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MRI and neurological symptoms
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MRI and neurological symptoms

I have been having the following symptoms for the last 3 months.
- Pins and needles sensation followed by cold and uneasy feeling (sometimes even during sleep)
- Dizzy
- Lifleless feeling and fanintish feeling
- Weakness when these attacks come on

Symptoms come at least once a week .

Brain MRI results:
- No evidence of demyelination diease
- Moderate size septum pellucudum cyst (normal variant)
- Tiny peri vascular space in the posterior part of corpus callosum
- Moderate ethmodial sinusitis

Doctors are still not able to diagnose and this is becoming really frustrating.  Please help.
Avatar_dr_m_tn
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 a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information (i.e., a differential).

(1) If your symptoms are worse in the hands and feet, this can be caused by a process called a neuropathy. There are 2 types of nerves that provide sensation to the feet, large nerves and small nerves. A problem with either of these could lead to burning and tingling. There are many many causes to this group of disorders called "neuropathies". They include but are not limited to most commonly diabetes, vitamin deficiencies, autoimmune disorders such as lupus or a disease called Sjogren's, certain types of neoplasm, and certain toxins (such as lead). As I mentioned, there are several other genetic, metabolic, and hereditary disorders that cause neuropathy, and what tests need to be ordered depend on the history and physical examination of the patient. With small fiber neuropathy, the EMG/NCS test which measures how nerves conduct electricity and how muscles respond to them may be normal. In large fiber neuropathy, it will be abnormal. Small fiber neuropathy can be diagnosed with a skin biopsy and with a test called a QSART.

(2) If your symptoms are present on one side of the body versus the other or in just one limb, this could include a stroke or the condition multiple sclerosis. These would best be excluded by an MRI which sounds like has already happened.

(3) If symptoms migrate (move from one place to the other) and are intermittent, causes might include seizures, migraine disorder or metabolic problems such as low calcium.

(4) Dizziness is nonspecific and can mean many different things to different people. Some causes are related to the inner ear (such as BPPV). However, some can be due to systemic processes such as thyroid problems, low blood pressure, dehydration, autonomic dysfunction, cardiac problems, and anemia.

(5) Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve.

These are just some causes for symptoms that you may be having. Continued follow-up with your doctors is recommended. Evaluation by a neurologist, if you have not already done so, is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

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