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Neuropathy, MS, CIDP or ?
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Neuropathy, MS, CIDP or ?

Thank you for this forum. I'm hoping to get some advice regarding my wife, who, until recently has been a healthy, active 39-year-old mom. 10+ wks ago, she started w/symptoms that seem possibly related to some kind of neuropathy, MS, CIDP or ?

Here's the history:
-4yrs ago: Confirmed case of shingles on right buttock/upper thigh, with rash, tingling, skin sensitivity, etc.

-6 months ago: Felt a similiar "shingles-like" pain in her right upper arm. Guessed it was shingles again. Got anti-viral scrip. Symptoms lasted for 6wks--no rash. Now dr. doubts that was shingles.

-10+wks ago: Started w/same types symptoms on left hip, lower back/stomach and upper thigh (left side only&can radiate to part of right back/stomach. Feels very tired and more shooting pains/deep aches/skin sensitivity in p.m. and needs daily nap.She feels like she's fighting something--systemically and w/pain. Feels like whole leg more "tired" and achy--like she did a 50-mile bike ride on that side. Symptoms/severity vary daily. Symptoms finally seem to be improving this week, though she's getting a numb big toes and foot/lower leg tingling (new).

Doc. referred to neurologist 3 wks ago. Ordered a lumbar MRI (normal). 2 wks ago: EMG (normal). A few blood tests (Lyme: Negative). Only test not normal was slightly elevated gamma immunoglobulin. W/normal EMG, doc said further testing wouldn't "yield much value" now. Said could be "post-infectious neuritis" and we should "wait and see." Offered Neurontin but sticking w/Advil for now.

We're frustrated. Could this be MS or CIDP or ? I know it's hard to pinpoint this kind of thing. Does it make sense to request further testing/2nd opinion--even though symptoms are finally improving? Health ins. may not be good next year, so now is preferable if it makes sense. Thanks in advance for your advice!

PS Only other medical issue: Dx w/Meniere's w/32% caloric weakness/vestibular loss on right side and hearing loss.
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Avatar_dr_f_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 your doctor

Without the ability to examine your wife, obtain a history from her, and review her testing, I can not comment on what her diagnosis is nor on whether or not she needs further testing. However, I will try to provide you with some general information.

In general, though there are exceptions, a normal MRI of the brain and entire spine makes MS very unlikely; however if only the lumbar spine has been imaged, MS can not be ruled out. A normal EMG, if done properly, excludes CIDP. However, as I said, there are a few exceptions.

MS is a diagnosis that is based on symptoms, objective neurologic manifestations, and tests such as MRI, or other tests like Lumbar puncture and evoked potentials. The “MS attacks” are manifested as episodes of focal neurologic symptoms (such as numbness, weakness, visual symptoms, coordination problems, etc) affecting different areas of the central nervous system at different time points. So when patients have symptoms that may be suggesting MS, if they do not fit the criteria, a second evaluation after a second attack can give a higher yield. In the evaluation of patients suspected to have MS, the MRI plays a major role, as it can detect lesions (usually lesions in the white matter of the brain), and subsequent MRIs can demonstrate appearance of new lesions in different areas at different time points. If there is still no diagnosis after neurologic examination and repeated MRIs, and if there is high suspicion, lumbar puncture for specific markers is performed, and if there is still doubt, other tests such as evoked potentials can be performed.

CIDP stands for chronic inflammatory demyelinating polyneuropathy. Symptoms typically included progressive sensory or motor loss (weakness), with episodes of worsening separated by weeks or months, and complete recovery after each episode is not necessarily the rule. There are other types of polyneuropathy and several causes of each. A large fiber neuropathy, i.e. a neuropathy of the large nerves to the extremities, is usually detectable on EMG. Sometimes when the EMG is done too early in the course of an illness (within the first few days of symptoms), it is not diagnostic and may need to be repeated (depending on the condition), but after 3 weeks of symptoms, the EMG is going to be abnormal if there is a large fiber neuropathy. A small fiber neuropathy, the symptoms of which are burning/tingling sensations often in the feet, among others, is not detected on EMG.

An elevated immunoglobulin level is often due to infection, but some cases of elevated proteins in the blood may be due to an abnormality of protein production such as multiple myeloma. This can be clarified by further testing of the blood to determine what the exact contect of the protein abnormality is.

I suggest that you follow-up with your neurologist and discuss you concerns with him/her. Improvement in symptoms is certainly comforting and may suggest that there was some infectious process which is resolving (but does not necessarily exclude a neurologic diagnosis). Occurence of new neurologic symptoms would definitely warrant urgent re-evaluation.

Thank you for using the forum I hope you find this information useful, good luck.
3 Comments
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215164_tn?1269469840
Hi.  I am wondering about your wife and how she is doing.  Our symptoms are very similar.  I have had this going on since march 2007 with no true diagnosis yet other then a generalized diagnosis.  My nerve conduction study was abnormal 5 months ago and we are repeating in in November.  I have not had the EMG (needles into muscles) study done. Hoping to finally get some answers.

Hope your wife is ok...has she been suffering from any dizziness/lightheadedness?
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