Undiagnosed neurological problem

    
      Re: Undiagnosed neurological problem
    


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Posted by CCF Neuro MD on May 27, 1997 at 09:49:56:

In Reply to: Undiagnosed neurological problem posted by Mike McConnell on May 20, 1997 at 10:43:24:

: My 36 year old wife has been experiencing several symtoms (symptoms) over the past ten months.  She began experiencing pain in the knees in the summer of 1996.  Also, she became fatigued on a regular basis and felt dizzy at times.  Her knees became swollen and she experienced goose bumps and chills throughout her whole body.    She was referred to a sports medicine Dr. by her HMO primary care physician (an  internist).  She started having problems with keeping her balance and some pain in her spine area at this time as well.   After a few visits and therapy sessions, the sports medicine Dr. sent her back to the internist (about mid-October) with a suspicion that my wife had M.S.  The internist ordered some blood work and found that B-12 level was in the normal range but a low normal.  He suggested that she begin taking a multiple vitamin.  He referred her to a neurologist, but the first available appointment was about 5 weeks away.  More symptoms started to appear including increasing fatigue, more acute problems with balance, body, arm and leg tremors (severe shaking), feeling of electric shocks going through her body, short term memory loss, shortness of breath, speech problems (trouble getting the words out), sensitivity to cold (could not tolerate cold outside temperatures).  On November 7, she had very severe body shakes and had excrutiating spine pain.  I called her internist and requested that she be admitted to hospital.  During her stay in the neuro ward, she had an EEG, spinal tap, MRI of the head and upper spine area,  and neurological exam.  Her internist prescribed B-12 shots while she was in hospital and then on a twice a week basis for about three months, then once monthly.  In addition to the shots, he recommended a twice-daily oral B-12 supplement.   After this two day hospital stay, she had two additional office exams by this neurologist. Also, another EEG was given.  At the last exam, the neurologist said she would refer her to a neuropsychologist or refer her to another neurologist for a second opinion as she could not arrive at a diagnosis.  The EEGs, spinal tap and MRI did not show any positive signs of disease or abnormalities. My wife opted for a second opinion.  She has seen the second neurologist twice.  He has scheduled a 24 hour EEG on June 4.  During the last office visit, he stated that he does not think her problem is neurological, but may be a disease that is affecting her neurological system.  He is referring her back to her primary care physician.  She continues to have the symptoms listed above and also has problems with ringing in the ears, eyes are sensitive to light, pain in both eyes at times, pain in chest area, pain in hands and ankles. Do you have any clues as to what tests could be given to arrive at a diagnosis?  Are there any other medical specialists that she should be referred to?  Two other items that may help arrive at a diagnosis:  she had a car/bicycle accident (she was on the bicycle) in 1983 and a motorcycle accident in 1990.  She did not seem to have any health problems after these two accidents after brief recovery periods, but is there a possibility that effects of these accidents may have contributed to her current medical problems?  Also, she vacationed in Costa Rica during January of 1994 and 1995.  Could a bug bite or contaminated food contributed to her current situation?
  Thanks for any advice you can give.  
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Hello Mike,
The symptoms that your wife has been having are not immediately suggestive of a specific neurologoic disorder.  Joint pain and swelling are not typicially associated with multiple sclerosis and are more often seen in rheumatologic disorders.  There are a group of rheumatologic disorders called connective tissue diseases that are thought to be autoimmune disorders which are diseases in which a person's own immune system attacks parts of the body. Rheumatologist are the specialist who deal with these group of disorders.  Other possible disorders that can cause some of the symptoms that your wife has been experiencing includes Lymes disease, sarcoidosis, and postviral encephalomyelitis just to name a few.  Postconcussion syndrome typically cause headaches as the central symptom as well as other problems like dizziness, fatigue and restlessness. However, in view of the complexity of your wife's case, it is impossible to render a diagnosis until after a thorough review of the history
and physical examination is performed.  Without having done this first it would be like shooting in the dark to suggests any tests.  It seems that your doctors have looked hard into various potential causes already.  Often as time passes, what was initially difficult to diagnose becomes more clear so don't give up hope.  I wish you and your wife good luck on finding the correct diagnosis and getting the proper treatment.