Post Viral Syndrome?

[Joan M.]

-- I am a 44 year old woman, who, with the exception of asthma, enjoyed
good health until November of 1999. In that month, I had an upper
respiratory infection, followed by a week of mild GI symtoms-nausea and
diarrhea. Then, I started having an aching pain in both thigh muscles,
as if I had overworked them. Within a few days, fatigue and vertigo set
in. I was not too concerned about this, because the year before I had
been dizzy for about six weeks, but this resolved on its own. Then, I
started experiencing extreme weakness in both legs. Saw the doctor at
this point, and he felt that I had a viral infection, did some blood
work (thyroid, diabetes, Lyme disease-all normal), and, to be on the
safe side, made an appointment with a neurologist. The following week, I

started having numbness and tingling in my toes and feet and the doc
tested my B12 levels, which were 187. He put me on supplements and
within a month, they were around 1000, so he felt there was no
absorption problem.
The neurologist ordered an MRI of the brain and Cspine, which was
normal. He also thought this was a viral infection.
Within 2 months of when this all started, I developed problems with
urine retention and leaking. An ultrasound showed an area on a kidney
that my doc described as something that might have been caused by a bad
UTI infection in the past, but we couldn't recall one. An IVP of the
kidneys and bladder was normal. The urine retention problem comes and
goes, but seems to be triggered by exercise.
Chest Xray was normal except for some calcification on a rib. Upper GI
tests normal. Thoracic spine MRI and evoked potential test of legs
normal.
In March, I developed joint pains-both shoulders, hips, and jaws.
Rheumatological panel all normal. Saw a rheumatologist beginning of May
who did a Western blot Lyme test, parvo and cocksackie. Again, all
normal.

So, here I am. Constant vertigo since November, weakness, fatigue, joint

pains, some visual disturbances of late, the bladder problems, memory
problems and numbness in the toes. I also have a tremor in my right hand
and head and tend to sway from side to side when I'm sitting. Also a lot
of trouble with
costochondritis, which I had developed in 1998. The rheumatologist is
calling it a post-viral syndrome at this point, and counselling a wait
and see approach. I've seen that advice given here before and I'm ok
with that. Just wondering if in this vast array of symptoms, anything
occurs to you that might not have been considered by all these docs, or if this is suggestive of anything besides the post viral syndrome
Thank you.

[Christine J.]

Dear Doc RPS:

I often wonder, in the case of suspected post viral illnesses, why a simple CSF analysis isn't performed immediately instead of putting a patient through an array of expensive MRI's, etc?  If GBS or CIDP is suspect at onset, then check for the elevated protein levels immediately.  Swift dx's leave amazing impressions in their wake.

Sincerely appreciative,

Christine J.

PS- I thought you might like to know that I have left Emory for Wake Forest.  Have a good one, Doc!

[Joan M.]

Thank you. I should have mentioned that initially the neurologist thought I might have a mild case of Guillain Barre, although my reflexes were extremely brisk. I will bring this up again with my PCP when I see him again. The neurologist doesn't want to see me unless I get new symptoms.
Enjoy your weekend.

[CCF Neuro[P] MD, RPS]

Dear Joan M:

Sorry to hear about your problems.  The only thing that jogs my mind is the possibility of a chronic inflammatory disseminated polyneuropathy.  A simple CSF analysis looking for elevated protein would be diagnostic.  But, I think I would agree that the most likely thing you might have would be a post viral illness.  But, I might check about the CIDP possibility.

CCF Neuro MD