Episodic Problem Walking

[giannasi]

I'm a 29 yo female, 2 young sons, normal weight.

I have always had Raynaud's syndrome, and really low blood pressure.  In 1998 I was dx with RSD in my right foot because it started burning and some temperature change was seen on a bone scan.  I took Vioxx a few years and then stopped, because it was low level pain. Still hurts sometimes.

A few years later I had a bad bout with mono, that took a while to shake.  Felt better in time.

I went to the doctor twice postpartum, feeling run down,  my legs were weak--and, sometimes at night, I would collapse when I first stood up.  But all blood work, thyroid, anemia issues were fine.

Two weeks ago I was feeling crappy and went to the doctor--signs of strep without sore throat or fever-has happened before.  Apparently throat looked awful.  Went on amoxicillin.

Four days after strep dx, I was sitting, holding the baby not feeling stressed.  Got dizzy, felt weird.   Once I got up, I had this crazy walk where I couldn't make my right leg move right or bear weight correctly.  Could walk correctly if I engaged muscles in thigh and kept leg completely straight.  My speech was slurred but my smile was symettrical, could do other stroke tests, so just decided to go to doctor next day.

Next day at doctor: low fever, lymph nodes enlarged, still walking funny, but speech almost totally normal.  Brain/cervical spinal MRI were perfect.  No MS. Blood work fine.  Had peripheral nerve work today, 2 weeks later, but NCV and EMG were fine. No CMT.

I was still walking funny when I left the ER, but within 48 hours I could walk and speak just fine, although my whole right side felt slightly weird.  

Is it worth it for me to follow this up? I feel like I'm going crazy.  Could it be rheumatological or cardiovascular?  Could it have been a TIA?  That is the only thing that scares me.  

[giannasi]

A few other tidbits of info, and then I will stop posting.

I am most concerned about a circulatory problem, as I have Raynaud's (hereditary, primary variety), have seen more and more "floaters" in my eyes in the past years, and particularly the past month, and my supposed "RSD" was dx based upon a bone scan showing abnormal circulation (but the main problem with my foot is stiffness, excessive popping, and low level burning, not the pain typical of RSD.  I was treated with Vioxx/Celebrex until it was interfering too much with my digestive tract, so I stopped on my own, pre-recall.  That did help the stiffness, while I took it.)

BUT--I am also a normal weight, active, low blood pressure, low cholesterol, 29 year old female.  So that doesn't add up.  But maybe this is why doctor's haven't explored circulatory causes.

I suppose I will wait for another flare in symptoms before returning to my internist.  It is frustrating to want to know what is going on, but to not want to irritate the insurance company or appear to be a hypochondriac!  Something is weird though.  Doesn't prohibit my lifestyle, mostly, but it seems like a time bomb.

[giannasi]

Two days after I posted this, I went back to my internist.  Turns out I had strep again, and he put me on a Z-pack.  His opinion is that there is no way it was a TIA, and perhaps it was related to strep (although I never had a fever above 99 or particularly sore throat).  He wanted to wait & see, not do anything further.  I went to ENT (on account of follow up strep infection) and Romberg was positive (but hearing is fine) so they did an ENG, which was almost entirely normal.

So I was left with "oh well."

Last night, for the first time in a long time, I slept on my right side.  Made a conscious decision to do so, as I naturally prefer the right side.  When I got up to shower I fell down.  Realized I couldn't exactly feel my foot/leg, but circulation came back fast and pins & needles weren't that bad.  Thought back, and realized that, two months postpartum, I had a mole removed from the side of my scalp, so I'd not slept on my right side for months (it took a while to heal because they cauterized instead of stitching).

So, the only thing I can add to this constellation of symptoms is that apparently I am falling down when I get up because my leg falls asleep (but only the right one, and only when I sleep on my right side).

If this would give you any further insight, I would appreciate it.

Right now I still feel weak at times and slightly dizzy at times but functional.  Just want to get to the bottom of this before it happens again.  Thanks so much.

[Kevin Pho, MD]

   I agree with the workup for neurological symptoms.  A negative MRI, nerve conduction studies and EMG's would make these possibilities less likely.  

A TIA is possible, and if suspected by your personal physician, a small dose of daily aspirin can prevent progression.

A rheumatological workup can be considered - as these non-specific symptoms can be caused by lupus and other joint diseases.  Blood tests looking at the ANA and rheumatoid factor can be considered.

A fasting blood sugar level can evaluate for hypoglycemia.  

I am not aware of other major causes for slurred speech.  If it recurs, I would discuss this symptom with another neurological opinion.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[Kevin Pho, MD]

I agree with the workup for neurological symptoms.  A negative MRI, nerve conduction studies and EMG's would make these possibilities less likely.  

A TIA is possible, and if suspected by your personal physician, a small dose of daily aspirin can prevent progression.

A rheumatological workup can be considered - as these non-specific symptoms can be caused by lupus and other joint diseases.  Blood tests looking at the ANA and rheumatoid factor can be considered.

A fasting blood sugar level can evaluate for hypoglycemia.  

I am not aware of other major causes for slurred speech.  If it recurs, I would discuss this symptom with another neurological opinion.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[giannasi]

Could it have been hypoglycemia?  I don't have diabetes or high blood sugar.  But I get dizzy easily when I don't eat.  I hadn't eaten in a long time when this happened.  Thanks, I appreciate it.  TIA just doesn't seem right but what else could account for slurred speech?