subjective weakness, derealization

I am a 31 yr old male with a history of a stable 3.5 cm fibrous dysplasia tumor in the left supraorbital area, with no effect on vision and just minimal brain contact.   It has been completely stable over 4 years since it was found.    I am not on any medications.    

Currently , I have been experiencing a subjective weakness in all 4 limbs,  it seems that when I do repetitive motions my muscles begin to burn and fatigure very quickly,  for example carrying something in my hand,  my arm begins to burn and fatigue and when walking my legs begin to burn and fatigue,  as if I have been exercising with weights.   When at rest, the arms and legs feel stiff in some way,  and when I type at the computer I may hit the wrong keys.     I have also 2 years ago been diagnosed with chronic derealization symptoms without anxiety manifestation...and this seems to be worse when I feel weak.     The feelings in my limbs may be present for just a couple days, then it goes away for a couple weeks, then comes back again.    I was given an MRI of the C/T spine and it was normal,  and my brain scan is normal except for the bony lesion.   I have had my BMP, CBC, TSH, and EKG recently taken with no abnormality

[Sara Khan]

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.

After reading about your symptoms, my concern would be for a problem with the muscle (myopathy) or a problem at the neuromuscular junction ( the location where the nerve meets the muscle). Patients with problems in these two locations, usually present with a feeling of muscle fatigue on use of the muscles. They can be differentiated on the basis of clinical exam and further detail on history. Myopathies can me inflammatory, hereditary or autoimmune. They can sometimes be associated with muscle tenderness. Usually there are no nerve related symptoms.

I think the next step for you should be and Electromyogram (EMG) and Nerve Conduction Study, which is the best way to look for myopathies and neuromuscular junction problems. You may also need further blood testing, to rule out inflammatory and autoimmune conditions. Some of these tests include ESR, CRP, ANA etc. The final diagnosis of such disorders usually requires a muscle biopsy. You should see a neurologist, if you haven't already, because a lot of times, these disorders can be further categorized on the basis of history and neurological exam.

I hope this helps. Good Luck