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Doctors' Answers to "Frequently Asked Questions" - Neurology
These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Question: I know someone who occasionally has trouble getting his words out.
It's as if he's "tongue-tied" for 3-5 seconds and then it clears. All MRIs,
EEGs, etc. are negative. He was taking Claritin for six weeks for head
congestion but stopped several weeks ago. the symptoms began when he was on
Claritin, but have continued, even gotten worse since he's off. He at first thought it occurred more often when he was congested, or got up quickly, but now it seems to happen at other times, too. He can sense it is happening, refrains from speaking for a few seconds, then goes on. Does this
ring any bells? He has seen a gp and neurologist. who else should he see, what else should he do? What doctor(s)/medical facilites would be the leading experts in the country on this?
Thank you very much
Answer: Sounds like an atypical seizure or transient ischaemic attack. The neurologist would be the correct person, what was their opinion? Any medications other than Claritin?
Question: What can cause no knee reflex?
Answer: Any peripheral neuropathy-that is disease of the nerves outside the brain. Some people have this without any identified problem and they can be hard to see if you don't know how to augment them. To do this pull your hands against one another while another person elicits the refles, usually augments the reflex.
Question: My son has Lennox-Gastaut Syndrome. Up to now, they haven't found any
cause to his seizures. He was completely normal until his first seizure at the age of 2
years and 4 months. We try to wean the steroids, but we don't know if that will be
possible. He is currently at 20 mg every other day. He has different types of seizures and
has some kind of seizures every day and some tonic-clonics every night. We are currently
testing to see if he has any metabolic disorder.
Answer: Sorry, some areas of neurology are too specialized for me to
help you much. If I were in your place, I would go to whomever is the world expert on this
disorder. Check with your neurologist for this person or find who writes the chapter in
the neurology text and call them. They are usually very accessible.
"Buzzing" Sensation in Limbs [posted 12/02/98]
Question: Holly is 17 years old and has complained of a buzzing sensation and
weakness in her limbs for approximately 2 years, She is an accomplished cellist and
currently is unable to play. Her symptoms began about 3 months after a swimming accident
when her head was snapped back as she came down a water slide into an inner tube. She has
passed two neurological conductivity tests with no problems and a muscle biopsy has shown
no abnormalities. A cervical MRI has been scheduled for her. She has seen two
neurologists, a pediatric rheumotologist, a hand surgeon, and a physical therapist. There
have been no causes found. Is there any other area we should check to try to find a
diagnosis? In most areas she is still able to function normally. She no longer has the
control and endurance to play the cello. What was effortless is now almost impossible. She
has performed solo with the Louisville Orchestra in highschool, and is now looking at
colleges. She is a National Merit semi finalist and hopes to be able to pursue her cello
playing in college.
Answer: Sounds like damage to the nerves to her hands. However, the
current measurement devices we have are very crude and only show gross changes. On the
other hand, if it has persisted it is probably either permanent or will take years to
Swelling Limbs [posted
Question: I have been having problems with entire body swelling. When I go to sleep
and later awake, my hands and feet swell even more, with my hands swelling so much that I
can hardly bend the finger joints. After getting up, it takes about 2-3 hours for the
swelling to go down in my hands. When I can almost make a fist, my hands cramp when trying
to grip. Later, when my hands are only mildly swollen, my fingers go numb if I do any
activity, or drive. I've noticed the appearance of spider veins on my thighs and in one
ankle. Sometimes my heart seems to race. When this first started happening, I had to let
my arms hang down off the bed for relief. This has been going on about 2 months. Any
ideas, Thank - you.
Answer: Is it just your arms? Sounds like a nerve compression syndrome
which occurs during sleep. See your m.d.
Thoracic Outlet Syndrome
Question: I am 25 years old. I have recently been diagnosed as having Thoracic
Outlet Syndrome. I am currently waiting to see a Neurologist for some tests. Could you
please tell me what kind of tests I will have done as I am quite anxious about this. Also
I am taking Ibuprofen for the pain because ordinary painkillers interfere with my
Irritable Bowel Syndrome. Is there any other medication I could take to help with this
dreadful pain in my neck, arm and fingers? Thank you for your time and your help.
Answer: This is pressure on the nerves in the neck, sometimes from an
extra rib, but there are other causes. The neurologist will probably perform emg tests to
document the problem and where the pressure is on the nerve.
Rosacea & Possible Neuropathy
Question: I have developed a condition suspected to be neuropathy. Could Flagyl or
Clonidine have caused this problem? How does Flagyl along with Clonidine work in
controlling Rosacea? What are the side effects of both drugs? I have also been on
Metro-Gel (Metronidazole .75%) and Noritate Cream (Metronidazole .l%). The Metro-Gel I
have been on for two years and the Noritate since April, l998. Could possible one or both
of these topical medications have caused the numbness and tingling in my hands and feet?
Answer: There are about 75 causes of neuropathy;but, these drugs would not
usually be on the list. Hard to know how flagyl works for rosacea;but, it clearly does.
Clonidine is a new one for me, can't help you here either. You need an evaluation for
What is Arm Numbness a Symptom Of
Question: Occasionally, and during normal activity, my left arm gets tingly and
goes numb, as though it is almost asleep. It takes from 20-30 minutes for it to go away.
It doesn't really hurt, but it is uncomfortable. I can't correlate any particular activity
with the onset of this problem. I do not experience any other symptoms with this, and want
to know if I should worry about this.
Answer: Three possibilities. First, nerve root compression at the neck as the
nerves emerge from the spinal cord. Second, pressure on the ulnar nerve. This is located
at the elbow and will result in the little and ring finger being numb. Lastly, carpal
tunnel-pressure at the wrist on the medial nerve producing numbness in the thumb, index
and middle finger. Carpal tunnel would be usually alleviated by splints-available in any
pharmacy-worn at night. Ulnar nerve palsy might require surgical transposition of the
nerve to avoid the problem. Cervical pressure will be the hardest to treat;but, the least
common. If there is any loss of muscle strength call your M.D. -these commonly need
surgical fixes of the above problems when there is loss of strength, coordination.
Next Steps After Parathesis Diagnosis
Question: I have been given a diagnosis of parathesis, since doctors have been
unable to diagnose what I have. I experience burning sensations in various spot on my legs
and arms which are not limited to one spot. The burning sensations appear are stronger
when there is no activity. I have been given a battery of tests of which have come up with
no results. These include urine, blood, MRI on spinal column. I've been given Neurontin
600mg per day which seems to control the sensations. I've experimented by reducing the
intake of the drug, but the results of the sensations seem worse than they were in the
beginning. I'm concerned with the long term affect wondering if taking the drug is just
masking the symptoms and that their might be some neurological damage that can't be
reversed. What steps should I pursue next.
Answer: Have you had a nerve biopsy? How about nerve conductions? These would be
my next picks.
Hand Symptoms [posted 10/23/98]
Question: I am hoping that someone can provide some insight into my hand symptoms
before I return to my doctor. I had severe UCL rupture in thumb and tore other surrounding
tissues about 3 1/2 years ago. Since then I've had the initial repair, 2 joint releases, 2
carpal tunnel releases. The thumb just doesn't bend past 30 degrees at IP joint. There is
much tremor when I try to bend the thumb and weakness too. After first surgery the hand
looks, acts,and feels differently and these symptoms persist:
- Fingers swell, feel stiff, swelling and feeling of "fullness" worsen with
- Thumb looks "shinier" than other digits, nail has vertical lines, is more
brittle than other nails. Thumb surgery site has sore nerve areas, and becomes purple when
exposed to cold, is painful.
- General hand color is whiter than other hand. Hand does not turn "red" when
exposed to hot water. Finger tips burn/hurt and uncomfortable feeling spreads down fingers
into palm when exposed to warm/hot water.
- Sometimes hand looks splotchy/mottled
- Palm gets extremely wrinkled in water, skin is a little scaly.
One surgeon said thumb had intention tremor, and some kind of dystrophy. My PT thinks
that the sympathetic nervous system is still disrupted. She said that the median nerve
controls a lot of sympathetic functions. I'd like to know what to ask my doctor at next
visit, such as why does hand respond this way, how can it feel better, what is going on,
etc. Thanks very much.
Answer: Sounds like Reflex Sympathetic Dystrophy check with a neurologist.
Neurology - Agent Orange May Have
Caused Peripheral Nerve Neuropathy [posted 10/23/98]
Question: Have been diagnosed as Peripheral Nerve Neuropathy. Doctors have ruled
out all of the systemic causes and I had a suggestion that it might be the result of
exposure to agent orange. My question is is there any treatment for this problem and what
is the prognosis.
Answer: There is only treatment for symptoms, pain usually. The prognosis is
usually for slow progression of the symptoms up your legs. This will usually take several
years if the diagnosis is accurate.
Sudden Jerky Movements [posted
Question: I have a 19 year old son,who started jerky movements several years ago.
At first he didn't jerk ,slowly it got to where when he didn't get enough rest,when he
first got up his hands would jerk a few times then quit. Later he got to where if he
didn't get enough rest ,he would lose his balance and have to catch himself or he would
fall,this doesn't happen very often. We took him to a neurologist and had a MRI done and
brain scan and they couldn't really find anything on the tests. The doctor said that he
had a mild cornic jerking and that he may in time grow out of it,so he put him on Klonopin
for at least 2 years. When he first took it ,it made a real difference.It nearly stops his
problem,but if he forgets to take it,it still happens (he has been on it for about a year
and a half). If he had this attention disorder when he was young could that have caused
this jerking to start because it was not checked then and is he too old to be checked now?
Is there any other medicine that will help him or is it still possible to stay on klonopin
and him grow out of it? He takes .05mg 2 times a day. Any advice and help we would
appreciate it. Thanks for your time!!!
Answer: This is not ADD. Secondly, I doubt he will "grow out of it". I
would take him to a neurologist who specialized in movement disorders.
Neuropathy [posted 10/6/98]
Question: Can neuropathy affect your brain function? I've been having pain in my
arms and legs since the first of the year. Since that time, I have also been experiencing
what I call mental confusion that can last for hours. I make silly mistakes in every day
activities, I don't drive well, I can't remember what day or month it is, etc. It is very
frustrating, and none of my doctors can pinpoint the problem. They are not sure I have
neuropathy, but I was just wondering if there was any correlation between the two. Thanks
for your time.
Answer: Could be depending on the cause of the neuropathy, there are about
75-100 causes and many could also affect brain function as well as peripheral nerves.
Neurology [posted 8/13/98]
Question: Over the last year I have experienced significant pain/numbness in my
left shoulder, arm and upper back quadrant. Standard lab, MRI, CT scans did not reveal any
answers. Low thyroid was diagnosed, but is normalized with synthroid. My physical
therapist has helped in relieving the thoracic outlet vascular impingement type symptoms.
However, there is a separate problem of diffused pain that is debilitating. Nortriptylene
worked on the diffused pain, but there were side effects. The pain returned within weeks
of stopping the drug. I switched to neurontin with some positive results. My physical
therapist says she can definitely feel the difference in my soft tissue when I am taking
the drug compared when I am not. Could I have a conditioned chemical (over) reaction to
pain that responds to the drugs? I had a hamstring injury years ago that left me in
significant pain for almost 6 years. Is my brain over responding now to another painful
condition in my back/shoulder? Instead of the drugs, would biofeedback be useful in a
situation like this? I can't help but be resistant to the drug therapy when no one can
tell me how these drugs work or what the long time side effects are.
Answer: The pain is due to something peripheral in your neck or arm. Your brain
and the drug interaction have nothing to do with the stimuli causing the pain - merely the
perception of the stimuli that we call pain.
Neurology - Nerve Damage [posted
Question: Could you please tell me what type of injury would render a person's hand
useless? Would this involve some type of nerve damage? If so, where would this damage have
to be and what would be the nature of the damage? I am particularly concerned with this
question in the context of a war injury.
Answer: Any injury from the neck to the shoulder of the brachial plexus would
leave the arm useless. This nerve plexus is a large "cable" which combines the
nerve roots from 6-8 spinal roots to the arm. It passes under the collar bone and close to
the artery of the arm. Right after the shoulder, it splits into smaller nerves. Check
Gray's Anatomy for the Brachial Plexus, which can be found in any large library.
Question: Ten years ago, I was given a diagnostic. I possibly have Multiple
Sclerosis or Lupus. Now I am experiencing a relapse which started last spring. For the
past month I have had intense numbing in my legs and arms. I have electrical surges
whenever I bend my head. I have recently found that there is such a thing as Lupus of the
central nervous system. What do you make of this?
Answer: Lupus of the central nervous system does exist, but usually not by
itself. That is, there are usually symptoms of lupus in other organs of the body, not just
the central nervous system. MRI scanners can be very helpful (not available ten years ago)
to differentiate between these conditions. It sounds like you have Multiple Sclerosis.
Damage to head
Question: A few years ago I received a very hard blow to the top left of my head,
about 2 inches above my forehead and an inch to the left of center. I was not cut and I
did not have a concussion. The point of contact of the blow is very painful when pressed
and other points of pain have appeared all over the left side of my head. Spasms of pain
occur which can be sharp or have a tingling sensation. I also get a tingling sensation
occasionally on my left cheek. X-rays have revealed no damage to the skull. Doctors have
said I have nerve damage. I would like to know if this sounds right. Why is it spreading
and is there anything I can do? Some days are good and I have few spasms, but other days
are really bad, particularly if I get hot. Would vitamins help nerve damage?
Answer: You probably have developed a neuroma at the site of injury.
Occasionally these can be excised or blocked in a pain clinic. See a neurologist.
Question: My husband has had 4 neck surgeries in the last five years. He now has
bone spurs and constriction of 3 more vertebrae in his neck. Our Neurosurgeon has decided
to not do surgery again, but wants to implant a nerve stimulator to "short circuit
" the pain to his brain.
Answer: I am sure that he has other patients who have had this procedure done.
Pain specialists could also help out with information and talking to other patients who
have had this performed.
Question: My 33 yr. old son has been diagnosed with PN. What are symptons,
prognosis, treatment. It has affected his feet, legs, arms, hands, bowels and urinary
tract. He needs a cane and/or a wheelchair if he will be on his feet very long. Is this a
permanently disabling condition. What are the causes, treatments?
Answer: There are several types of degenerative nerve diseases. The most common
is peripheral neuropathy. This is a symmetrical loss of feeling in the feet progressing up
the leg. About the time that loss of sensation is at the knee, there will occur a loss of
feeling in the fingers as well-with progressive loss. Peripheral neuropathy represents a
slow dying of the neuron bodies. Since the nucleus for the nerve body is located in the
spinal cord, the nerves with the longest processes are affected first-the nerves in the
leg. As the nerves slowly get damaged and die the shorter nerves are affected.
There are numerous causes for peripheral neuropathy. The evaluation should start with a
complete physical and proceed to nerve conduction testing if no underlying disease is
found. Nerve biopsy is necessary in progressive cases. The most common cause of peripheral
neuropathy is Diabetes Mellitus. Control of the Diabetes will slow the disease. Currently,
research is ongoing with different drugs to minimize Diabetic peripheral neuropathy. These
are probably 2-3 years away from being released. The most easily treated causes are B12
Deficiency and Hypothyroidism.
Loss of Feeling in Legs
Question: I have no feeling in both my feet and halfway up my legs. My dr. has said
its neuropathy and the nerves are dead and nothing can be done. Why did the nerves die? I
have only been given blood tests and a neurologist checked me. Cant any further test
be done to see why the nerves died and maybe something can bring the nerves back. As the
day goes on my feet swell and I cant sleep at night because my toes feel like ice cubes.
To the touch they are OK but to me inside the cant get warm.
Answer: There are many potential causes of peripheral neuropathy. Diabetes
Mellitus is probably the most common. Easily fixable causes are B12 deficiency and
hypothyroidism. Other causes may be diagnosed but, are rarely fixable. Nerve conduction
studies should be done and if no obvious cause exists you should certainly see a
neurologist. So far, you aren't describing any diagnostic evaluation for the causes.
Question: I'm looking for info on the way optical illusions are formed in the
brain. Why do we see optical illusions? I know it is our brain playing tricks on us, but
I'm looking for a more detailed answer.
Answer: Interesting question;but, not one they teach in medical school.
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