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Extremity discomfort, burning and heaviness
I am a 35 year old male with a history of bilateral extremity discomfort, burning, heaviness and perceived weakness. Otherwise, I am in excellent health. My history is as follows:
August 2001: experienced burning sensation in both hands and both feet (worse on right side). Sensations seemed to focused on nailbeds. The sensations continued and evolved in a tight feeling around bicep (as if a cuff was applied). The feeling resembled a heaviness in all extremities, again worse on the right side. There is no numbness but the feeling is as if the hands, feet, calves and arms are full of blood -- minor tingling. There were muscles twitches in the calves and tighteness in calves. I had a full neuro workup including blood work (including lyme and B12), MRI of brain and cervical spine, EMG and spinal tap. Everything came back normal. Physical exams by two respected NYU neuros were normal. Prior to 2001, I had a history of headaches on right side of head and eye pain. Eye exams were normal
Symptoms persisted for six months and then resolved spontaneously.
April of 2005: identical symptoms reappeared at the tail end of very bad cold/virus and the midst of a very stressful situation. Neuro exam normal and repeat MRI of brain and cervical spine w/ and w/out contrast were normal. The symtoms have been constant for over 45 days.
I am concerned about MS and I have done far too much reading about it. Is there another explanation for the symtoms? What is the likelihood this could be MS? Is there anything else I should be doing? Thanks.
August 2001: experienced burning sensation in both hands and both feet (worse on right side). Sensations seemed to focused on nailbeds. The sensations continued and evolved in a tight feeling around bicep (as if a cuff was applied). The feeling resembled a heaviness in all extremities, again worse on the right side. There is no numbness but the feeling is as if the hands, feet, calves and arms are full of blood -- minor tingling. There were muscles twitches in the calves and tighteness in calves. I had a full neuro workup including blood work (including lyme and B12), MRI of brain and cervical spine, EMG and spinal tap. Everything came back normal. Physical exams by two respected NYU neuros were normal. Prior to 2001, I had a history of headaches on right side of head and eye pain. Eye exams were normal
Symptoms persisted for six months and then resolved spontaneously.
April of 2005: identical symptoms reappeared at the tail end of very bad cold/virus and the midst of a very stressful situation. Neuro exam normal and repeat MRI of brain and cervical spine w/ and w/out contrast were normal. The symtoms have been constant for over 45 days.
I am concerned about MS and I have done far too much reading about it. Is there another explanation for the symtoms? What is the likelihood this could be MS? Is there anything else I should be doing? Thanks.
There is no suggestion of MS especially given the repeat normal MRI brain an cervical spine - I would try to decrease your reading about MS!
I cannot give you a definite clinical diagnosis over the internet, but some suggestions that may have been approached already might be a postviral syndrome/neuropathy given the assocaiation with a viral illness and the length of time it took to resolve - that implies that your prognosis is very good
Some postviral syndromes can be more severe such as Guillan Barre syndrome (one cause of it), so if your symptoms get markedly worse you should seek further medical attention.
Otherwise testing for B12, folate, Lyme, inflammation (ESR, ANA), monoclonal proteins, porphyria, diabetes et c can be done to look for another cause but the likliehood that anything specific will be found is probably low. In a large percentage of case like yours no cause is found. Do not fret though as it is very encouraging that all your tests have been normal
Good luck
I cannot give you a definite clinical diagnosis over the internet, but some suggestions that may have been approached already might be a postviral syndrome/neuropathy given the assocaiation with a viral illness and the length of time it took to resolve - that implies that your prognosis is very good
Some postviral syndromes can be more severe such as Guillan Barre syndrome (one cause of it), so if your symptoms get markedly worse you should seek further medical attention.
Otherwise testing for B12, folate, Lyme, inflammation (ESR, ANA), monoclonal proteins, porphyria, diabetes et c can be done to look for another cause but the likliehood that anything specific will be found is probably low. In a large percentage of case like yours no cause is found. Do not fret though as it is very encouraging that all your tests have been normal
Good luck
A related discussion, burning extremities was started.
One respondent wrote:
>>Some postviral syndromes can be more severe such as Guillan Barre syndrome (one cause of it), so if your symptoms get markedly worse you should seek further medical attention.
Otherwise testing for B12, folate, Lyme, inflammation (ESR, ANA), monoclonal proteins, porphyria, diabetes et c can be done
<<
I share similar symptoms (tingles in hands, lips, chin, tinnitus) but I've been associating these with blood-pressure changes. BUT..it actually had occurred to me that a severe sinus infection I'd had last year may have something to do with these manifestations.
I'd put the blame on the medication, maybe; I was prescribed
Levaquin, and Bactrim, both of which I had slight but noticeable allergic reactions to. I just wonder what's really going on; the symptoms are fairly unnerving and, like everyone else's tests,
mine all come back 'normal'.
Unfortunately, 'normal' is a setting on your washing machine, Not a clinical diagnosis.
-TJB
>>Some postviral syndromes can be more severe such as Guillan Barre syndrome (one cause of it), so if your symptoms get markedly worse you should seek further medical attention.
Otherwise testing for B12, folate, Lyme, inflammation (ESR, ANA), monoclonal proteins, porphyria, diabetes et c can be done
<<
I share similar symptoms (tingles in hands, lips, chin, tinnitus) but I've been associating these with blood-pressure changes. BUT..it actually had occurred to me that a severe sinus infection I'd had last year may have something to do with these manifestations.
I'd put the blame on the medication, maybe; I was prescribed
Levaquin, and Bactrim, both of which I had slight but noticeable allergic reactions to. I just wonder what's really going on; the symptoms are fairly unnerving and, like everyone else's tests,
mine all come back 'normal'.
Unfortunately, 'normal' is a setting on your washing machine, Not a clinical diagnosis.
-TJB
Hi Balt,
I have similar symptoms -- bilateral burning and pain in my arms and legs. I also have weakness and clumsiness in my fingers. I was extremely worried about MS for a while, but my cervical and brain MRIs came back normal. I'm not a medical professional, but my understanding is that a brain/cervical MRI would be abnormal in 90-95% of people with MS, so I now know that's very unlikely for me. (And for you to have had two normal MRIs makes it even less likely, I think.) I have also had tests for rheumatoid arthritis and lupus, as well as metabolic problems like thyroid -- have you had these tests? At this point, I think lyme disease is the most likely candidate for me (I hike a lot, though I'm in a low-risk area), and I'm going to ask the neuro about getting tested for it. I know how frustrating it is to go from being a perfectly healthy person to having chronic problems like this ... I hope you get some answers soon.
I have similar symptoms -- bilateral burning and pain in my arms and legs. I also have weakness and clumsiness in my fingers. I was extremely worried about MS for a while, but my cervical and brain MRIs came back normal. I'm not a medical professional, but my understanding is that a brain/cervical MRI would be abnormal in 90-95% of people with MS, so I now know that's very unlikely for me. (And for you to have had two normal MRIs makes it even less likely, I think.) I have also had tests for rheumatoid arthritis and lupus, as well as metabolic problems like thyroid -- have you had these tests? At this point, I think lyme disease is the most likely candidate for me (I hike a lot, though I'm in a low-risk area), and I'm going to ask the neuro about getting tested for it. I know how frustrating it is to go from being a perfectly healthy person to having chronic problems like this ... I hope you get some answers soon.
The description of your symptoms is eerily similar to that of my own (see my earlier post:http://www.medhelp.org/forums/neuro/messages/33611.html)
Like you, I'd initially read up on and suspected MS. Here is what I can tell you based on what I've been told from medical professionals:
1. It is very unusual for MS to present itself with simultaneous, bilateral pain, numbness, etc. in all four extremeties. MS usually presents itself via lesions on specific areas of either the spinal cord and brain that then affect specific areas of your body relative to the location of those lesions (for example, symptoms may occur in your lower extremities but not your upper ones; one leg or one arm; your vision, etc.)
2. It is very unusual for MS not to show up on two sets of MRI's done as many years apart as your MRI's. I'm assuming your spinal tap tested for oligoclonal bands, which typically appear if you have MS. That your spinal tap came back negative should be re-assuring. That test alone doesn't rule out MS, BUT that test IN COMBINATION with negative MRI's and bloodwork makes it unlikely.
3. When MS recurs, it often does not recur with symptoms identical to the last attack.
We appear to be, in many ways, sitting in the same boat. If you haven't done so already, you may want to pursue a consultation with a Rheumatologist, looking for connective tissue disorders that mimick neurological ones. What part of country are you from? You may want to check with the CDC to determine if there are any spikes of unusual cases in your area (Lyme disease, lead poisoning, etc.)
Have your symptoms been mostly sensory-related (i.e. your doctors can't physically "see" or objectify your symptoms)? Perhaps your issues are also related to what the neuro described in my post: the phenomenon known as "Central sensitization."
Like you, I'd initially read up on and suspected MS. Here is what I can tell you based on what I've been told from medical professionals:
1. It is very unusual for MS to present itself with simultaneous, bilateral pain, numbness, etc. in all four extremeties. MS usually presents itself via lesions on specific areas of either the spinal cord and brain that then affect specific areas of your body relative to the location of those lesions (for example, symptoms may occur in your lower extremities but not your upper ones; one leg or one arm; your vision, etc.)
2. It is very unusual for MS not to show up on two sets of MRI's done as many years apart as your MRI's. I'm assuming your spinal tap tested for oligoclonal bands, which typically appear if you have MS. That your spinal tap came back negative should be re-assuring. That test alone doesn't rule out MS, BUT that test IN COMBINATION with negative MRI's and bloodwork makes it unlikely.
3. When MS recurs, it often does not recur with symptoms identical to the last attack.
We appear to be, in many ways, sitting in the same boat. If you haven't done so already, you may want to pursue a consultation with a Rheumatologist, looking for connective tissue disorders that mimick neurological ones. What part of country are you from? You may want to check with the CDC to determine if there are any spikes of unusual cases in your area (Lyme disease, lead poisoning, etc.)
Have your symptoms been mostly sensory-related (i.e. your doctors can't physically "see" or objectify your symptoms)? Perhaps your issues are also related to what the neuro described in my post: the phenomenon known as "Central sensitization."
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