Peripheral Neuropathy?

    
      Re: Peripheral Neuropathy?
    


[ Follow Ups ] [ Post Followup ] [ The Neurology Forum ] [ FAQ ]



Posted by CCF NEURO MD on June 26, 1997 at 11:46:48:

In Reply to: Peripheral Neuropathy? posted by John Norman on June 17, 1997 at 00:33:36:

: I am a 32 year old male that has been experiencing tingling, abnormal sensations
  and mild pain over the past 10 months.  It had an abrupt onset in my left
  hand and forearm, and progressed to both feet over the next few days.  The
  pain is localized to my left bicep and both quads.  Also there is pain down
  the back of my legs (sciatic in nature), especially after sitting for a long
  time.  More recently, I have developed tingling in in my left upper lip and
  cheek.  I have also noticed slight weakness (not demonstratable in an exam)
  and muscle twitching predominantly in my quads.  The symptoms seem to be
  roughly symmetric in distribution, and seem to vary in intensity with
  approximately a 3 week period.
  I have had brain and neck MRIs, nerve conduction studies, blood work including
  B-12 and protein electrophoresis, LP and evoked potential testing.  The only
  abnormal finding was a slightly elevated CSF protein level (58 mg/dl).
===========================================================================================
Dear John,
Your neurologist appears to have done a very thorough and appropriate work-up.  The good news is that no abnormalities were found, the bad news is that you have no answers.  Thoughts that come to mind, but were excluded by your tests were, multiple sclerosis, strokes, cervical spinal cord disease or compression, vitamin B12 deficiency, polyradiculopathy and other systemic illness.  If your EMG was normal it is unlikely that you have a peripheral neuropathy or mononeuritis multiplex.  An acute demyelinating process may still be a possibility, but should be improving with time.  I believed your neurologist evaluated you for all these possibilities.  I am unable to diagnose you without evaluating you and asking you additional questions that may clue me into a diagnosis.  A second opinion by another neurologist may be reasonable at this point, to see if they have other ideas or feel that any additional laboratory tests may be helpful.  They will be able to review your prior studies.  If you are interested in
coming to the Cleveland Clinic, call 1-800-223-2273 ext 45559 or 216-444-5559 to arrange an appointment with one of our neurologists.  Good luck.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options for your specific medical condition.  
  My neurologist seems to be at a loss for an explaination.  He has suggested
  that MS is not likely, and that it may be a "monophasic demylenative event"
  or some type of peripheral neuropathy.  I would sure like to hear your
  thoughts.