Strange neuro symptoms - worried about ms or als

[mjr813]

Hi,

I'm a 23 year old female who until recently has had no major health concerns. Two months ago, a few days after I had a mild flu, I had what I thought was a migrane (I normally get 1-2 per year). I normally get an aura, but with this one I had double and blurred vision, and it lasted 2 days. Following this, I had four more days of off-on headaches with vision difficulties (mostly relating to glare from computers, tvs, fluorescent lights). This went away, and I started to get tingling sensations throughout my body. Some numbness accompanied them, but tingling was primary. The sensations would bounce from one area to another, sometimes lasting for seconds, sometimes for hours. Sometimes the tingling felt like burning. Another week went by of this, and then the tingling almost stopped completely. My right arm was weak for a day (very weak, difficulty holding my cell phone, pushing buttons as I felt I had reduced control). This feeling highly concerned me.

The next day, my left arm was just as weak. This continued for several weeks, with a varying intensity of weakness in the left arm. My other symptoms abated. Generally, the weakness did not happen first thing in the morning, generally 1/2-1 hour after I got out of bed. However, it was still there in the evening when I went to bed. Sometimes I felt like my arm was lead, sometimes it was mild, like the muscle was tight. Sometimes it was the whole arm, sometimes just a portion. Then, all of my symptoms disappeared. For about two weeks, I only had slight problems with glare from computers/fluorescent lights. My arms felt totally normal, I worked out like I had been prior to the headaches. Then, slowly, I felt my left arm was a little weak again. I started to get twitches in my left arm, which concerned me with the weakness. Now, my left arm is mildly weak, and my right arm is off/on weak. I have twitching, primarily in my left arm and hand (by my thumb), but also in my right arm, abdomen and lower legs.

Help?

[momrn422]

Hello,

I don't mean to bump into the discussion... I have had some similar symptoms and, more so, reservations about visiting my doctor again.

Currently, I have been experiencing right-sided tingling and weakness without numbness. The tingling is most prominent in my pinky finger and exists in varying quality in my right arm and leg. The weakness is most noticeable in my right upper arm and entire right leg. I've had some intermittent tingling in my face, on the right side as well. Another concern is some blurred vision similar to that described above. I feel like there is a strip or light spot impeding the vision in my right eye. I do not feel pain in my eye. Lastly, yesterday evening I started to develop signs of a panic attack... tightness in chest, difficulty breathing, headache, and worsening tingling and weakness.

My biggest concern is that I had a similar experience to this two years ago that lasted approximately three weeks.  I saw my GP a number of times during that period.  I had a normal neuro exam except for nystagmus (they said may be benign). I had a normal brain MRI as well. I think the general consensus what that anxiety is the primary problem and they started me on Zoloft 100 mg/d and Ativan 0.5 mg prn. I stopped taking the Zoloft about 6 months ago because I was hoping to get pregnant. I took 1 mg Ativan last night due to panic but have not used otherwise in months.

Point being... should I make an effort to see a neurologist considering the two separate incidents? There is a great deal going on in my life right now but I felt as though I was handling it all well. Is it more likely there is something neurological going on or just some bottled anxiety rearing its ugly head?

Thanks for your time and advice... also for the ability to share my concerns.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Blurred vision is nonspecific but can be associated as an aura with migraines. Blurred vision in this setting is usually called scintillating scotoma (i.e., a shimmering arc of light that may be zigzag, straight band, etc). This can make it difficult to see to read or drive.

The aura can also be associated without a headache. These are called acephalgic migraines. Since you have a history of migraines, I am more suspicious of this.

Additionally, migrating (move from one place to the other) symptoms can be associated with migraines. However, other causes of migrating symptoms can be seizures and metabolic (such as low calcium or thyroid disorders).

Benign fasciculation syndrome, which I will abbreviate as BFS, is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve.

Since the symptoms you are experiencing now are different from previous, you should be evaluated by your physician or a neurologist. You may need an MRI of your brain.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[mjr813]

My questions are:

Could the weakness I experience still be there, even when I'm not feeling it? I'm worried, with the twitching coming after the weakness, about ALS.

I've read about BFS, but every post says 'twitching without weakness', which isn't my case. I am understandably anxious about this, and have consulted my physician. Prior to the second round of weakness. He scheduled an MRI, but did not think much of the other symptoms. That was reassuring, until my weakness began once more, accompanied by twitching. I am frightened of the possibility of ALS, and was initially frightened by a potential MS diagnosis.