Suggest Treatment For Numbness In The Leg And Muscle Weakness

Posted on Sat, 25 Jun 2016

Question: About four years ago, I woke one morning at about 4:00 am with severe weakness and seeming numbness in both legs from the thighs down. The symptoms had come on over a very short period. Over the next weeks, the weakness spread to my upper legs arms and facial muscles. (Note that these symptoms arose 4 weeks after a very severe bout of flu which progressed to pneumonia).
I suffered extreme lack of energy and loss of leg muscle strength and endurance, and lost about 30 pounds in two months. I had been an avid hiker before and could no longer climb either mountain trails or staircases. The symptoms as the condition progressed included what I called "crawlies" (muscles moving beneath the skin), a vague but powerful sensation of "detachment" and pain from my legs and arms.
Several doctors performed a variety of neurological tests, each of which came out negative. (Note that two tests were not performed: 1 spinal fluid examination; and 2 nerve conduction testing).
At no point in the early or later testing was I ever given a diagnosis. Eventually, the doctors implied (but did not diagnose) that my symptoms were psychological, after which I was more or less shunned by the system as a malingerer. No psychiatric treatment was prescribed. After over two years, I had a nerve conduction test performed, which turned out negative. When I asked if the condition might be Guillan Barre (sp?) syndrome, the neurologist said that it couldn't be that condition because the symptoms had come on very quickly.
The severe symptoms lasted about three years before beginning to subside, but I have never regained my leg strength.
Any insights on this condition would be appreciated.

Answered by Dr. Ishu Bishnoi (3 hours later)

Brief Answer:
Consultation

Detailed Answer:
Hi xxxxxxxxxxxxx, thanks for asking from HCM.

I can understand your concern. Sudden weakness in limbs which spread from lower to upper limbs and face along with weight loss, it could be

: Guillan Barre syndrome - You have already talked about it and it has been ruled out. It is a temporary disease and recovery is the rule. It presents as weakness in limbs, no sensory loss, symptoms usually occur after flu infection.

Your symptoms are matching. As 4 years have already passed, so recovery must have occurred if it was the diagnosis. Still confirmation of weakness in lower limbs can be done by
: Power, tone, bulk and reflex examination of muscles
: Electromyography

It will determine degree of loss and involved muscles.

: Another reason could be Multiple sclerosis - It is spontaneous nerve demyelination disorder. It can be precipitated by some infection like flu, presents as progressive weakness in limbs, sensory loss, current sensations in limbs, occurs in episodes.

It can be confirmed by
: MRI brain
: NCV and EMG

: Another possibility could be spinal lesion like tubercular spine, tumor bleed - It might be the cause of sudden deterioration and then spontaneous recovery. Sometimes, tumor bleed or tubercular spine with sudden access release may manifest in such manner and then recovery occurs due to subsidence of inflammation and swelling.

It can be confirmed by local examination of spine
: MRI spine (torso-lumbar) plain with contrast

So my advise is to consult neurologist for confirmation of functional loss in muscles,
weight loss and get above mentioned investigations. If you have lost 30 pounds weight and weakness in limbs is persisting, it should not be "Psychological cause".

Hope it will help in reaching upto some conclusion. Still in doubt, do let me know.

Thanks. Take care.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ishu Bishnoi (20 hours later)

Thanks so much for your prompt reply. My symptoms have subsided enough that I probably won't have any further tests.

My contact with you was primarily to describe my symptoms and hopefully receive some other response than "this is a psychiatric condition" followed by dismissive and often downright rude treatment for several years following.

From what I've read about Guillian Barre, the two best diagnostic tests are 1) spinal fluid analysis; and 2) nerve conduction testing, neither of which had been done when the doctors ruled out Guillian Barre.

A response like yours, including differential diagnoses and understanding of the problem, would have been very valuable during this very disturbing time in my life.

Answered by Dr. Ishu Bishnoi (3 hours later)

Brief Answer:
Thank you

Detailed Answer:
Hi xxxxxxxxxxxxxxxxxxxxxxx, thanks for the appreciation.

It is good that you have recovered significantly. And it is true that doctors wasted that time when it could have been easily diagnosed.

Anyway, you are fine now. If you still have any doubt, do let me know.
Thank you. Take care.

Above answer was peer-reviewed by : Dr. Arnab Banerjee