viral myelitis or something else

[ahoskrn]

Dear Doctor: I am a 40 year old female, no prior health issues.
9 weeks ago I began tingling in my left fingers and hand. 2 days later horrific diareah which included violent shaking and drenching sweat. 2 dyas later tingling spread to my right hand and fingers. 2 days later to my right toes,leg and then left toes,leg. My symptoms have included: On again off again numbness, sharp shock feelings, pins and needles, burning, stinging, "hot" boiling water pouring down my thigh, buzzing in all four extremities. My muscles have felt heavy and weak on and off. I have had tremoring in my hands and arms on and off. All blood work including thyroid panel was negative except for elevated Neutrophils at 84. B-12 level was low normal at 301 (211-990).  Reflexes a little brisk. Tremoring visualized.   Brain MRI and C and T spine MRI with and without glad were normal. Lumbar puncture, normal, no bands, protein a normal 24, no WBC. I was put on 4mg Decadron BID for 5 days when I saw the neuro 4 weeks into symptoms. It seemed to make everything worse. I have been placed on Lyrica 75mg BID and it is helping to quiet the symptoms down, but they are still there. The doctor thinks it is somekind of viral myelitis. Question: is there any other test we can do to pin point what is going on with my nervous system. Does this sound like anything else you've ever seen? Can these nerves heal and what would be a reasonable time limit? Prior to the onset of symptoms, I had been using tagamet a lot and did a course of prilosec. Could this have anything to do with my symptoms?

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.      
   The symptoms that you describe are non-specific, but are concerning and will require more testing.  The symptoms of chills, sweats and diarrhea followed by tingling in the fingers, weak muscles (spreading from the legs then to the arms) are symptoms of Guillan Barre syndrome(GBS).  However , GBS is associated with decreased reflexes and a high protein in the CSF (making GBS less likely for you).  Your symptoms of burning, buzzing feeling and weakness with increased refexes, could possibly be related to a myelitis (spinal cord problem).  When MRI of the Brain, cervical and thoracic spine are normal then somatosensory evoked potentials (SSEPS) may be helpful in determining is a function lesion of the spinal cord exists.  Given your equivocal B12, I would suggest a homocysteine level and a MMA (methyl malonic acid), which will both be elevated in a B12 deficient state.  I would also suggest an EMG of your arm/leg to determine if a polyneuropathy (of the peripheral nerves) could be contributing to your symptoms.    I agree with the use of medications for neuropathic pain (including lyrica, neurontin, elavil, cymbalta etc) for symptomatic control.  I do not think the use of tagament or prilosec are related to your present symptoms.  Except that decreased acid production in the stomach can lead to decreased B12 absorption.
I hope this has been helpful.

[JCmcc]

Myelitis (TM/ATM) symptoms aside from respiration troubles, symptoms remain below the belt as this is usually at the thoracic level.

Good Luck!
JCmcc.

[AMO]

ahoskm,
i do hope your doctors can realize  what is happening with you, and hope for you to be welll very soon.
keep faith, amo


John ,
a simple google search .... myelitis + viral... reads that  TM can cause symptoms  not only effecting below the belt but can effecting the arms as well , so, symptoms can be more than respiration troubles above the belt.

[JCmcc]

Why are you referring to me by first name? How do you know my first name? That is prohibited on here. I do not appreciate that.

Aside from that mess up:

You bring up and interesting point. I was always taught/told that ATM/TM presents only below the belt. This is interesting. Where did  you find that information?

4 neurologists, including one in my family, dispute that information but then again they also dispute that I have LD and not MS.

?

[Quixotic1]

The heavy use of antiacids or acid reducing meds can cause B12 deficiency because the B-12 is poorly absorbed when the stomach acid is reduced. This is an especially common  cause of  acquired defciency.  Low B-12 can mimic many types of serous neurological illness and is especially known for it's sensory effects, paresthesias, tinglings, hot/cold sensation etc.  Your level was "low-normal".  Could that "iffy" level have reflected a couple doses of a multivitamin or something and not reflect an earlier much lower level?  I am not at all dicounting a TM or related post-viral entity, but you might want to Google B-12's symptoms and medicine side effects which cause it.  The treatment would be B-12 shots which are relatively innocous.  If you think you might have resumed vitamins or taken more when you had mysterious and scary symptoms, discuss this with your Dr.

Good luck, Quix

[Gracygirl]

I am having the same trouble the symptoms came on a bit different, but it sounds like what I had all last year and continue to recover from.  See my story below:
Last March (2006) I started to experience symptoms of numbness, tingling, burning and severe weakness in my thigh and calf muscles. Simmultanously I also got carpel tunnel in both wrists. I was very sick from the pain found that sitting relieved my symptoms briefly but eventually they would return when I attempted to walk. Gradually I began to get sicker and my neuroligist told me after several blood tests that I had the coxsackie virus, but he was not sure the coxsackie was responsible for the neuropathies. After 5 hospital vistis including the Cleveland Clinic, 2 muscle biopsies, MRI's, CT scans, spinal tap and several rounds of rehab, all testing was negative except for original bloodwork which showed my immunogammaglobulins were out of wack and my ANA was slightly elevated. It was concluded by a neuromuscular specialist that I suffered from a post viral syndrome and she felt that I would slowly recover within a year . I am not confident that this is what caused these symptoms and am concerned that something is being overlooked. The diagnosis given was purely based on exclusion. I was using crutches, and a walker for the first 5 months and then for the final part of the year (7 months)I was in a wheelchair and unable to walk. I started walking in mid-December and have continued successfully without a great deal of pain until now. The past few days I feel the symptoms cropping up again and I am not sure if it is normal for this to happen after such a long illness and recovery. The weather is very damp here and It may be just a temporary setback, but I am searching for anyone who may have had this or knows someone who did. I need advice on how to deal with the pain. Can I recover from these neuropathies? Thanks all.

I am in WYN, we have seen quite a few similar cases of viral myelitis here...I wonder if there is a connection.

[Ziggy22]

I have been experieng the same symptoms.  Fianally after four months i am able to move around a little.  I have been through several test including three MRI.  All of the MRI's show very little or small non specific lesions.  I has a severe case of bi lateral optic neuritis which has causes me to go leagally blind without glasses and the vision loss they are saying may now be permenant.  Had a spinal tap and for the most part not too unual however, the City I live in recieved a very vague report that stated possible aseptic menegitis.  I have not had a fever recently and no rash was reported.  I am so frustrated at this point I do not know where to turn.  The neurologist I am seeing is as frustrated as me.  Does anyone have any advice.