thigh, and lateral calf. (It does not "radiate" down my leg). Bilateral. A few days later, similar sx in my arms and trunk. Worse at night, better when standing. Worst in my calves. 1 wk ago started having pains too. First a focal aching/boring pain, then a pinpoint stabbing pain in my arms, legs, fingers, toes, face. Occasional burning. Had a few muscle flutterings, but no weakness or GI/bladder sx.
PMH: For many yrs I have had sporadic itching of my left hand and tingling over my left shoulder blade. I saw a neurologist for this 3 yrs ago, had MRI: bulging disk in neck. I have no medical problems. Not a diabetic. Meds for melasma (started Azelex cream about 6 wks ago). Family hx unremarkable. 1 glass of wine/week. No tobacco. No dietary restrictions. No recent travel or URI. I was using a sage hair treatment in the 3 wks prior to onset of sx – stopped it when I read that sage contains thujone which in toxic amts can cause paresthesias. Don't know if can get toxic levels via scalp?
I saw a neurologist a wk ago. Motor nl. Decreased pinprick in bilateral 4-5th fingers (neurologist 3 yrs ago noted this on the left).. Brisk DTRs. 3 beats of clonus. Babinski down. Gait, heel-toe, balance normal. Cranial nerves intact. Brain MRI (w and w/o contrast) and cervical spine MRI (w/o contrast) both nl. 18 d after sx started, had an EMG/NCS on all 4 limbs. Only abnormality was right ulnar motor low amplitude of 4.0, but no conduction block or focal slowing. Electrolytes and thyroid nl.
Any ideas? Is there anything that will help with the pain? –ibuprofen isn’t helping. Thanks!
PMH: For many yrs I have had sporadic itching of my left hand and tingling over my left shoulder blade. I saw a neurologist for this 3 yrs ago, had MRI: bulging disk in neck. I have no medical problems. Not a diabetic. Meds for melasma (started Azelex cream about 6 wks ago). Family hx unremarkable. 1 glass of wine/week. No tobacco. No dietary restrictions. No recent travel or URI. I was using a sage hair treatment in the 3 wks prior to onset of sx – stopped it when I read that sage contains thujone which in toxic amts can cause paresthesias. Don't know if can get toxic levels via scalp?
I saw a neurologist a wk ago. Motor nl. Decreased pinprick in bilateral 4-5th fingers (neurologist 3 yrs ago noted this on the left).. Brisk DTRs. 3 beats of clonus. Babinski down. Gait, heel-toe, balance normal. Cranial nerves intact. Brain MRI (w and w/o contrast) and cervical spine MRI (w/o contrast) both nl. 18 d after sx started, had an EMG/NCS on all 4 limbs. Only abnormality was right ulnar motor low amplitude of 4.0, but no conduction block or focal slowing. Electrolytes and thyroid nl.
Any ideas? Is there anything that will help with the pain? –ibuprofen isn’t helping. Thanks!
Doctor's Answer
by Lama Chahine, MD, Jun 28, 2009 09:59PM
, Jun 28, 2009 09:59PM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
Your symptoms may be consistent with what is termed a small fiber neuropathy. There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, symptoms including burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. The EMG/nerve conduction studies (NCS) which it sounds like you had and were normal will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems. Up to a third of cases are of unknown cause, but the symptoms still respond to medications that are used to treat nerve pain, what is termed neuropathic pain.
If the diagnosis of small fiber neuropathy is confirmed, there are specific treatments which can be helpful. The pain associated with nerve irritation is called "neuropathic pain", and specific medications are effective in this type of pain. Neurontin is one such medication. There are several other possible treatments to neuropathic pain. As with other conditions, medications that were originally invented for other purposes are useful for pain. This is true of neurontin and lyrica which were originally invented for seizures. Lyrica is similar to neurontin but has less side effects and often people who can not tolerate neurontin benefit from lyrica. However it is more expensive. This is also true for medications such as amitryptiline, which was originally used for depression but is not a mainstay of treatment for neuropathic pain. However, it has several side effects and may not be used in patients with heart problems.
If a small fiber neuropathy is not diagnosed in you, one potential cause for vague pains throughout the body is fibromyalgia. This best treated with medications such as lyrica and neurontin, exercise, and physical therapy.
Continued follow-up with your neurologist is recommended.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
Your symptoms may be consistent with what is termed a small fiber neuropathy. There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, symptoms including burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. The EMG/nerve conduction studies (NCS) which it sounds like you had and were normal will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems. Up to a third of cases are of unknown cause, but the symptoms still respond to medications that are used to treat nerve pain, what is termed neuropathic pain.
If the diagnosis of small fiber neuropathy is confirmed, there are specific treatments which can be helpful. The pain associated with nerve irritation is called "neuropathic pain", and specific medications are effective in this type of pain. Neurontin is one such medication. There are several other possible treatments to neuropathic pain. As with other conditions, medications that were originally invented for other purposes are useful for pain. This is true of neurontin and lyrica which were originally invented for seizures. Lyrica is similar to neurontin but has less side effects and often people who can not tolerate neurontin benefit from lyrica. However it is more expensive. This is also true for medications such as amitryptiline, which was originally used for depression but is not a mainstay of treatment for neuropathic pain. However, it has several side effects and may not be used in patients with heart problems.
If a small fiber neuropathy is not diagnosed in you, one potential cause for vague pains throughout the body is fibromyalgia. This best treated with medications such as lyrica and neurontin, exercise, and physical therapy.
Continued follow-up with your neurologist is recommended.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
