Am concerned about new symptoms

[twitchychick]

I am wondering if these new symptoms are related. My symptoms started about 1 year ago. Things were better for a while but have been back since the summer. My main complaint was twitching and a deep pain in my left cheek that would travel to my temple, ear, back of head and down my neck. The pain sometimes is worse when I bend over. I have also had a weird sensation when I have been sitting, out of nowhere, the room will shift. I have had migraines for years with the visual aura and this is something completely different.

In the last few weeks, I have some new things happening that I am concerned about. First, when I am in the shower or washing my face at the sink, I can't feel the water hitting my left hand. It also seems weaker. I have also noticed that when the warm water hits my left foot, it feels cold, even though the water is warm. When I have been sitting on the couch, I will feel like my left foot is wet across the top of it. I've even taken off my shoes, or thrown the blanket off to see what spilled. There is nothing there, but it feels wet. On the left ankle, I get these really quick jolts of pain. They hurt enough that I yell out loud, but it's only for a few seconds. I have twitching, have since this all started, all over my body, but primarily my face, torso, butt, and calves. Also, it feels like an electric current is sending little pulses to my foot, around my chest, my right shoulder blade in back. These are quick, but very uncomfortable.

I guess what I'm wondering is if this could be a pinched nerve in my neck. Or is this all related to the PNHS that I was diagnosed with last year. I was also found to have brisk reflexes and the EMG show mild abnormalities. There was no MRI done at that time, but several symptoms are new. I had an MRI done a few years ago because I had a significant increase in my migraines. I just assumed they were hormone related.

I have an appointment with a new neuro that specializes in movement disorders the 15th. I'm taking about a dozen ibuprofen throughout the day (4 at a time which starts when I first get up) with some brief relief to the head pain, but it does nothing for the other. I also take 100 mg nortriptyline for the twitching, but it has not been effective. It has helped my mood, but nothing else.

Can anyone shed some light on what might be causing these new symptoms or what I might want to discuss with my doctor? I just don't want to waste my appointment trying to get him up to speed and not mention the most important symptoms.

[COBOB]

Not that I can really think of.  Because you have facial and scalp sensory issues on top of the sensory issues in the extremities, the odds weigh heavily towards CNS as the origin of the symptoms.  I forget whether you had an EMG/NCS for your diagnosis of PNHS or not.  If you did, the results of the test can rule out several of the mimics.   There is also the very difficult issue of "comorbidities." Comorbidities (additional morbidity) is multiple disease processes occurring concurrently.  We want to take all the signs and symptoms, and match them to a single disease.  Sadly, that rarely works.  

By the way, some (maybe many) specialists start from the view of "Do all these signs points to a (fill in specialty) disease?"  In some cases symptoms, being subjective, carry little value.  As far as clinical signs, some of us "have to few" or "have too many" or "Those just don't fit together."   It is very difficult to figure out a patient that might have a combination of 2 or 3 disease. When this happens, we get bounced between, Neurology  Rheumatology, Infectious Disease, Psychiatry, etc.

Bob

[twitchychick]

Thanks for your input Bob. You always explain things so rationally. In your opinion, does this sound at all like one of the MS mimics? One specifically that may be able to rule out with some of the tests I've already had? I know almost all of my blood work was in the normal range, other than the hormones. My calcium was high I believe and they repeated that again and it was ok. Also, my vitamin D was low about a year ago and I take a supplement for that. I've also had frequent UTI's but assumed that was related to the hysterectomy somehow. The sense of urgency has gotten better.

I guess I'm trying to rationalize my symptoms that they are caused by several different things going on at the same time, rather than one big thing. But it's looking less likely with these new symptoms I guess. Would this more than likely show up on an MRI? Of what specifically? Brain? Neck? Spine?

I really appreciate your feedback.
Twitchy

[COBOB]

I would say this is not likely to be associated with a associated with a "pinched nerve." A compressed nerve root or another condition that causes a radiculopathy, typically effects a specific dermatome (in terms of sensory.)  Multiple locations with sensory changes begin to point towards a CNS cause.  Considering that you have some facial pain and twitching I'd look for a CNS cause at or above the brainstem.   The Facial Cranial nerve inserts at the brainstem.

Now there are a few things that should have been ruled out along the way, including increased MMA levels, heavy metal or other toxicity, etc.

Definitely stuff you should discuss with your neurologist.  That's just my opinion.  

Bob