Various symptoms - very confused!
 

I'm new here so bear with me - not even sure where to post as I don't have diagnosis yet. I'm a veterinarian and thought I knew basic neurology fairly well - but apparently people are NOT animals! Anyway...

I'm 43, onset 5 1/2 months ago, had been "perfectly" healthy.
Everything has been symmetric/systemic.

Initially was middle toe numbness, progressed to top of feet, then patchy numbness up legs.

At same time was leg cramps and fascicularions - I do a lot of standing and they really ached if I stood still.
Also several times if I didn't move my legs "fell asleep".
Well, that numbness gradually went away back to my toes, but then developed whole body sensory loss.

First noticed scalp pain when out in hot sun, then encroaching sensory loss of head, face, then mid-body, then eventually everywhere. I can still feel most placed but not really pin-prick sensation.

Then came the lethargy - woke up one morning VERY lethargic, lasted ~2 days. I have had several more of those episodes, and more recently induced by exercise.
Along with sensory loss came ED - had weak sex for 3 nights, then next "unable to", followed by 2 days of severe lethargy.

My new symptom is muscular fatigue? example - I carried a 30# box for about 5 minutes, felt arms just trembling, then severe lethargy again for several hours. Now moderate lethargy is not going away, and legs are consistently weak.

Early on I also had more episodes of arms and legs falling asleep from seemingly benign positions. Oh, did I mention dry eyes now? (used to yawn and produce some tears - but not anymore).

ALL lab work has been normal. Ruled out diabetes, thyroid, Lymes, Myesthenia, etc... Both local and OSU Neurologists think Small Fiber but has no clue on the fatigue. EMG & NCS normal. I have some skin biopsies scheduled but doubt that will be helpful big-picture-wise. \

Never has been any real pain, but now I'm getting really scared with the weakness which does not seem to be going away.

Sigh. Anyone have any thoughts or direction for me?? THANX!!

First off.... B12. Low B12 leads to weakness etc and other neuro symptoms. Your test should be 400-500 or above to be normal.

I would also get tested for heavy metals. Arsenic, mercury, cadmium etc.

Did you have vaccines recently? Autoimmune markers?

Being a vet, could you have contracted some virus?
Have you had viral titres for Herpes family?

GBS causes numbness, and you might have a slow variant.
This can come from vaccines, or some infections. Campylobacter is a known cause (from poorly cooked chicken).
Trichinosis?

I have to say, my cat sneezed on me last year at this time, and I got a nasty virus from HER! Never mind the human viruses! :rolleyes:

I'd sure go thru all the diseases of animals you are exposed to, first.

I would also get better Lyme testing. Go to the top! Western blot has false negatives.

Do you use statins? Have you had fluroquinolone antibiotics recently?
Both of these damage nerves.

Thanks for the quick reply!
Unfortunately B12 OK, no vaccines, no immune abnormalities (don't have lab work here but ANA OK, etc.). Never any fevers. Not on any medications.

Just strange about the episodes of severe fatigue - I could predict them, hard work then down for about 2 days. But now persistent...

Doses of Methyl-cobalamin (not cyano-cobalamin) in the range of 2000mcg-5000mcg per day will help with the lethargy/weakness - no matter what your test scores are
(I would be conservative and say below 600 is sub-normal and needs bolstering)

If it is PN (the skin biopsies will confirm small fiber, that the EMG won't catch) weakness and inability to get motivated can be s/e.

Your age is on the young side for most PN onset- but inherited,
or autonomic causes should be ruled out first.

The dry eyes could be a sx of Sirojens (sp?) syndrome,
& you might want to look in that direction.

As far as the ED, you might want to peek in on the Sexual Dysfunctions forum, here - and see what they have to say.
Usually, with PN, ED is a s/e of meds such as Neurontin/Gabapentin & that genre of medication- rather than the PN itself, but there are such varied sx with this condition that its difficult to rule anything out.

ED is not very common without a medication being in the way, but stress is a huge factor in PN flares-and stress can be the underlying cause for the ED episodes..

I would go visit our MG forum anyway. There are variants to MG that are seronegative, that some of them have and describe.
It wouldn't hurt to read them a bit there. The characteristic weakness which resolves when rested, is typical of them.

http://neurotalk.psychcentral.com/fo...aysprune=&f=77

Some of them have swallowing and breathing difficulties too.

Things that will help muscle weakness are:
B6 (pyridoxal)
acetyl carnitine
CoQ-10
r-lipoic acid

These help with mitochondrial issues. It is possible you have a mito disorder that just appeared. It can happen that way.
Research on mito disorders is ramping up now. There is alot on the net about it.

Severe allergies can also cause a weak feeling. But not that numbness.

They should do a Lyme test on your CSF. Also if you were treated with antibiotics, your titer is basically frozen where you took the abx. I had Lyme 15 years ago and now have autoimmune issues. I had the EM rash. I believe my dog brought the tick in my house, and I sat on it. Was bitten in the thigh. I did not know it for days until I scratched off what I thought was a small scab. I live in an endemic area tho, so it could have come from anywhere. Those Lyme tests are very inaccurate.

My titer started to climb and then stopped under the cut off for +. So I test negative, except when they do bands. And I was diagnosed and treated within 2 weeks of the bite...and had a classic EM rash, that was quite big.

I would seriously consider some transmissible disease, due to the acute onset.

Have they done a brain MRI?

Short of it being Lyme, have the ANA repeated....an FANA, the expensive kind. Your post implied you are a male, and the chances of autoimmune disease are less than in females, but not impossible. Dry eyes can be neurological or inflammatory. Other tests that pick up inflammation, sed rate, C-reactive protein, platelet count (high) CD4/CD8 ratio....eh, but you knew that already. Don't think you don't have a substantial knowledge base....a lot of research applied to people is done on animals....we share a lot.

Your presentation seems very acute.

Mine evolved over decades.

Good luck to you and I hope you find an answer.

Thanks everyone...

For completeness, my blood work thus far (all "normal"):

CBC/Chem, ANA direct, sed rate, B12 795 pg/ml, CK 127, free T4 1.2, TSH 1.27, Acetylcholine receptor Ab (all), Lyme IgG/IgM, IgM quant, CK again 151, Aldolase, Phos & Mg again, CK again, Proteins incl. electrophoresis, T4 and TSH again, intact PTH, Autoimmune serology (RF, Smith, RNP, SS-A, SS-B), and more proteins/immunofixation (IgG, IgA, IgM, monoclonals).

I don't believe in the word "Idiopathic", although as a veterinarian I know that that is where a diagnosis sometimes ends, but there must be a cause somewhere. I'm still stumped by the muscular fatigue that I know I can induce with overexertion, predictably followed by several days of fatigue. Cortisol? A (micro)vascular problem? I've also checked my glucose during those episodes looking for The Simple Answer.

:frown:

Given that you are a veternarian--
 

--have they done any PCR's to test if you've got any viral titres?

One of the things that came to mind with your symptoms was cytomegalovirus, which is certainly present in domestic pets, can infect humans, and can have neurological sequelae. (Parvovirus came to mind, too.)

Yes, I am thinking this is infectious. Perhaps going to an infectious disease specialist may help.

The only other thing that causes numbness and weakness besides some infectious agent would be organophosphate poisoning.

This list of symptoms of chronic exposure, seems to fit your
descriptions:

http://www.drmyhill.co.uk/article.cfm?id=291

No viral PCRs, yet.

And while I am very familiar with organophosphates, luckily I have not handled any directly for probably 10 years. I have seen several pets, usually cats, last was maybe 4 years ago, owner applied to pet (and often wrong dose or already debilitated pet) and ... oops. No, luckily that's not me.