[gooilers18]

Hello all,

I'm at a bit of a loss. About 2 months ago I woke up one morning and my entire left side was numb and tingly. It came out of nowhere. Later on I started getting some tingling in my face and shortly after it spread everywhere. Now it is completely random depending on the day. The most common thing is tingling in my left leg from my knee down to my foot. But, both arms and legs have had both numbness and tingling at some point. The numbness is more common in my arms while the tingling is most common in my feet. The burning is more common when I'm indoors and the AC is running but after laying in bed for a while it eventually goes away. They do feel cold to touch. Sometimes my hands will be similar but not nearly as bad. There really is no rhyme or reason to where the symptoms are honestly. They tend to not be as noticeable if I'm active like doing work around the house or in the gym. When I'm sitting it's far more noticeable. I've been to the ER twice first the only thing they found was low potassium. The second time I got dizzy and lightheaded while driving and went in but I ended up testing positive for covid 2 days later and the dizziness is mostly gone a few weeks later.

So far I've had a ton of bloodwork done and a brain MRI and everything has come back clean. No diabetes, liver and kidney function are normal, no inflammatory markers or abnormal proteins. Things like B1/12, thiamine, etc. have all been checked and they are high but I have started supplementing more consistently lately so they might be artificially elevated. Only thing is my blood pressure has been slightly high for a few years now but not high enough to take medicine for according to my dr. Plus with no drinking right now it should lower to a normal level but the anxiety isn't helping that. My EMG is scheduled this month so that should tell me more. But in the meantime any ideas what this could be? I've asked both my PCP and a neurologist that I had an initial appointment with and they are both unsure. They don't think it's from my drinking but it could be possible. For the past 10 years I've probably averaged around 15 drinks spread over 1-3 days on the weekend. It could be anywhere from 2 beers 1 day only to ~20 drinks spread over 3-4 days. It's higher than I should be drinking but from what I've read people have drank far more than that before they got any damage from alcohol. Plus, my bloodwork has never shown any issues. Here is what the neurologist said after my appointment. He did mention that he was encouraged by the exam so it appears that went well. No strength or weakness issues and everything appeared mostly normal.

Differential diagnosis include electrolyte, metabolic abnormalities, increased alcohol intake related symptoms, nonspecific paresthesias, neuropathy, nerve injury. Central nervous system process such as MS or demyelinating disorder cannot be ruled out, especially given it does have relapsing and remitting type of symptom pattern .

Any ideas? Alcohol is the only thing I can think of but the way the symptoms came on make no sense. Usually they would start in the feet and work up not on one side and spread rapidly from there despite stopping alcohol. Plus I stopped entirely drinking 2 months ago except last month I had a bit over a weekend. Nothing since. I have another appointment once my EMG is done but that's a month+ away and the anxiety is driving me crazy. Thankfully I've learned how to keep it under control enough to not go back to the ER because the anxiety is messing with me too badly.

Here's my neuro exam notes if it helps:

Vital Signs:
BP (!) 144/97 (BP Location: Left arm, Patient Position: Sitting, BP Cuff Size: Adult) Comment: 2nd reading | Pulse 81 | Temp 36.6 °C (97.8 °F) (Temporal) | Resp 18 | Ht 188 cm (6' 2") | Wt 86.2 kg (190 lb) | BMI 24.39 kg/m² | Pain Score: 0-No pain

Neurologic Exam

Mental Status
Oriented to person, place, and time.
Level of consciousness: alert
Knowledge: good.

Cranial Nerves
Cranial nerves II through XII intact.

Motor Exam
Muscle bulk: normal
Overall muscle tone: normal

Strength
Strength 5/5 throughout.

Sensory Exam
Light touch normal.
Vibration normal.
Pinprick normal.

Specifically no abnormalities in sensory modalities. He does report feeling tingling in the left lateral leg above the ankle and going down to his dorsal aspect of the foot. However no deficits when touching the leg.

Gait, Coordination, and Reflexes

Gait
Gait: normal (Arises from chair unaided. Good cadence, normal stride length. Narrow base. Normal arm swing bialaterally.)

Coordination
Romberg: negative
Finger to nose coordination: normal
Heel to shin coordination: normal
Tandem walking coordination: normal

Tremor
Resting tremor: absent
Intention tremor: absent
Action tremor: absent

Reflexes
Reflexes 2+ except as noted.
Right brachioradialis: 0
Left brachioradialis: 0
Right biceps: 1+
Left biceps: 1+
Right triceps: 1+
Left triceps: 1+
Right patellar: 0
Left patellar: 0
Right plantar: normal
Left plantar: normal
Right ankle clonus: absent
Left pendular knee jerk: absent

[gooilers18]

Forgot to include some other bloodwork that may or may not be relevant:

Taken on 6/16
Sodium 140 mmol/L
135 - 145 mmol/L
Potassium 3.9 mmol/L
3.5 - 5.0 mmol/L
Chloride 105 mmol/L
99 - 109 mmol/L
Carbon Dioxide 27 mmol/L
23 - 33 mmol/L
Anion Gap 8 mmol/L
5 - 16 mmol/L
Blood Urea Nitrogen 12 mg/dL
8 - 25 mg/dL
Creatinine 1.03 mg/dL
0.70 - 1.30 mg/dL
Blood Urea Nitrogen Creatinine Ratio 11.7 ratio
10.0 - 24.0 ratio
Estimated Glomerular Filtration Rate 84
>60
eGFR units = mL/min/1.73 meters squared

If the patient is African American multiply the Estimated Glomerular Filtration Rate result by 1.21.
Glucose 112 mg/dL
65 - 110 mg/dL H
Calcium 10.0 mg/dL
8.7 - 10.4 mg/dL
Albumin 5.0 g/dL
3.5 - 5.0 g/dL
Protein, Total 7.4 g/dL
6.2 - 8.2 g/dL
Globulin 2.4 g/dL
2.2 - 4.2 g/dL
Albumin Globulin Ratio 2.1 ratio
1.0 - 1.9 ratio H
Bilirubin, Total 0.80 mg/dL
0.10 - 1.50 mg/dL
Aspartate Aminotransferase 20 U/L
10 - 45 U/L
Alanine Aminotransferase 18 U/L
10 - 65 U/L
Alkaline Phosphatase 65 U/L
35 - 115 U/L

Taken on 6/9

Calcium 9.9 mg/dL
8.7 - 10.2 mg/dL
ALT 16 IU/L
0 - 44 IU/L
Glucose 99 mg/dL
65 - 99 mg/dL
Sodium 139 mmol/L
134 - 144 mmol/L
Potassium 4.4 mmol/L
3.5 - 5.2 mmol/L
Chloride 100 mmol/L
96 - 106 mmol/L
CO2 24 mmol/L
20 - 29 mmol/L
Albumin 4.7 g/dL
4.0 - 5.0 g/dL
Bilirubin, Total 0.8 mg/dL
0.0 - 1.2 mg/dL
BUN 13 mg/dL
6 - 20 mg/dL
Creatinine 1.23 mg/dL
0.76 - 1.27 mg/dL
EGFR (Calc) 80 mL/min/1.73
>59 mL/min/1.73
BUN/Creatinine Ratio 11
9 - 20
Protein, Total, Serum 6.9 g/dL
6.0 - 8.5 g/dL
Globulin 2.2 g/dL
1.5 - 4.5 g/dL
Albumin/Globulin Ratio 2.1
1.2 - 2.2
Alkaline Phosphatase 75 IU/L
44 - 121 IU/L
AST 13 IU/L
0 - 40 IU/L

White Blood Cells 10.5 Thousand/mcL
3.8 - 11.0 Thousand/mcL
Red Blood Cells 5.22 Million/mcL
4.20 - 5.70 Million/mcL
Hemoglobin 15.7 g/dL
13.2 - 17.0 g/dL
Hematocrit 45.0 %
39.0 - 50.0 %
Mean Cell Volume (MCV) 86.2 fL
80.0 - 100.0 fL
Mean Corpuscular Hemoglobin (MCH) 30.1 pg
27.0 - 34.0 pg
Mean Cell Hemoglobin Concentration (MCHC) 34.9 g/dL
32.0 - 37.0 g/dL
Red Cell Distribution Width (RDW) 12.1 %
11.0 - 15.5 %
Platelets 294 Thousand/mcL
150 - 400 Thousand/mcL
Nucleated Red Blood Cells 0.0 /100 WBCs
0.0 - 0.9 /100 WBCs
Differential Type Automated
Neutrophils % 82.0 %
40.0 - 75.0 % H
Immature Granulocytes % 0.3 %
0.0 - 1.0 %
Lymphocytes % 11.8 %
15.0 - 48.0 % L
Monocytes % 5.5 %
0.0 - 12.0 %
Eosinophils % 0.1 %
0.0 - 7.0 %
Basophils % 0.3 %
0.0 - 2.0 %
Neutrophils, absolute 8.65 Thousand/mcL
1.90 - 7.40 Thousand/mcL H
Immature Granulocytes, absolute 0.03 Thousand/mcL
0.00 - 0.05 Thousand/mcL
Lymphocytes, absolute 1.24 Thousand/mcL
1.00 - 3.90 Thousand/mcL
Monocytes, absolute 0.58 Thousand/mcL
0.00 - 0.80 Thousand/mcL
Eosinophils, absolute 0.01 Thousand/mcL
0.00 - 0.50 Thousand/mcL
Basophils, absolute 0.03 Thousand/mcL
0.00 - 0.10 Thousand/mcL

Vitamin B12 988 pg/mL
247 - 911 pg/mL H

[Kitt]

Welcome gooilers18. Someone will be along.

[echoes long ago]

research neutrophils % divided by lymphocyte% ratio. anything over 3 indicates inflamation. yours is 7 . i use that ratio to keep track of how my sarcoidosis is doing. it may have implications for the issues you are having also.
that is pretty high.

your sugar levels are also borderline or high, which could have caused a problem long term.

[gooilers18]

Originally Posted by echoes long ago

research neutrophils % divided by lymphocyte% ratio. anything over 3 indicates inflamation. yours is 7 . i use that ratio to keep track of how my sarcoidosis is doing. it may have implications for the issues you are having also.

that is pretty high. your sugar levels are also borderline or high, which could have caused a problem long term.

That was taken 2 days before I tested positive for Covid so that might explain it. I had just started to get my first symptoms. Earlier in the day I got dizzy while driving which was likely Covid related since it’s better now. At least I hope thats the case.

[echoes long ago]

i didnt mean i think you have sarcoidosis. i use the ratio to keep track of inflammation which for me means if sarcoidosis is active, flaring or not.
That ratio is an indication of inflammation, no matter what the cause of it.

check out those numbers again in a few months.

[gooilers18]

Originally Posted by echoes long ago

i didnt mean i think you have sarcoidosis. i use the ratio to keep track of inflammation which for me means if sarcoidosis is active, flaring or not.
That ratio is an indication of inflammation, no matter what the cause of it.

check out those numbers again in a few months.

I will. I have a follow up after my EMG probably in a month or so. I was just offering a possible explanation for the inflammation. I did find it surprising that a higher ratio was present for people that had worse outcomes with covid. Found that interesting but thankfully Covid is done with me for now. Definitely explained the weird crappy symptoms I got.

[echoes long ago]

Originally Posted by gooilers18

I will. I have a follow up after my EMG probably in a month or so. I was just offering a possible explanation for the inflammation. I did find it surprising that a higher ratio was present for people that had worse outcomes with covid. Found that interesting but thankfully Covid is done with me for now. Definitely explained the weird crappy symptoms I got.

yes, i think you got lucky there with your covid outcome with that ratio being as high as it was. without a doubt that raised your ratio. it will be interesting to see what it goes down to now. i would ask for a c reactive protein test the next time they take blood for you also.

[echoes long ago]

it sounds like you might have small fiber neuropathy, due to your symptoms and that it moves around to different areas of your body. if it is, it won't show up on an emg/ncs, so don't get discouraged if that testing proves to be negative , get a skin punch biopsy to test for small fiber neuropathy.

you also may not have one cause for your symptoms. There could be a synergy effect with long term alcohol use, lack of proper nutrition if you werent eating correctly while you were drinking at higher levels, and possible pre diabetes from long term high normal sugar levels.

[gooilers18]

Something intersting here. I had a previous ER visit where they only found low potassium. They treated that and they sent me on my way. That was 2 weeks before the reading and they did some blood work there as well. During that time my WBC was high at 14.37 and my neut was at 9.43. However, the % was 65.6/26 which is only 2.5 No idea what caused my WBC to be raised during that visit. I'm not sure if low K can cause that. But with the readings I posted my WBC was within normal range even though my neut was high.