W. Africa

[Amy769]

I am a 41 year old female who spent two weeks in the Ivory Coast of W. Africa in 1996.  Upon returning I had stroke-like symptoms (slowed speech, slowed gate, slowed thinking) and was subsequently diagnosed with viral meningitis/encephalitis.  Ruled out Lymes, malaria (via smear), CSF was elevated WBC, Lymphocytes.  Symptoms resolved within eight days with the exception of bilat leg weakness, such as the inability to lift my legs into the car, and severe fatigue.

I returned to the Ivory Coast for the last four years, each in February.  The only resulting illness was pneumonia in 1998 with a resulting bronchospasm and emergency evacuation by the French military.  No respiratory problems since.

However, for the past year, I have had increasing bilat leg weakness, hypertension, severe insomnia, to the point of barely being able to climb stairs.  I have had an extensive neurological workup, inlcuding a week at the Cleveland Clinic.  They had an initial diagnosis of LEMS but discharged witih no diagnosis.  MRI's are negative, no lesions, no MS.  No Myopathy.  No ALS.  VERY extensive lab work (including ANA, lupus, etc) was all negative except CK levels were mildly elevated at 300.  EMG's were also negative.  The only other thing that has happened is that every six months, for the last two years, I have had an episode lasting 2-3 days of neurological slowness again.  CSF again showes elevated WBC, Lymphocytes, and ologinical bands.  No protein, no glucose.  Diagnosis is always viral meningitis with a discharge to home.  Heperpes and Aids have also been negative.

Is there a chance that I could have resulting damage from viral meningitis/encephalitis, or a continued infection that has not been discovered?  Also, there was a massive meningitis epidemic when I was there each time (X4) and received multiple mosquito bites even with prevention.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello again Amy,

I apologize for the delay in my reply to your most recent posting.

I would encourage you not to give up.

In cases such as your's, with symptoms and physical examination findings that have yet to be completely explained, the medical community ends up trying to eliminate the possibilities of maladies--one by one, by leveraging what we can gather from a history from you, the patient; the physical examination; consults (like you have experiences) and diagnostic tests (hopefully based on some sort of reasonable clinical rationale).

In terms of a muscle biopsy, this seems reasonable considering your symptoms and otherwise inconclusive consultations and diagnostics. I don't believe that I asked you before...Do you have a family history of any sort of muscle disease?

Feel free to keep this line of communication open.

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical or legal advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[Amy769]

Dr. Parks,

Thank you so much for taking time to answer.

The follow-up plan from Cleveland was nothing.  They estimated that the problem wasn't neurological.  The attending said he didn't need to see me again....It surprised and frustrated me.

My medications are:
Wellbutrin XL 300mg QD
Diovan 80 mg BID
Lopressor 50mg BID
Allegra 60mg BID
Gastrocrom 200mg BID
Doxycycline 100mg BID
Ambien CR 12.5mg Q HS

When discharged from the hospital in May, I was on Ambien only.

Today I contiue to struggle with the same symptoms, leg weakness, etc.  I have had a new symptom of migratory muscle pain (dull ache) only occasionally in my joints, but starting every afternoon/evening.   No redness or swelling noted.  

My GI doctor, after an EGD/Colonoscopy in August, suspected Whipple's Disease, no DNA confirmation.  Trying five weeks of Doxy 200mg/day.

This begs the question, did getting sick exacerbate an already underlying disease, or do I quit looking for a diagnosis and suspect residual damage?  I know you cannot answer this in this type of forum, but feel I am too young to give up yet.

Can you recommend, from a physicians point of view, how I would proceed from here? My current neurologist is suggesting a possible muscle biopsy in the future.

Of note, I traveled extensively to Central and South America, and also spent a month in Senegal Africa, in the previous years of 1991-1996.  I had no problems at any of those times.

Thank you

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Hello Amy,

It is possible to have residual neurologic symptoms (physical and cognitive) following meningitis (viral or bacterial) and is also possible to have an autoimmune illness such as LEMS (or other illnesses) that may result in muscle weakness. A link that lists the many potential causes of proximal muscle weakness: http://www.aafp.org/afp/2005/0401/p1327.html

From the details that you have shared here in this forum, the positive findings that seem to be important are: elevated CK, proximal muscle weakness, fatigue, hypertension, cognitive difficulties, and insomnia.

After you concluded your week at the Cleveland Clinic, what was the follow-up plan?

How are you feeling today?

What medications to you currently take every day?


~•~ Dr. Parks

This answer is not intended as and does not substitute for medical or legal advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.