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Neurology (Expert Forum)
Fluctuating paraesthesiae, gastric symptoms, balance problems, coughing clear gel like mucous
Answered by
Cleveland Clinic, MD - Neurology
Cleveland Clinic
Cleveland - OH
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Fluctuating paraesthesiae, gastric symptoms, balance problems, coughing clear gel like mucous
by Alpha16, Jun 20, 2007 12:00AM
Am 37 yrs female, w allergies,bout of 'chronic fatigue' 3y ago.
9 months ago had Flagyl 400mg bd x7 for vaginal infection. During Flagyl had pins&needles in right hand/leg. On last day of Flagyl during (fish) dinner felt suddenly unreal, right cheek/throat/arm/leg went numb. Balance off, nausea, belching, mid back pains,electric shocks, extreme thirst&hunger. Temp up to 38, bp fluct btw 90/60-145/95, itchy rash. WBC 9.3 had 2x antib. Brain MRI w contr,lumbar punct-normal. Blood normal excpt Eosinophilia 11%, prev Leptosp. Parasite tests negat (live in West Africa). Diagn Ciguatera or poss parasitic inf.Improved over wks/months. In March symptoms returned.
Symptoms now are (all symptoms fluctuate):
1. Paraesthesiae hands/forearms feet/lower legs. Worse from use ie. lifting.
2. Slight muscle weakness forearms after use
3. Dizziness, at times vertigo
4. Pain TMJ/temples
5. Coughing clear gel-like mucous balls.
6. Tightness in neck w. breathing bit obstructed
7. Belching
8. Hypoglycaemia like sympt
9. Tinnitus
10. Itchy rash and wheezing at times
Could Ciguatera do this? My tropical specialist thought Ciguatera would not fluctuate like this. Neuro wnts to do EMG/TT and poss oligcl bands. What would you recommend? Should I see a gastro/internal specialist? Do you think this could be CNS related? MS? Lyme or some other entity that still produces neurotoxins? Thanks
9 months ago had Flagyl 400mg bd x7 for vaginal infection. During Flagyl had pins&needles in right hand/leg. On last day of Flagyl during (fish) dinner felt suddenly unreal, right cheek/throat/arm/leg went numb. Balance off, nausea, belching, mid back pains,electric shocks, extreme thirst&hunger. Temp up to 38, bp fluct btw 90/60-145/95, itchy rash. WBC 9.3 had 2x antib. Brain MRI w contr,lumbar punct-normal. Blood normal excpt Eosinophilia 11%, prev Leptosp. Parasite tests negat (live in West Africa). Diagn Ciguatera or poss parasitic inf.Improved over wks/months. In March symptoms returned.
Symptoms now are (all symptoms fluctuate):
1. Paraesthesiae hands/forearms feet/lower legs. Worse from use ie. lifting.
2. Slight muscle weakness forearms after use
3. Dizziness, at times vertigo
4. Pain TMJ/temples
5. Coughing clear gel-like mucous balls.
6. Tightness in neck w. breathing bit obstructed
7. Belching
8. Hypoglycaemia like sympt
9. Tinnitus
10. Itchy rash and wheezing at times
Could Ciguatera do this? My tropical specialist thought Ciguatera would not fluctuate like this. Neuro wnts to do EMG/TT and poss oligcl bands. What would you recommend? Should I see a gastro/internal specialist? Do you think this could be CNS related? MS? Lyme or some other entity that still produces neurotoxins? Thanks
Doctor's Answer
by Cleveland Clinic, MD, Oct 16, 2007 02:13PM
, Oct 16, 2007 02:13PM
I am happy to address the questions that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a replacement for an office visit with a neurologist. Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.
You have many symptoms that involve multiple body systems, mainly the GI tract and the nervous system. These symptoms are non-specific and can be the manifestation of variety of condition. However, your constellation of symptoms and the results of teh workup you had done so far ruled out many infectious and neurological diseases. it seems to me that Ciguatera poisoning is still a likely possibilty.
Typically Initial signs of poisoning occur within six hours after consumption of toxic fish and include perioral numbness and tingling (paresthesia), which may spread to the extremities, nausea, vomiting, and diarrhea. Neurological signs include intensified paresthesia, arthralgia, myalgia, headache, temperature sensation reversal and acute sensitivity to temperature extremes, dizziness, vertigo, and muscular weakness to the point of prostration. Cardiovascular signs include arrhythmia, bradycardia or tachycardia, and reduced blood pressure. Ciguatera poisoning is usually self-limiting, and signs of poisoning often subside within several days from onset. However, in some cases the neurological symptoms are known to persist from weeks to months. In a few isolated cases neurological symptoms have persisted for several years, and in other cases recovered patients have experienced recurrence of neurological symptoms months to years after recovery. Such relapses are most often associated with changes in dietary habits or with consumption of alcohol.
There is no objective test to establish the diagnosis, it is based on the symptomatology and ruling out other mimicers and possible infectious, metabolic disorders. Lyme disease can present with a wide spectrum of neurological manifestations, but it is usually more specific and focal than your symptoms. You also had an unremarkable neurological workup so far (MRI, CSF studies, EMG). I suggest you see an infectious disease specialist to revisit your illness and reevaluate the whole course. If the diagnosis of Ciguatera poisoning is established, management is typically by supportive care and symptomatic treatment. There is no effective treatment or antidote for ciguatera poisoning. Some medications, dietry supplements and natural therapies have been tried with variable results. There are no good data to suggest any of these as therapeutic options. Symptoms like nerve pain or the sensory disturbance can be managed by using some medications like Gabapentin.
Good luck, I hope you feel better soon.
You have many symptoms that involve multiple body systems, mainly the GI tract and the nervous system. These symptoms are non-specific and can be the manifestation of variety of condition. However, your constellation of symptoms and the results of teh workup you had done so far ruled out many infectious and neurological diseases. it seems to me that Ciguatera poisoning is still a likely possibilty.
Typically Initial signs of poisoning occur within six hours after consumption of toxic fish and include perioral numbness and tingling (paresthesia), which may spread to the extremities, nausea, vomiting, and diarrhea. Neurological signs include intensified paresthesia, arthralgia, myalgia, headache, temperature sensation reversal and acute sensitivity to temperature extremes, dizziness, vertigo, and muscular weakness to the point of prostration. Cardiovascular signs include arrhythmia, bradycardia or tachycardia, and reduced blood pressure. Ciguatera poisoning is usually self-limiting, and signs of poisoning often subside within several days from onset. However, in some cases the neurological symptoms are known to persist from weeks to months. In a few isolated cases neurological symptoms have persisted for several years, and in other cases recovered patients have experienced recurrence of neurological symptoms months to years after recovery. Such relapses are most often associated with changes in dietary habits or with consumption of alcohol.
There is no objective test to establish the diagnosis, it is based on the symptomatology and ruling out other mimicers and possible infectious, metabolic disorders. Lyme disease can present with a wide spectrum of neurological manifestations, but it is usually more specific and focal than your symptoms. You also had an unremarkable neurological workup so far (MRI, CSF studies, EMG). I suggest you see an infectious disease specialist to revisit your illness and reevaluate the whole course. If the diagnosis of Ciguatera poisoning is established, management is typically by supportive care and symptomatic treatment. There is no effective treatment or antidote for ciguatera poisoning. Some medications, dietry supplements and natural therapies have been tried with variable results. There are no good data to suggest any of these as therapeutic options. Symptoms like nerve pain or the sensory disturbance can be managed by using some medications like Gabapentin.
Good luck, I hope you feel better soon.
I have had the same as you but also have unequal pupils and sinus tachycardia which is constant with right bundle branch block.
I have had balance problems on and off (a couple of times a year), gastric symptoms, coughing gel like mucous which is clear, stuffy nose, pressure on sinuses, paresthesias which fluctuate.
1 -3x a day or Frenagreek tea
you may have yeast in GI tract
can give bloating gas bleaching.
I also have that cough
I 'd go to an allergist or Holestic DR.
antibiotics can cause GI tract discomfort.
lyme disease is something to check
though I have found it doesn't always show up but ya
may have it.
for my cough I bought a saline nasel spray to flush out my nose
I also take bendryel for the postnasel drip which has
helped my coughing
but I have lyme disease and the cough is due to that.
Lyme also effected my GI tract big time.
this is what has helped me.though I am not a Dr.
good luck feel better
Yes, tested Lyme negative, but I know that doesn't mean anything, want to see a Lyme literate doctor.
Quills - I also get blurred or double vision, comes together with the balance problem. Do your symptoms all fluctuate? I just had about two weeks of coughing the gel balls and more paraesthesias but now they are gone again, but I have more feeling of pressure in cheeks, teeth, TMJ, temples etc, sometimes feel like inside my palate is numb.
I was also itchi