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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.

[posted 08/17/1999]
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?

[posted 08/12/1999]
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.

Neurology [posted 1/5/99]
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.

Weakness & "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 heal/regenerate.

Swelling Limbs [posted 11/24/98]
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 [posted 10/30/98]
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 [posted 10/30/98]
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 peripheral neuropathy.

What is Arm Numbness a Symptom Of [posted 10/28/98]
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 [posted 10/28/98]
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 jogging, etc.
  • 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 10/13/98]
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 7/22/98]
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.

Neurological Problems
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.

Nerve Stimulation
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.

Peripheral Neuropathy
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. Can”t 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.

Optical Illusions
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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