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Gradual demyelinization ongoing for 4 years
by epsilon, Jul 23, 2008 01:15AM
Patient is male, 40 years-old, athletic, non-smoker, non-drinker. Antecedents of mild diabetes (father, grand-father) but patient has always tested negative (most recent was one ear ago).
Issue: patient developed over the last four years a gradual worsening of neurological problems involving tingling, pain, loss of sensation and loss of dexterity in many areas of the body, but mostly, by decreasing order, in the hands, arms, legs, feet, left side of the face.
The symptoms are more pronounced on the left side (could be related to sleeping position) in the hands (which appear to be related to use of computer keyboard) and in the legs (pressure at the back of the legs due to sitting position), overall anywhere nerve pressure or friction occurs. As an example of that, massaging the underside of the left arm brings shooting pain to the left fingers.
Using a chart of dermatomes for comparison, thingling and pain is mostly in C8 (cubital nerve), with C7, C6 and C4 affected at times. Also S1 and L5 are affected, with S2, S3, S4 and S5 present during acute episodes. Lately, tingling in V1, V2, and V3 has become more important.
The symptoms appear in cycles of roughly 1 to 3 months, and more recently are accompanied by tremendous difficulty to concentrate. During the most acute episode, a strong constant pain occurs in the spleen, which is more uncomfortable depending on position. Patient has history of adolescent mononucleosis, and the same spleen pain kept recurring for many years after the initial attack, mainly during periods of stress and fatigue.
During these acute episodes, patient encounters severe pain and sleep disruption, as legs and arms appear restless. And during those episodes, the pain follows precisely the path of a given set of nerves (sciatic, cubital, etc), is accompanied by acute pain at the relevant articulations, and intense tingling in the relevant extremity. For example, pain along left side of the left leg, left side of the left knee and tingling on the small toes of the left leg.
Patient tested negative to diabetes, HIV and lupus. Cerebral MRI shows no sign of MS, and columnar MRI no sign of narrowing nerve passages. Blood tests show no sign of infection. EMG however clearly shows indications of alterations (slower impulses), within the normal range but at the extreme limit, compatible with demyelinization, in the four members. Reflection MRI indicate that the problem isn't limited to the peripheral nerves.
The onset was fours years ago, following what appears to be an impact to the left ulnar nerve. Patient lost gradually during the period of a month the use of the left hand (dexterity and mobility related to ulnar nerve) and that lost lasted a year. All of the symptoms in the other extremities developed following that incident. The loss of the hand created tremendous stress as it occurred during an already stressful period of personal issues.
Patient is also suffering from episode of reactive depression triggered by the worsening situation, the pain, the loss of activity, the disbelief encountered in the medical profession, and the impact that this medical issue had on work, lifestyle and relationship. Periods of relative freedom from pain are also relatively free from depression of stress. Patient manages these episodes with the support and comfort of his higher-power.
As the years passed, the symptoms became clearer, and with the indication as noted above of demyelinization, investigations into environmental factors were made without success. Patient moved to a different country, completely changed habits, work and regime to no effect. The only finding are that periods of total abstinence from caffeine, or alcohol, or with large intakes of vitamin B, C and D have a positive impact on the amount and severity of tingling and pain.
The most interesting recent finding and hope is that episodes of pain can be stopped with the intake of ciprofloxacin 500mg q 12 h 14 d.
Patient would appreciate if someone could indicate tests to perform and physicians to meet.
Patient has worked in South America (Brazil) and in the region of the Sahel, Africa (Mali, Burkina Faso). Former partner appears unaffected by these issues, but patient can not confirm.
Issue: patient developed over the last four years a gradual worsening of neurological problems involving tingling, pain, loss of sensation and loss of dexterity in many areas of the body, but mostly, by decreasing order, in the hands, arms, legs, feet, left side of the face.
The symptoms are more pronounced on the left side (could be related to sleeping position) in the hands (which appear to be related to use of computer keyboard) and in the legs (pressure at the back of the legs due to sitting position), overall anywhere nerve pressure or friction occurs. As an example of that, massaging the underside of the left arm brings shooting pain to the left fingers.
Using a chart of dermatomes for comparison, thingling and pain is mostly in C8 (cubital nerve), with C7, C6 and C4 affected at times. Also S1 and L5 are affected, with S2, S3, S4 and S5 present during acute episodes. Lately, tingling in V1, V2, and V3 has become more important.
The symptoms appear in cycles of roughly 1 to 3 months, and more recently are accompanied by tremendous difficulty to concentrate. During the most acute episode, a strong constant pain occurs in the spleen, which is more uncomfortable depending on position. Patient has history of adolescent mononucleosis, and the same spleen pain kept recurring for many years after the initial attack, mainly during periods of stress and fatigue.
During these acute episodes, patient encounters severe pain and sleep disruption, as legs and arms appear restless. And during those episodes, the pain follows precisely the path of a given set of nerves (sciatic, cubital, etc), is accompanied by acute pain at the relevant articulations, and intense tingling in the relevant extremity. For example, pain along left side of the left leg, left side of the left knee and tingling on the small toes of the left leg.
Patient tested negative to diabetes, HIV and lupus. Cerebral MRI shows no sign of MS, and columnar MRI no sign of narrowing nerve passages. Blood tests show no sign of infection. EMG however clearly shows indications of alterations (slower impulses), within the normal range but at the extreme limit, compatible with demyelinization, in the four members. Reflection MRI indicate that the problem isn't limited to the peripheral nerves.
The onset was fours years ago, following what appears to be an impact to the left ulnar nerve. Patient lost gradually during the period of a month the use of the left hand (dexterity and mobility related to ulnar nerve) and that lost lasted a year. All of the symptoms in the other extremities developed following that incident. The loss of the hand created tremendous stress as it occurred during an already stressful period of personal issues.
Patient is also suffering from episode of reactive depression triggered by the worsening situation, the pain, the loss of activity, the disbelief encountered in the medical profession, and the impact that this medical issue had on work, lifestyle and relationship. Periods of relative freedom from pain are also relatively free from depression of stress. Patient manages these episodes with the support and comfort of his higher-power.
As the years passed, the symptoms became clearer, and with the indication as noted above of demyelinization, investigations into environmental factors were made without success. Patient moved to a different country, completely changed habits, work and regime to no effect. The only finding are that periods of total abstinence from caffeine, or alcohol, or with large intakes of vitamin B, C and D have a positive impact on the amount and severity of tingling and pain.
The most interesting recent finding and hope is that episodes of pain can be stopped with the intake of ciprofloxacin 500mg q 12 h 14 d.
Patient would appreciate if someone could indicate tests to perform and physicians to meet.
Patient has worked in South America (Brazil) and in the region of the Sahel, Africa (Mali, Burkina Faso). Former partner appears unaffected by these issues, but patient can not confirm.
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Both of my arms feel weak and I have tingling sensation on the shoulders and arms, loss of sensation on the scalp, all of it more pronounced on the left side.
I don't want to take cipro again. Any suggestion welcome. Anything.