crazy or ms or back

[pennyfound]

I have several problems hhhx is allergies 2 sinus surgies 2008and 2007 . cc was dizziness blurred double vision, fluttering in eye moves back and forth.  vertigo hx 8years ago started episodes average 2x yr till recently about 8 wks.  along with sever numbess tingling of r arm leg left foot feels extra hot like some one burning it.  work in dental difficult to hold instruments and diminished tactile sensitivity.   mri head wnl.  next is mri of cervical and eeg,vepand baer next week.  fatigue so much a speak like i am drunk however i dont drink.  starting to become inappropriately anxious. unable to do normal task open jars walk like i am waddling and foot slaps on pavement.  tons of floaters first in L ey now in R eye.  feels like some one is running fingers through my hair and random numbess of face. meds are zyrtec d and nasonex.  could this be injury due to work.  had probes test arms and L side showed significant lag of sensory reflex (i am r handed go figure) noticed weakness in muscles and cramping of legs.  co workers have noticed facial movements during conversation.  i feel symptoms not stopping but increasing in sverity missed work due to vertigo and fear of driving unable to feel in r hand today but may feel diff tomorrow.  please help i am starting to feeal a little looney

[Lama Chahine, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

It sounds like you are having multiple symptoms including vertigo, numbness, fatigue, unsteadiness, and some vision symptoms. It is difficult to tie all your symptoms together.

One potential cause to your arm and leg symptoms is neuropathy. There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, symptoms including burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. The EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems

The other type of sensory neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. The symptoms are sensory loss and if motor nerves are involved ,weakness. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called a oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes, autoimmune problems and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Other causes include abnormalities of protein metabolism, as in a type called amyloidosis or monoclonal proteinemia. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles) are involved, leading to sensory symptoms as well as weakness.

The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond.I am not sure this is what you had when you mention a probe above.

Treatment for neuropathic pain (pain coming from nerves) includes neurontin and lyrica, and medications such as elavil (which is an antidepressant but has actually been found to be helpful with neuropathic pain as well).

For your generalized fatigue, potential causes could be thyroid problems, sleep apnea (which is particularly common in overweight people who snore and can cause a lot of day time fatigue; diagnosed with a sleep test called a polysomnogram), anemia, and others.

Regarding your vertigo, the causes could be either the inner ear or the brain. Inner ear causes of vertigo most commonly include benign positional vertigo (BPPV), which is due to small particle in the inner ear that moves out of place, and can be repositioned with simple head maneuvers. The symptoms often include vertigo that occurs with turning of the head, often while turning over in bed. Another cause, if your symptoms are associated with tinnitus (ear ringing) and hearing loss is called Meniere’s disease and can be treated with medications and sometimes surgery. And so on, several other causes from inner ear problems exist.

Vertigo can also be due to problems in the brain. A normal MRI of the brain excludes multiple sclerosis and tumors as a cause. Thyroid problems can also lead to vertigo. Your symptoms may be consistent with a variant of migraine called basilar migraine. Basically this is marked by several hours of vertigo associated with nausea, light-sensitivity, and sometimes other symptoms. Headache may or may not be present. The treatment is different from that used to treat other migraine types; the treatment in this case is a type of medication called calcium channel blocker, such as verapamil, which is actually used to treat blood pressure but works in type of basilar migraine as well.

That you are very anxious could potentially suggest that some of your symptoms are due to being depressed. In some people, depression can cause physical symptoms rather than a depressed mood, and is associated with anxiety. Treatment of the depression with anti-depressant medications can improve the physical symptoms.

It sounds like you have had a lot of testing, and the fact that your MRIs and some of your other tests are normal is definitely reassuring that a serious neurologic problem is not going on within the brain or spine. I am not sure if you have had an EMG/NCS to investigate whether or not you have a neuropathy, but if not, this may be something worth pursuing. Finally, if some of your symptoms sound like the basilar  type of migraine discussed above, it may be worth discussing this with your neurologist so that treatment can be started. Also, thinking more about whether or not there may be an underlying depression is important. Continued follow-up with your neurologist is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.