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Neurological complications after appendectomy
I am a 26 year old male who was in good health before my appendectomy in July. I spent most of July and August in the hospital for infections related to surgery. Over the last 4 months, I have been experiencing numbness in my hands, arms, feet, legs, and right shoulder. There were many days that I had trouble controlling/moving my legs. In the last month, my symptoms have been reduced to numbness in my hands/arms and severe fatigue. I have been to 4 neurologists, done multiple MRIs and blood tests, and everything is normal. I have been checked for lupus, lyme disease, and Rhuematoid Arthritis. I don't have any of them. I just want an answer and hopefully a cure for my symptoms, as I can no longer function as I did just 4 months ago. Please help me to find an answer. Thank you.
MEDICAL PROFESSIONAL
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.
Neuropathy, or nerve injury, can present in different ways depending on the fiber involved. There are two types of sensory neuropathies in the body – large and small fibers. With small fiber neuropathies, symptoms include 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) (tests done to check for neuropathy) 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, and autoimmune problems.
The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. The symptoms are sensory loss and if motor nerves are involved, weakness may occur. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called a oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes (such as in a disease called Charcot-Marie-Tooth, in which there is a family history of sensory neuropathy usually from an early age associated with other clinical features such as high-arched feet), autoimmune problems (such as lupus (SLE), Sjogren's, Churg-Strauss (in which asthma also occurs), polyarteritis nodosa, which affects blood vessels), and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism, as in a type called amyloidosis or monoclonal proteinemia. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles) are involved, leading to sensory symptoms as well as weakness.
The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerves conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required.
Treatment for neuropathic pain (pain coming from nerves) includes neurontin and lyrica, and medications such as elavil (which is an antidepressant but has actually been found to be helpful with neuropathic pain as well).
Given your recent surgery, I would suggest you having B12 and MMA levels checked. B12 can be affected by anesthesia that may be used during surgical procedures. MMA can verify B12 deficiency if B12 is only moderately low. Also, a screen for diabetes is always recommended for neuropathy workup. This includes a test called oral glucose tolerance test.
Additionally, you would benefit from having an EMG/NCS performed to assess nerve damage and to help localize the problem. An MRI of your cervical spine is also recommended. An injury there could cause sensory changes in the territories you describe.
If your symptoms continue with a negative workup, a spinal tap (or lumbar puncture) should be considered.
You should continue to discuss your concerns with your neurologist.
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 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.
Neuropathy, or nerve injury, can present in different ways depending on the fiber involved. There are two types of sensory neuropathies in the body – large and small fibers. With small fiber neuropathies, symptoms include 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) (tests done to check for neuropathy) 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, and autoimmune problems.
The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. The symptoms are sensory loss and if motor nerves are involved, weakness may occur. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called a oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes (such as in a disease called Charcot-Marie-Tooth, in which there is a family history of sensory neuropathy usually from an early age associated with other clinical features such as high-arched feet), autoimmune problems (such as lupus (SLE), Sjogren's, Churg-Strauss (in which asthma also occurs), polyarteritis nodosa, which affects blood vessels), and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism, as in a type called amyloidosis or monoclonal proteinemia. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles) are involved, leading to sensory symptoms as well as weakness.
The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerves conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required.
Treatment for neuropathic pain (pain coming from nerves) includes neurontin and lyrica, and medications such as elavil (which is an antidepressant but has actually been found to be helpful with neuropathic pain as well).
Given your recent surgery, I would suggest you having B12 and MMA levels checked. B12 can be affected by anesthesia that may be used during surgical procedures. MMA can verify B12 deficiency if B12 is only moderately low. Also, a screen for diabetes is always recommended for neuropathy workup. This includes a test called oral glucose tolerance test.
Additionally, you would benefit from having an EMG/NCS performed to assess nerve damage and to help localize the problem. An MRI of your cervical spine is also recommended. An injury there could cause sensory changes in the territories you describe.
If your symptoms continue with a negative workup, a spinal tap (or lumbar puncture) should be considered.
You should continue to discuss your concerns with your neurologist.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Were u treated with ciproflox, an antibiotic for severe infections, then u might have developed polyperipheral neuropathy, i have the same prob and i read online that the fda had issued a warning abt the risk of nerve and tendon damage when taking cipro
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