What do you think my problem is?

[Charles]

Hello, doctor.  I am a 32yo male internist practicing in NYC.  I am 5

[tempusedaxrerum]

A related discussion, Sudden onset occipital-cervico-brachial neuralgia was started.

[Charles]

Hello doctor.  Recently I have started to take a new antibiotic, Avelox.  I have tried empirically, Augmentin and Ciprofloxacin in the past without any response.  Although I have no other constitutional symptoms, I gave Avelox a try anyway since the drug rep is very eager to give me free samples.  I took it for 3 days and my symptoms are much improved.  I can sit better more comfortably.  Because of this, I have postponed my EMG study.  I will wait and see if my symptoms would completely resolve on this antibiotic.

[Charles]

Thank you, doctor, for your response.  I will consider your advice seriously and will suggest SSEP to my neurologist as part of my work up.  I will keep you updated on any new development of my condition.  Once again thanks for your input,  It is very much appreciated,  

As for "M", thank you for your input as well.  I agree with you wholeheartedly that some doctors often dismiss a patient's complaint as "anxiety" when they could not figure out what is going on.  This not only insults a patient's intelligence but also betrays his or her trust,  After my ordeal over the past 2 years, I have learned to be a better physician who cares and listens, even more so than before.  Once again thanks for your support.

Charles

[M.]

I'm not a doctor, but I have pain in the jaw area you describe. Have you considered trigeminal neuralgia or a related facial neuralgia? Obviously, that cannot account for your other symptoms, but as I understand it TN can sometimes occur with multiple sclerosis -- which often has variable and odd sensory symptoms and which does not always reveal lesions at first on the MRI? Have you had an MRI of the brain or only of the spine?

As well, I ordered some TN information from the TN association, and I seem to recall that some of the causes of TN can be a viral demylenating process or something like that. Perhaps you had a kind of virus which caused demyelination of the trigeminal nerve and in another place on your spine or brain which is not severe enough to show up in the MRI and which will get better?

A friend of mine with MRI- proven MS has in recent months had a lot of neuropathic pain which is not explained by any new lesions. So, scans can't reveal everything.

Whatever you do, don't let them convince you it's anxiety. You know your body best -- keep on looking until you find a doctor who will help you find out the answer. Maybe a neurologist or an infectious disease specialist.

[CCF Neuro[P] MD, RPS]

Dear Dr. Shum:

Thank you for your complete history.  I am not sure what to tell you.  The problems seem to be sensory in nature and therefore one suspects somesort of spinal problem.  However, the MRI of the spine, and various lab testings seem to leave you at a dead end.  Since there is almost no abnormality to speak of, I think following is the only thing to do and wait for somesort of definitive symptom change or lab change.  The differential of intramedullary, extramedullary (intradural, extradural) is pretty broad.  However, the MRI and lab testing would unravel most of the differential.  Since it is not pressure sensitivity, per se, I would exclude Issac's syndrome.  May be some SSEP of the lower extremities might pick something up?  

I will respond again if I think of anything.

Sincerely,

CCF Neuro MD