strange multiple symptoms - frustrated

[klm3739]

I have been having weakness in my thighs, cramps in the muscles of my hips, buttocks and backs of thighs, muscle cramping at the edge of my right rib cage close to the sternum - bad enough to pull me down - and at times the muscle band that runs from there diagnally down to the left lower quadrant will actually twist - very painful; also have feeling of being on a boat that lists to the right with occasional feelings of the boat rising and falling as if a wave picked it up; extreme fatigue in leg muscles after walking short distances - 30-40 ft feels like I walked a marathon; head pain - no not headaches - pain - shooting/stabbing from right front of forehead to the base of my skull causing pain at the base of skull, pain moving eyes left or right (like to glance in sideview mirrors) or up to glance in rearview; depression - now on wellbutrin sr 150mg 1tab 2x/day; joint pain where tendons attach; tested for lyme, lupus, ra, oa, cbc, wbc, etc all normal - vit d deficiency - corrected with supplements - still have symps-  EMG NCV negative, EEG negative, MRI - 1.08 cm CSF space in right medial temporal lobe with some partial peripheral area of contrast enhancement also shows T2 bright signal in bilateral fontoparietal lobe and one involving the periventricular region.  My neurologist says "definitely not MS" - doesn't know what it is and has left me hanging since the EEG a month ago.  I have trouble driving due to the floating sensation and eye movement - these come and go.  must drive to get to work and am frustrated - any suggestions?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

There are several causes for muscle cramps and muscle fatiguing. Muscle cramps are not an uncommon manifestation of a systemic viral illness, however, this seems less likely since you don't have other symptoms of a viral infection and this has been going on for a while. Another possibility is a myopathy, which is basically a generic term for a muscle problem. Myopathies can be inflammatory, as is the case with a disorder called polymyositis which is an autoimmune disorder. Also, there are genetic myopathies, of which there are several, each with its own characteristics and features. Finally, and probably most commonly, metabolic causes such as thyroid problems or low potassium can be the cause of muscle cramping. The latter two can be diagnosed with simple blood tests.

EMG in addition to simple blood tests such as a CK level can assess for the presence of myopathy, and can also diagnose/exclude ALS. It sounds like you have had the EMG, but no CK level.

Certain medications, particularly cholesterol medications called statins, can cause muscle cramping. Another medicine that you mentioned, Bupropion, has been associated with causing tremors, muscle aches, weakness, arthralgias, arthritis, sensory changes, neck pain, and twitching.

With regards to the headache, headaches can be a primary headache (such as a migraine) or secondary headache (such as from a structural lesion in the brain). One type of headache in the posterior part of the head is a cervicogenic headache. This headache is "referred" to the head from bony structures, muscles, and other soft tissue in the neck and shoulders. Symptoms are usually one-sided and include: precipitation of head pain by neck movement or awkward neck positions, head pain when external pressure is applied to the neck or occipital region, restricted range of motion of the neck, and neck, shoulder and arm pain. Treatment for cervicogenic headache includes physical therapy, medications.

Another type is occipital neuralgia. This headache is caused by irritation or injury to two nerves that run from the upper neck to the back of the head. The irritation could be due to neck trauma, pinching of the nerves (by muscles or arthritis), and other causes. Symptoms include a piercing sharp pain that travels from the upper neck to the back of the head and behind the ears. It is usually a one sided pain but can be on both sides of the head. Treatment includes physical therapy, medications, and in some cases injections, "nerve blocks", during which a physician injects the irritated nerves with an anesthetic.

I suggest that you continue following up with your neurologist. You may also benefit from physical therapy. Lastly, if you are still on wellbutrin, you may wish to speak to the ordering physician to determine if there is alternative medicine for you.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[klm3739]

I am not on any other meds and had these symptoms prior to the start of the wellbutrin.  We did stop the wellbutrin for a week and the symptoms did not abate.  I was on etodolac too, but that actually made the muscle cramps and pains worse and that was discontinued.  The cyst that appers on the MRI is in the same location from when I was 13 - only then it was the size of a golfball and was shrunk using a very large dose of prednisone (this was in the late 70's).  I have had multiple head traumas with LOC, as well as spine trauma (used to break and train horses), and broke my right hip 2x.  xray was negative for arthritis.  Head pain does not start at neck and go forward, it starts above the right eye mid way to right temple and goes on a downward angle to base of skull - deep.  I will ask about the CK level if my neurologist ever calls me back - I haven't heard from him in 8 weeks and that was before the EEG.  I can't get him to explain what he thinks the bright signals are that are seen in the brain and whether he feels an mri of the spine or a ct of the brain or spine would be useful, or a lumbar puncture.  I was worked up at Johns Hopkins in the late 80's for MS - couldn't rule it out and couldn't rule it in.  Thanks for the suggestions.