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Neurology (Expert Forum)
benign or not?
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benign or not?
by kat2, Feb 16, 2005 12:00AM
I am 50 yrs old and previously fit runner. 4 weeks ago developed severe acute thoracic back pain and dermatomal (T10) sensory loss. Similar but milder episodes for many years. XR/MRI showed degenerative disc disease. This has largely resolved. HOWEVER, 2 weeks ago suddenly developed muscle twitching, starting R thigh. Since then has become generalised (both legs R>l, arms L>R,face, tongue occasionally, most persistent R thigh and L biceps.) Essentially constant, including when awake at night. No localised muscle weakness, but 'shaky' when going up or down steps and noticeable muscle fatigue if attempt to run more than a short distance. Quick neuro exam apparently unremarkable. Routine bloods showed slightly low Mg (0.7, LLN .8) and slightly elevated CK (+/-220, ULN 170). No other investgations. No medications other than calcum supplements and vitamins. Perimenopausal and noticeable increase in hot flashes over past month. The twitching and drastically reduced exercise tolerance is bothering me. Is worsening rather than improving. Went to ER, who referred me to family doc, who said (telephonically) should go to ER if worried and was likely due to 'fatigue'. Could this be related to menopausal symptoms? Does the acute/ generalised nature suggest a benign cause? Should I request further investigation? Irrational or not, this is a source of anxiety (and worse, inactivity) at present! Thanks in advance .
Doctor's Answer
by CCF-Neuro-M.D.-CS, Feb 18, 2005 12:00AM
If you have the above symptoms associated with a completely normal examination, and the twitches have appeared over such a short period (2-4 weeks) it is unlikely that you have a chronic neurodegenerative disease like ALS.
Reduced exercise tolerance can be caused by a number of conditions like cardiac and respiratory disease so this should be evaluated. Especially if you have a high CK - it can come from skeletal muscles OR cardiac muscle.
Twitching on its own, especially if widespread, and not associated with other abnormalities such as muscle weakness and wasting, is usually not suggestive of a serious neurological disease. I cannot tell you for sure without seeing you - but you do need to have these symptoms evaluated thoroughly
Is it possible to see your family doctor non-telephonically!!
Good luck
Reduced exercise tolerance can be caused by a number of conditions like cardiac and respiratory disease so this should be evaluated. Especially if you have a high CK - it can come from skeletal muscles OR cardiac muscle.
Twitching on its own, especially if widespread, and not associated with other abnormalities such as muscle weakness and wasting, is usually not suggestive of a serious neurological disease. I cannot tell you for sure without seeing you - but you do need to have these symptoms evaluated thoroughly
Is it possible to see your family doctor non-telephonically!!
Good luck
