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Neurology (Expert Forum)
Tingling and Numbness with Rapid Paralysis
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Tingling and Numbness with Rapid Paralysis
by DesperateFamily, Feb 15, 2006 12:00AM
My mother is 66 years old. She is a smoker with very high cholesterol. In November 2005 she began experiencing tingling in her left big toe and two fingers of her right hand. The tingling got rapidly worse. By Thanksgiving (3 weeks after first tingling) the tingling and muscle weakness had progressed up both legs and she was forced to use a walker. By Christmas, she was wheelchair bound and only able to make it from her chair to the toilet. By mid January she had absolutely no use of her legs or trunk area and had lost the use of her left arm. She still has complete feeling in all extremities but no muscle control and severe tingling(tingling even occurs in her trunk stomach area). She also has no pain just says that she feels extremely weak. She also says that she can actually feel the weakness coming up her body(a little more each day). We’ve had her to many doctors and even spent a week at the Mayo Clinic - Jacksonville(St Lukes) but still have no diagnosis. To date, the only thing that has come back abnormal is her B12 levels, EMG and nerve conduction study. Doctors also frequently comment on the fact that she has no reflexes left. The doctors finally started her on B12 injections three days ago(shots for 3 days and then once a month). As of yesterday, she had lost most of the use of her one remaining limb(her right arm). She is no longer able to feed herself, cough, sneeze or take a deep breath. Do you think that there is anyway a B12 deficiency could cause this severe or rapid progression? If so, could she expect to make a full recovery now that she is taking B12 injections? If not, do you have any suggestions for how we should proceed? As info the Mayo clinic has ruled out the following; GBS, Cancer, large blood vessel pressing against spine, problems in her spinal fluid or a genetic disease.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Feb 21, 2006 12:00AM
I cannot give you a formal clinical opinion as this forum is purely educational
Your mother obviously has a serious and progressive condition involving the peripheral nerves (as noted by the loss of reflexes)
B12 deficiency occurs very slowly over time, so it would be unusual to evolve so fast. It can cause pretty severe disability if untreated but the presentation with multifocal motor weakness is atypical. With B12 treatment some of the deficits may be reversible, depending on the severity and duration of nerve damage
Other things that come to mind are CIDP (chronic inflammatory demyelinating polyneuropathy, the chronic form of GBS) which causes predominantly motor weakness, is diagnosed by EMG/NCS, spinal fluid analysis and/or nerve biopsy.
Also, mononeuritis multiplex can rapidly affect one then multple nerves and has a variety of causes including vasculitis, diabetes, Lyme among others. Tests include various blood tests and/or a muscle or nerve biopsy.
Treatment is available for both conditions and consists of various forms of immunosuppression (ie steroids, cytoxan) as the dmaage is thought to be caused by the bodys own immune system.
One might also consider a paraneoplastic syndrome (as she is older and a smoker there may be an underlying cancer) or polymyositis (absent reflexes go against this but could occur in profound muscle weakness) or a rapid onset ALS type disease (caused by ALS itself or sometimes viruses like West Nile).
Ask your doctors whether these diagnosis have been considered.
Good luck
Your mother obviously has a serious and progressive condition involving the peripheral nerves (as noted by the loss of reflexes)
B12 deficiency occurs very slowly over time, so it would be unusual to evolve so fast. It can cause pretty severe disability if untreated but the presentation with multifocal motor weakness is atypical. With B12 treatment some of the deficits may be reversible, depending on the severity and duration of nerve damage
Other things that come to mind are CIDP (chronic inflammatory demyelinating polyneuropathy, the chronic form of GBS) which causes predominantly motor weakness, is diagnosed by EMG/NCS, spinal fluid analysis and/or nerve biopsy.
Also, mononeuritis multiplex can rapidly affect one then multple nerves and has a variety of causes including vasculitis, diabetes, Lyme among others. Tests include various blood tests and/or a muscle or nerve biopsy.
Treatment is available for both conditions and consists of various forms of immunosuppression (ie steroids, cytoxan) as the dmaage is thought to be caused by the bodys own immune system.
One might also consider a paraneoplastic syndrome (as she is older and a smoker there may be an underlying cancer) or polymyositis (absent reflexes go against this but could occur in profound muscle weakness) or a rapid onset ALS type disease (caused by ALS itself or sometimes viruses like West Nile).
Ask your doctors whether these diagnosis have been considered.
Good luck
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Her consults were many. Gastroenterology, psychiatry ( two psychiatrists told the family she was A) depressive psychotic and B) schizophrenic, nephrology, and finally a neurologist was called in. Guess what? She had a condition called Porphyria. And every time we gave her narcotics for pain, we were worsening her condition. The woman had been in our unit almost TWO months but within 48 hrs of the neuro consult ( he immediately discontinued all pain meds ), she walked out with her family, totally recovered. I gained a new and profound respect for neurology that day.
The moral of this story is...it may take awhile and some crazy diagnoses but answers are almost always found and often in the patient's favor. So keep hunting for them.
Tomorrow, do ask if they ran a thyroid profile. Fcar has something there. My guess is that they did...it is pretty standard. Myasthenia appears to have been considered, as it was ruled out. Has your mom had a positive changes with the B-12 injections?
Let us all know how you are doing with all this..and remember, the neuro on here has been answering every night. Good luck.
That said, B-12 deficiency can indeed cause terrible symptoms. Make sure she is getting enough; a monthly shot for such a severe case? The most important thing is to get her to another neuromuscular expert asap.
Best of luck.
If they're doing plasmapherisis, it's because they suspect (or have found) your mother has made antibodies to parts of her own nervous sytem. It's called an autoimmune neuropathy. Theory is, an invading virus has a part that looks similar to a part of a neuron, so your body starts attacking its own neurons by mistake. (This is how GBS is supposed to work.) Plasma exchange is an accepted treatment that often works very well for such situations. In cases where it doesn't work, or simply as an alternative, doctors many administer intravenous immunoglobulin (IVIg) as another way of neutralizing your mom's bad antibodies. Both are top-of-the-line treatments that aim to stop or reverse the symptoms.
I would still speak to the docs about methylcolabamin b-12, just in case. It's pretty cheap, no doctor has ever suggested any side effects to me, and it might be good insurance just in case. People who actually do malabsorb B-12 end up having to take high amounts; I know folks who take between 1000 and 5000 mcg a day. That would make my head spin! but it seems to work for them. And yes, there are studies showing a theoretical benefit to the methyl- versus cyano- form.
I have a sister in law in the hospital right now with accute transverse myelitis. She had the exact same symptons as your mother but the symptons progressed more rapidly. I would suggest you do a search on transverse myelitis and you will see all the symptons. The treatment is with sterides and a product called IGG.An MRI should have shown this also a spinal tap is required. Good luck!!!
If you want some informative reading (but it's very technical, take your time) try this: http://www.neuro.wustl.edu/neuromuscular/time/nmacute.htm#neuropathy
There are lists of possible tests here: http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=CAP_LabDiagnosis_PeripheralNeurop.htm and here: www.lizajane.org Most of those focus on causes other than b-12 deficiencies.
Good luck, and please report back.
I just noticed your mom has high cholesterol. Neuropathy is a known side effect of statin drugs in some people. Is she on one, like Lipitor? Do some research. I'm not aware that statin neuropathy is as severe or acute as you've described; I'm just throwing an idea out there.
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijn/vol2n1/vitamin.xml
Looks like the patient got more frequent b12 injections than your mom.
I hope you will continue to let us know how things are progressing and how you are feeling. A mother is "precious cargo " to her children.
Watch TBN network - sometimes all we have left is prayer and the support of caring wonderful people. There are phenomenal
healers - Benny Hinn.. etc. Miracles happen every day!