Suggest Treatment For Pneumonia And Numbness On Upper Lips
MRI x 3
CT scan
Nerve conductor tests (Twice)
Lumbar puncture
All tests have come back clear. None of the neurologists have been able to make a diagnosis. I have no difficulty swallowing, but it takes me a long time to masticate food to the point where I am comfortable swallowing it. My tongue doesn't seem to be able to move food round my mouth the way it should do. My ability to suck is limited, with the unexpected consequence that I have reduced my cigarette intake from 20 per day to 3, as there is just no point! I intend to give up completely. My general health is excellent...I have a little asthma, but nothing else. I have had very little down time with illness over the years. My only hospitalisation in 30+ years was for carotid artery surgery about 12 years ago. I have also had minor surgery to correct ptosis. I eat and sleep well, live independently and am well supported b y family and friends. Would you or any of the doctors online be able to diagnose this neurological condition, which is obviously progressive? I understand that motor neurone disease has virtually been ruled out
I meant to include this in the initial information. The way my spine has grown at the back of my neck has meant that a slight curve has pushed my head forward a little. About 3 weeks ago, my daughter observed that this was more pronounced than usual. A couple of days later, I had a slight ache at the back of my neck which I had not had before. That went, but as I became more tired toward night, my head started to droop to the left hand side. It became something of an effort to hold it up. This has continued. It does not happen during the day unless I have had my head down doing something for a long time. It does not happen when I am sitting. Since this has happened, I have found it marginally more difficult to breathe at times, but again, this is no problem when I am sitting or lying down. I saw my neurologist today, who says the muscles at the back of the neck are weaker, and she is ordering more nerve conduction tests. I have recently had a neck xray, also a chest xray, neither of which have thrown up any problem.
Need to exclude myasthenia.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the detailed description of your symptoms and it is unfortunate to note that despite having seen 4 neurologists, a definite diagnosis has not been made. Moreover, you are suffering in your daily life activities on account of your neurological symptoms.
Possibilities include:
1. Brain stroke, brain tumor, infections, demyelinating illness, vasculitis- All these have been excluded by doing MRI of brain and lumbar puncture, as these conditions would be picked up on MRI/CSF analysis.
2. Motor neuron disease- can cause all these symptoms, but has been excluded by EMG.
3. Myasthenia gravis- can also cause all these symptoms. Repetitive nerve stimulation test can help in excluding this condition. A trial of pyridostigmine tablets may be given to see, whether your symptoms get better or not with the use of pyridostigmine tablets.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Many thanks for your response. I have been reading everything I can find on myasthenia gravis, and found much I can relate to. No neurologist I have seen to date has raised this as a possibility, and I am wondering why.
I know that with the nerve conductor tests that have been carried out to date, there were no concerns. I am due to have some more tests done on my neck as a result of the recent changes to my head and neck which I referred to in my email to you. This is the first time muscle weakness has been suggested.
Just a couple of questions: When nerve conductor tests are carried out as a component of diagnosis, is it standard practice to do the repetitive nerve stimulation test you referred to in your reply? Or is that a completely separate test for myasthenia gravis?
RNS is not routinely done.
Detailed Answer:
Thank you for getting back.
As part of routine nerve conduction tests, repetitive nerve stimulation (RNS) tests are not done. Only if the neurologist/treating doctor requests for it, RNS would be done.
However, it is a very simple test and can be completed in 15-20 minutes.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
I do get tired but maybe not as much as appears to be normal for those with MG.
If my GP/neurologist prescribes Pridostigmine, what difference(s) will I notice and how soon? Does it impact on breathing problems, as my breathing has gotten marginally worse since I experienced that head droop about 3 weeks ago.
What would need to be established for removing the thymus to be considered as the best option?
If my lungs have been affected by a neurological condition, including MG, will exercise such as walking, exercise regimes, Pilates etc, help to build breathing capacity? I look forward to your response.
Pyridostigmine would help in a few days.
Detailed Answer:
Thank you for getting back and providing more information.
If your doctor prescribes pyridostigmine, you would feel more strength in the weaker muscles, your breathing would get better, and your head droop would also improve. Mastication and tongue movements would also get better. These improvements would be seen in a few days of starting pyridostigmine.
Thymus removal would be considered if there is enlargement of thymus on the CT scan, or if the acetylcholine receptor levels in the blood test are elevated.
Breathing exercises would also help you.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
One final question: if the diagnosis is formalised through an assessment and the medication you recommend is prescribed, can I also expect an improvement in my dysarthria, and would there be any change to the numbness in the left hand side of my face?
Many thanks. I appreciate your help
Kind regards
XXXX
Dysarthria would improve.
Detailed Answer:
Thank you for getting back.
With treatment, dysarthria would improve, as it could also be related to myasthenia.
Numbness of the face is not a symptom of myasthenia, so, we still would need to find its cause.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)