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Have Fasciculation Without Loss Of Sensation In Calves, Visual Snow, Dizziness, Headache, Fatigue. Concerned About Paraneoplastic Syndromes

Posted on Tue, 27 Aug 2013

Question: I have fasciculation without loss of sensation or weakness. The fasciculations are nearly constant in my calves but occur throughout the body. I additionally have been dxed with visual snow or persistent visual XXXXXXX without migraine by a neuro ophthalmologist at the u of Minnesota. I have cns symptoms of dizziness, chronic headache and chronic fatigue. I can walk on my heels and toes as well as having 3 normal neuro exams the past 10 months. I wake up feeling like I received no sleep. I am an ex smoker of about 5 pack years and am 29 years old. I am concerned of paraneoplastic syndromes like morvans syndrome or sensory motor neuropathy with encephalomyelitis. I had a negative chest ct 8 months ago and a negative chest X-ray 1 month ago what recommendations do you have.

Answered by Dr. Sudhir Kumar (39 minutes later)

Hi,

Thank you for posting your query.

First of all, I would like to reassure you that your symptoms do not suggest any serious neurological illness, even though I can understand your concern regarding paraneoplastic or other serious illnesses.

This is because you have a completely normal neurological examination, and relatively younger age, both of which are unlikely in a serious neurological illness.

In my opinion, the most likely diagnosis in your case could be benign fasciculations, which are self limiting, and are of no serious clinical consequence.

Regarding Morvan's syndrome, it is rare, less than 20 cases have been reported in the whole world (I have not seen any case). As per the literature, the patients have severe insomnia, excessive perspiration, hallucinations, and other features that you do not seem to have.

In sensory motor neuropathy, there should be numbness and weakness of hands and feet, which you do not have.

Regarding encephalitis, there should be memory loss, confusion, behavioural changes, etc, which you do not have.

Please check vitamin D, B12 and thyroid profile, if not checked.

I hope it helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (35 minutes later)

Thank you for your response.

I didn't mention I have had chest pain under sternum as well as dizziness and visual problems with severe fatigue upon waking up. Could these symptoms be a part of neuromyotonia? Do you think with severely disabling symptoms of pns and cns but normal neuro exam that a paraneoplastic antibody panel is warranted.

Answered by Dr. Sudhir Kumar (1 hour later)

Thank you for getting back with more details.

In my opinion, you need to be evaluated for your symptoms, which could be related to vitamin deficiencies, thyroid disorder, or other metabolic factors. The symptoms do not appear like neuro myotonia, and I feel paraneoplastic work up/panel is not required in your case.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (25 hours later)

Would having anti-neuronal antibodies cause severe systemic headache pain which is unlike any other headache ive had in my life, except it is daily for the past 8 months. Ive had metabolic panels all within the normal range as well as thyroid test within the normal range both more than once in the past 6 months. If it is not paraneoplastic could it potentially be autoimmune or possibly lyme? I have never had health issues in my previous 28 years of life, but over the past 8 months I have had major pain. Weakn feeling in arms and legs, fasciculations, dizziness, visual disturbance permanant, chest pain. I continue to look back at paraneoplastic as the logical choice because of my prior smoking history of 5 years and the sudden onset of diverse neurologic symptoms. I do have a follow up neuro exam in the next couple of weeks to hopefully sort some of this out.

Thanks in advance

Follow up: Dr. Sudhir Kumar (0 minute later)

additionally I have had normal Brain MRI as well as all segments of my spine.

Answered by Dr. Sudhir Kumar (26 minutes later)

Good news. Normal MRI of brain and spine rules out several serious neurological illnesses.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar