Re: Help me please. I need a diagnosis.

Posted By CCF Neuro MD MJD on September 25, 1998 at 23:04:34:

In Reply to: Help me please.  I need a diagnosis. posted by Joanne on September 25, 1998 at 16:17:08:






I have been doctoring for some time now and no one can come up with a diagnosis. I have been tested for MS (MRI and Visual and Auditory evoke potential) , Parkinson's, Arthritis and for Lyme's disease.  The results have been negative.
My symptoms are many.  I have problems with my balance, coordination, fine and gross motor skills.  I have trouble walking as the lower part of my leg has become stiff and once I  lost all sensation in my legs for three minutes.  One time, I fell when my leg went out from under me.  Climbing steps is a problem.  I am not overweight.  I used to have beautiful handwriting but now I can barely write.  Buttoning shirts and tying shoelace has become very difficult.  I can't hold anything in my hands as it drops out.
I have seen two neurologists,a rheumatoligist, a chiropractor, mds, and finally a psychologist to see if this was in my head.  The psychologist suggested that I seek info on the Internet.
After several hours with my friend this is the first site that seemed to fit the bill.  Are you able to help me with a diagnosis.  If not what can you recommend?  Thank you for your help.



_______
Unfortunately, no one here is going to be able to give you a diagnosis because we really would need to hear the subtleties of your history and examine you.  But let's go over some aspects of your problems that might help you.
Coordination and weakness are very nonspecific symptoms.  Weakness by itself could indicate a problem in the brain, spine, nerves or muscles. Part of your description helps a little.  You describe deterioration in both your gait and fine movements of your hand - from your description that sound like weakness.  While this could indicate a central problem (brain and spine) or a peripheral problem (e.g. nerves), the stiffness you describe is more suggestive of the former.  Do you have any visual problems, facial weakness, speech problem or swallowing problems?  These would help localized it to the brain or brainstem.  You say that you've been worked up for Multiple Sclerosis - did that include an MRI of the Head? (this would be helpful to look at the cerebelloum too which controls coordination)  Even so, with just arm and leg weakness and stiffness, this could indicate a spinal problem.  Any back/neck pain or urinary urgency or incontinence.  These might help place  your problem in the spine.  Has your Spine specifically your Cervical Spine (Neck) been imaged with an MRI?  
These would be two tests to ask your doctor about if you have not had them already.  The rest of your workup depends on what your doctor thinks of your presentation.  Your symptoms do sound neurologic though hard to put together from your description.  Other tests often ordered - A spinal tap.  How would that benefit you?  The spinal fluid bathes the brain and the spinal cord.  So often problems with these will show indirectly in your spinal fluid.  Sometimes it is nothing more than noinspecific inflammation but it may point the doctor in the right direction.      Although the stiffness seems to point to the brain and spinal cord - again it is nonspecific - sometimes people will experience cramps as stiffness with nerve and muscle disease.  If these are issues, an EMG (electrical tests of your nerves and muscles) is a helpful test.
So you see without an exam and more history, it's difficult. But I hope this gives you some helpful information.  Remember, there are many other disorders besides the four you mentioned above, and some of them take a good deal of searching.  But I would continue with seeing a neurologist, asking him what's going through his mind and seeing which of the above tests yuo might need.  If you have any other information, please tell us.