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Neurology (Expert Forum)
numbness, tingling, back pain, painful tongue, upper arm pain, etc
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
numbness, tingling, back pain, painful tongue, upper arm pain, etc
by Yond, Dec 16, 2008 09:27AM
I am a 45 year old female. In generally good health.
I recently began having symptoms that at first appeared to be independant and random but now I think perhaps they could be related and part of a bigger picture.
Numbness and tingling in toes which progressed to my feet, then ankles,fingers and hands, lower legs and lower arms. I am now beginning to notice it in my thighs and upper arms, lips, mouth, nose and scalp. 1.5 months.
My tongue hurts just along the ridge on the sides of the tongue starting about half way back and going back to the base of the tongue. There is no discoloration, 2 Months
Burning pain in my right upper arm halfway between my shoulder and elbow outside of the arm a tad toward the front. It doesn't hurt any more with activity, it does not hurt more when I move it. It comes and it goes very intense and almost unbearable when it is there. October of 2007.
Incontinence recently had to undergo surgery to put a sling under my Urethra. caused by sudden contraction of those muscles. surgery September 2008 about a month and a half after the incontinence began.
cramps on my abdomen.cramps are not in my abdomen they are on my abdomen. the skin and right below it just contracts. Similar to a leg cramp but on my stomach. 1.5 months or so.
vertigo. Not your typical vertigo, I mean vertigo for 24 hours. I can't get out of bed. All I can do is lay there while the room spins. 3 seperate occasions over the last year.
Low back spasms from walking short distances or standing ie, doing dishes and such
note:
surgery in 01/08 to remove a 12cm tumor that was attached to the internal side of my tailbone. extensive disection to reach it at the bottom of the pelvic bowl. No organs were breached by the tumor or during the surgery. It was a benign dermoid cyst. 22 vertical staples to close the incision. 3 transfusions.
B12 deficiency negative, thyroid normal, adrenal normal, no lupus lesions
Please help figure this out
I recently began having symptoms that at first appeared to be independant and random but now I think perhaps they could be related and part of a bigger picture.
Numbness and tingling in toes which progressed to my feet, then ankles,fingers and hands, lower legs and lower arms. I am now beginning to notice it in my thighs and upper arms, lips, mouth, nose and scalp. 1.5 months.
My tongue hurts just along the ridge on the sides of the tongue starting about half way back and going back to the base of the tongue. There is no discoloration, 2 Months
Burning pain in my right upper arm halfway between my shoulder and elbow outside of the arm a tad toward the front. It doesn't hurt any more with activity, it does not hurt more when I move it. It comes and it goes very intense and almost unbearable when it is there. October of 2007.
Incontinence recently had to undergo surgery to put a sling under my Urethra. caused by sudden contraction of those muscles. surgery September 2008 about a month and a half after the incontinence began.
cramps on my abdomen.cramps are not in my abdomen they are on my abdomen. the skin and right below it just contracts. Similar to a leg cramp but on my stomach. 1.5 months or so.
vertigo. Not your typical vertigo, I mean vertigo for 24 hours. I can't get out of bed. All I can do is lay there while the room spins. 3 seperate occasions over the last year.
Low back spasms from walking short distances or standing ie, doing dishes and such
note:
surgery in 01/08 to remove a 12cm tumor that was attached to the internal side of my tailbone. extensive disection to reach it at the bottom of the pelvic bowl. No organs were breached by the tumor or during the surgery. It was a benign dermoid cyst. 22 vertical staples to close the incision. 3 transfusions.
B12 deficiency negative, thyroid normal, adrenal normal, no lupus lesions
Please help figure this out
Doctor's Answer
by Lama Chahine, MD, Dec 18, 2008 09:12AM
, Dec 18, 2008 09:12AM
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 your symptoms are from. However, I will try to provide you with some possibilities
Your symptoms are difficult to tie together in 1 unifying diagnosis. Regarding your symptoms of tingling and numbness in your fingers and toes which has progressed, these may be consistent with a neuropathy. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). The small nerve endings supply the skin and sweat glands. 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. 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. Some toxins can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism.
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. Small fiber neuropathy is diagnosed by skin biopsy. Other tests are ordered based on the history and clinical picture.
It sounds like you have a known diagnosis of vitamin b12 deficiency. some causes of this are autoimmune. This is called pernicious anemia. in these cases, if there is documented vitamin b12 deficiency or low MMA levels, oral supplementation with vitamin B12 may not be adequate and injections may be necessary. This is only indicated in documented cases of pernicious anemia (otherwise excess amounts of vitamin b12 can be as harmful as a deficiency). Your tongue pain is ununusual, sometimes vitamin B12 deficiency can cause a time of mucositis that affects the tongue.
Regarding your incontinence, it sounds like you were recently evaluated and had a surgery; there are many causes of urine incontinence, some are urologic and some neurologic. A neurologic cause would possibly be related to the dermoid cyst you had, as it sounds like it was in an area of the body near the sacral spinal cord and nerves which is involved in control of the bladder and urethral spinchter. If you have over-contraction of your bladder, this could be a local bladder problem or related to the spinal cord.
I recommend continued evaluation by your primary doctor for further work-up of yours symptoms with referral to a neurologist should a neuropathy or another neurologic problem be suspected. Follow up for your vitamin B12 deficiency and ruling out the presence of diabetes or glucose intolerance (with a glucose tolerance test) may be indicated.
Thank you for using the forum I hope you find this information useful good luck.
Without the ability to examine you and obtain a history, I can not tell you what your symptoms are from. However, I will try to provide you with some possibilities
Your symptoms are difficult to tie together in 1 unifying diagnosis. Regarding your symptoms of tingling and numbness in your fingers and toes which has progressed, these may be consistent with a neuropathy. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). The small nerve endings supply the skin and sweat glands. 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. 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. Some toxins can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism.
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. Small fiber neuropathy is diagnosed by skin biopsy. Other tests are ordered based on the history and clinical picture.
It sounds like you have a known diagnosis of vitamin b12 deficiency. some causes of this are autoimmune. This is called pernicious anemia. in these cases, if there is documented vitamin b12 deficiency or low MMA levels, oral supplementation with vitamin B12 may not be adequate and injections may be necessary. This is only indicated in documented cases of pernicious anemia (otherwise excess amounts of vitamin b12 can be as harmful as a deficiency). Your tongue pain is ununusual, sometimes vitamin B12 deficiency can cause a time of mucositis that affects the tongue.
Regarding your incontinence, it sounds like you were recently evaluated and had a surgery; there are many causes of urine incontinence, some are urologic and some neurologic. A neurologic cause would possibly be related to the dermoid cyst you had, as it sounds like it was in an area of the body near the sacral spinal cord and nerves which is involved in control of the bladder and urethral spinchter. If you have over-contraction of your bladder, this could be a local bladder problem or related to the spinal cord.
I recommend continued evaluation by your primary doctor for further work-up of yours symptoms with referral to a neurologist should a neuropathy or another neurologic problem be suspected. Follow up for your vitamin B12 deficiency and ruling out the presence of diabetes or glucose intolerance (with a glucose tolerance test) may be indicated.
Thank you for using the forum I hope you find this information useful good luck.
I am eagerly awaiting the MRI results.