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Cold sensation in arms and legs
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Cold sensation in arms and legs

My husband has been experiencing some strange cold sensation in his thighs and shoulders over the last 6 months. It appeared during an ordinary cold he got some months ago but it never went away. His GP says it may be some post-viral symptom but his blood tests are perfect and they dont show any recent viral infection. Could this be a neurological problem? He had a brain scan and some sensory tests performed but they all came out OK. Thank you in advance for your help.
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Dear lukrezia,

Thank you for submitting your question pertaining to your husband.
I will answer your concerns to the best of my abilities, but please be informed that I am unable to offer a diagnosis based on your history and list of symptoms regarding your husband.
I am extremely limited in not having the opportunity to perform a full neurologic examination on your husband, nor am I able to review the pertinent imaging.
This is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.

To begin, the simple answer to your question is yes -- your husband's symptoms can be neurologic in nature and can be due to his past viral infection.

It is reassuring to me to know that he has seen a physican and that his brain scans and sensory tests were "okay."
I am assuming that this means that objective sensory testing by his physician did not find any abnormalities.

As neurologists, we see various neurologic type symptoms that emerge following an infection, usually viral -- even after the viral symptoms have subsided.

Many viruses are known to attack the nerves to various degrees of severity.

The most worrisome post-infectious neurologic disease is Guillian-Barre Syndrome.
Guillain-Barre (ge-YAH buh-RA) syndrome (GBS) is an inflammatory disorder in which your body's immune system attacks the nerves outside the brain and spinal cord (peripheral nerves) and, rarely, parts of the brain itself. Severe weakness and numbness in your legs and arms characterize GBS. Loss of feeling and movement (paralysis) may occur in your legs, arms, upper body and face.

GBS affects an estimated one to three in every 100,000 persons annually in the United States. It can strike any race at any age, but its incidence increases with age. GBS may occur within days or weeks after a viral infection such as influenza (flu) or diarrhea. It may be triggered by pregnancy or a medical procedure, such as a vaccination or minor surgery, or have no evident reason for developing. Because the cause of GBS is unknown, there's no way to prevent the disease from occurring.

In its most severe form, GBS is a medical emergency and may require hospitalization. Severe GBS may result in total paralysis, potentially dangerous fluctuations in heart rate and blood pressure, and inability to breathe without respiratory assistance. The muscles you use for eye movement, speaking, chewing and swallowing also may become weak or paralyzed. People with severe GBS often need long-term rehabilitation to regain normal independence, and as many as 15 percent experience lasting physical impairment. In some cases, GBS can be fatal.

Most people recover from even the most severe cases of GBS. Available treatments, if started soon after signs and symptoms appear, may lessen the severity of GBS and reduce recovery time.


Signs and symptoms

The signs and symptoms of GBS usually appear rapidly over the course of a single day. These may include:

Weakness, tingling or loss of sensation that often begins in your feet and legs and spreads to your upper body and arms
Moderate pain throughout your body
Difficulty breathing
Paralysis of your legs, arms, respiratory muscles and face
Difficulty with eye movement, facial movement, speaking, chewing or swallowing
Very slow heart rate or low blood pressure
Difficulty with bladder control or intestinal functions
GBS progresses quickly, with most people experiencing the most significant weakness in the legs, arms, chest and other areas within three weeks of the start of this disorder. In some cases, the signs and symptoms of GBS may progress very rapidly with complete paralysis of legs, arms and breathing muscles over the course of a few hours.

If GBS is mild, the signs and symptoms may not extend beyond a feeling of general weakness. GBS may improve on its own within a few weeks, and some people initially may think the signs and symptoms are due simply to a common virus.

The signs and symptoms of GBS may last days, weeks or months before muscle sensation begins to return. Regaining your pre-illness strength and functioning is slow, sometimes requiring months or years. However, most people with GBS return to normal within months.

In the inpatient hospital setting, we see the severe forms of GBS.
In the outpatient setting however, I have seen the mildest cases of GBS, where patients only complain of small patchy areas of tingling that eventually self-resolve.

In your husband's case, it is reassuring that his symptoms have not progressed beyond these cold sensations over 6 months.
This argues against GBS.

If his symptoms persists, I recommend seeing a neuromuscular specialist.
Various tests can be performed to further investigate his symptoms.
Two specifically, are as follows:
Electromyography (EMG). An EMG helps establish a diagnosis and the extent of a neurological problem by measuring the electrical activity of a muscle in response to nerve stimulation. The test also measures the nature and speed of impulse conduction along a nerve. In an EMG, a technician inserts electrodes in fine needles into the muscles being tested and places electrodes on your skin over peripheral nerves.
Spinal tap (lumbar puncture). This procedure involves inserting a needle into your spinal canal, usually at the low back (lumbar) level. Your doctor can determine the pressure of the cerebrospinal fluid (CSF), and a sample of fluid can be removed for laboratory analysis. This analysis may include checking for evidence of bleeding, the number and types of white blood cells, the levels of glucose and protein, the types of proteins, and tests for bacteria and fungi.

Based on the mild severity of his symptoms over the course of 6 months, I am optimistic that it should self-resolve however.

Best of luck to you and your husband,
Hope this helps,
JKL, MD
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