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Experiencing numbness and tingling in hands, fingers, feet, toes and tongue. Suggestions

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Practicing since : 1998
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I have been experiencing some strange symptoms and I'm hoping you can shed some light on what I have been experiencing.

I am seeking a second opinion.

I have been experiencing numbness and tingling- hands, fingers, feet,toes, tongue, lips.
Left foot going completely numb and white randomly throughout the day and night.
Toes and finger tips turn really red, random burning sensation, face is also affected, gets hots and burns, have to cool down with a cold towel.

I developed blurred vision at the same time these symptoms first appeared around 3-4 weeks ago. Everything has a dark outline and is not clear, appearing as a slight 'double'. I could read close up without my glasses but now it is blurry. Far away vision is also affected, I can't read signs in the distance etc, I could read them with my glasses with no problem, now I can't at all. I have my short-sighted vision checked every year and new glasses 6 months ago and the prescription had slightly improved. Some days my vision is better than other days but It still has not returned to way it was before this initial onset. I also have black areas in my left eye that come and go.

I was checked at Armadale Hospital 4 weeks ago, all bloods normal except BSL was high. Had follow up bloods done at Kelvale, fasting BSL normal, Cholesterol was high, Urea was slightly elevated and CRP was elevated also. CT scan normal but did suggest MRI for suspected brain stem pathology. Hospital referred me to private Neurologist for MRI to check for lesions and an Opthamologist for vision problems. My paternal Aunty was diagnosed with MS last year. I didn't get the MRI done as I can't afford to do it privately.

Symptoms progressed and got significantly worse 2 weeks ago, checked by ER Neurologist at XXXXXXX Gardiner. He did a neurological examination, hot/cold tests etc. His opinion was Peripheral Neuropathy with benign symptoms but couldn't be sure without EMG study, referred me back to GP for referral to Neurology Department for follow up EMG study. He didn't think the vision problems were related to the other symptoms. He told me if the symptoms change or get worse and I was concerned then come back.

My GP referred me publicly to the Neurology department for full work up. Referral has been received just waiting for appointment.

Symptoms progressed further last weekend where I couldn't see properly at all, and my left foot was completely numb for a few hours and I couldn't walk. I also had pain in my left arm and tingling/numbness in my left hand. I was having difficulty speaking and was feeling very foggy and confused. I went back to Armadale hospital, they rang the Neurologist at XXXXXXX Gardiner who saw me previously and he said the Consultant will contact me for an earlier appointment. I haven't heard anything as yet.

The last 4 days, I have awoken with numb tongue, lips, and left side of face. It is numb to the touch but I can still move my face. These symptoms change throughout the day, being noticeable in the morning when I first wake up and tend to increase in severity as the day progresses. The altered sensation and tingling is there almost all of the time since it appeared 4 weeks ago. The numbness in my limbs seems to be worse if I am lying down or sitting. It's very similar to when your arm or leg 'falls asleep' or if you sleep funny or cut the circulation off in some way. When my arms goes numb its similar to when you hit your 'funny bone' but it's totally numb from the elbow to the finger tips. I am waking up at night finding my foot or entire arm completely numb, it's quite distressing as it's happening so often. Or I'll stand up from the lounge and almost fall as my foot is totally numb.

I'm wondering if there is also the possibly of a circulatory problem causing a lot of these symptoms. I didn't have the redness, nor was my left foot turning completely white when I saw the Neurologist at XXXXXXX Gardiner ER.

I feel like my circulation is being interrupted in some way or has definitely become sluggish. My skin has changed in appearance and feeling. Blood tends to pool in my feet and hands which are also puffy.

Is there a Vascular Specialist I can be referred to?

I do have a significant Urological history which may or may not be related.

I was diagnosed with Interstitial Cystitis by a Urologist via cystoscopy in 2008 after having symptoms for 10 years. I have chronic severe pelvic pain, urinary frequency, nocturia (every 30mins), hesitation. Over the last few years I have had 4 episodes of total incontinence, that I had no control over whatsoever. (I mention this as It may be related neurologically) The specialist thought I had problems with the nerve endings in the bladder, causing symptoms of pain etc. I have had many different medications/procedures including Hydrodilation etc for the IC but they have failed to provide any significant relief. I currently take Promethazine 75mg at night as prescribed by Urologist (supposed to help with the mast cell, histamine production within lining of bladder) Tramadol and Oxynorm prn for pain. I also have a Pain Specialist at Shenton Park who has tried me on Pregablin with no improvement.

The peripheral numbness etc appeared after I started using a TENS machine for IC pain control through the Armadale Hospital Physiotherapy Dept. I have stopped using it now. Not sure if that had anything to do with it.

I also have a mental health history of Major Depression and anxiety which is currently well controlled with Pristiq 100mg once a day.

I'm finding the neurological symptoms quite distressing as I don't know what is going on. I would like to do a blood pressure Holter to monitor my BP as it is usually quite low, but spikes quite high. The last time I was at hospital my Bp was changing significantly from 140/90 to 90/58 whilst lying down in the space of half an hour. That was noted by the nurse at the time. I also feel when I stand up that my heart races and I have to hold on to the wall to stop myself from blacking out. Everything goes starry and black for a few seconds. That happens regularly. I do have anxiety issues and have had 2 panic attacks in the past, but this doesn't feel at all like those episodes.

I feel like the parasthesia, visual, circulation and blood pressure symptoms are all related in some way.

I understand that medications have a lot of side effects and my current Dr has put most of these symptoms down to side effects but I would like a second opinion as I don't believe they are totally caused by medication.

Any help is greatly appreciated.

Thank you.
XXXXXXX Weatherall. 7/09/1983
Posted Sun, 2 Jun 2013 in Brain and Spine
Answered by Dr. Sandhya Manorenj 3 hours later
Hi ,

Thank you for the query.

Based on details you provided, I consider that you have been suffering from paresthesia involving limbs, lips and at time face .This symptoms are associated initially with blurring of vision and now vision is impaired. In a young girl like you with positive family history of MS, relapsing remitting form of MS has to be ruled out.
You require MRI brain with screening of spine with contrast if needed.
You also require VEP ( visual evoked potential ) study and EMG (Electromyography) test to rule out optic nerve and peripheral demyelination too. Meantime you need statins for lipid control, drink plenty of fluids for raised urea. Consult nephrologists for raised urea.

Interstitial cystitis can be secondary to overactive bladder secondary to central lesion affecting brain, hence diagnosis to be confirmed further. In your case symptoms are neurological than vascular. Blood pressure also is controlled by vasomotor centre of brain (Located at brainstem). Hence you need to go ahead with opinion of neurologist, than going for vascular surgeon. Hope this will help you.
Continue the antidepressants and treatment option planned for interstitial cystitis by your doctor. You need to have neuralgic medicine, pregabalin 75 mg daily and to titrate it to twice daily dosage as per your body weight. Avoid long term usage of painkillers that will affect kidney and further elevation of renal functions (urea, creatine)

Kindly get back if you require any additional information

Wishing for a quick and complete recovery.

Dr Sandhya Manorenj
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