Dr. Abhijeet, undiagnosed neurology disorder

[sandy38]

Dr. Abhijeet,
I'd appreciate any comments you could give me on these symptoms and what direction you'd suggest:

This all started w/a very short bout of minor foot slapping in August.  In October it came back but much worse and EMG testing showed diffuse denervation of the tibiailis anterior muscle among other abnormalities, along with NCS.  I had no pain at all but the classic "sock" numbness.  Neuro ran CT's, MRI's  and lab studies, including a spinal tap; all were basically normal.  I have one non-specific white matter lesion in the peri-ventricular space.  I've regained about 80% of muscle strength in my ankle but still have the numbness.  During this time I also had some muscle cramping in calf/feet.  I've developed transient eye symptoms as well, but most worrisome now is I've developed a horrible tremor.  It's not just in my hands, it's in my legs, arms, even my face.  Light pressure (like lightly using the break to back out of the drive) will cause my leg to visibly shake.  I've become extremely heat intolerant and have horrible night sweats; gyn r/o hormone issues (5 years past menopause).  And I'm concerned that my abnormal tongue & mouth movements have something to do with all of this, along with the constant need to unplug my ears.  My husband gets very embarrassed by them and views it as a nervous thing.  I compelled to put my hand on my neck and this bugs him too (do it a lot).

I also got trigeminal neuralgia and dentist/endo ruled out dental issues. I was dx w/carpal tunnel in both hands a year ago, much worse on left (I'm a right handed stay at home Mom) and all of a sudden they are bothering me more.  So far, the neuro says that whatever has attacked my nervous system is putting it on "hyper alert".  I have common variable immune deficiency and receive monthly IVIG therapy (which should be helping w/this stuff).  Docs have run every autoimmune test, plus lyme's all negative.  The IVIG should actually be helping w/all this stuff.

Any insight would be greatly appreciated and thoughts for what direction I go from here.

[sandy38]

Thank you for your response.  The neuro too thought I had a virus attacking the nerve bundle after the spine tests came back neg.  But the CSF showed no virus, nor did it show any abnormalities outside high pre-alb/but low albumin, high beta globulin and low CSF IgG synthesis.  CBC diff showed 1/2 the low normal of Eosin's.  My IgG index was 1.1 and was taken 15 days after my last IVIG infusion.

I have no significant bladder issues outside of going more.  The vision problems are definetly new.  After reading at night, one eye gets like a black curtain over it.  I can still see some light, but it's a big difference.  I've also notice I see colored rods a lot (like when you look at a light then look away and you see color shapes).  Once I had a totally weird thing happen where the lamp/light looked like it pulsing.  I had thorough eye exam when this started and everything checked OK (outside of declining vision, lol).

[Abhijeet Deshmukh, MD]

Hello.

Finally noticed your post. I am sorry you had to bump a lot.

I get he feeling that I will not be able to contribute much. And the reason is that almost all the tests are done. but now thinking from a clinical point if view, your symptoms are involving different areas. And this suggests that there is something that affects the nervous system widely, or there are a number of diseases existing together. But this generally does not happen. Since Lyme test is negative, my focus shifts to inflammatory polyneuropathy. There could have been a common source of infection which caused the CVID and the trigeminal neuralgia.

Thinking of a demyelinating cause, the CSF should have shown increased proteins, Increased IgG index, oligoclonal bands. Have you seen these values in the report ?

Have you had any bladder problems ? And are the vision problems new ?  I am thinking of MS. But as any other Neurologist, I will be looking to rule out any other cause before I can say anything. And I am afraid, I can not diagnose here on this forum. This forum is not for medical advice. It is for information and knowledge.

Regards