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Suggest Treatment For Persistent Tingling Sensation In Body And Neck Stiffness
Question: Hi, my name is xx, for the past month I have been experiencing tingling on my entire left side that eventually moved to my face. In addition to the tingling, I have experienced a burning sensation in my left leg and arm, stiffness on the left side of my neck, and at times I felt as if my throat was closing. Also, to add to that mix, I am experiencing fasciculations throughout my body. have seen my GP and was told that most of these symptoms are anxiety induced; however, for my peace of my mind, he referred me to a neurologist for further review. I went to the neurologist and he conducted a neurological exam, indicated that everything appears normal, yet he wanted to get a few more test in the mix such as 3 blood tests to rule out infection, vitamin deficiency, and inflammation count which all returned normal. Second, he also ordered a brain MRI which returned normal. He assured me that I do not have ALS. I am becoming concerned because my left hand has become stiff over the past 3 weeks and I am afraid that it may become week at some point even though I still have 100 percent strength at this time. I have another consultation scheduled for tomorrow for a second opinion, as I would like to get an EMG to rule that out. My background consist of the following: I am 32 years old, XXXXXXX XXXXXXX no morbidities, and high cholesterol which I am working to lower. Please help me, I am truly fearful that I have come to the end of my life. I feel like I have the onset symptoms of ALS (Lou Gehrig’s Disease). I Really hope that I do not, as I do have any weakness yet, but the stiffness scares me.
Brief Answer:
ALS unlikely
Detailed Answer:
I read your question carefully and I understand you are under great distress.
I do not think ALS to be that likely in your case. One simple cause for that is your age. ALS typically appears later on in life. I am not saying it is excluded, cases have have been encountered at any age, but it is very very rare under the age of 40, personally in 7 years dealing with neurological cases haven't had any case under 40. So you being 32 alone doesn't make ALS likely.
The presentation being so strictly unilateral isn't that typical either, it starts unilaterally on one limb, but you mention all three sectors being involved arm, leg and cranial nerves, generally some contralateral involvement would be present. The lack of weakness is important as well, the spasticity in nervous system disorders is somethin which is on top of weakness not isolated. There are other signs as well such as atrophy or abnormal reflexes which your neurologist I am sure tested and didn't find. Also burning is not typical, ALS as the name motor neuron disease indicates involves motor function doesn't cause such abnormal sensations.
So again I do not think ALS likely. Since you are obviously under great distress for this issue you can have get the second opinion and schedule an EMG to put your mind at ease, but in the meantime I hope my answer serves to relieve some of the anxiety you obviously feel on this issue.
I remain at your disposal for further questions.
ALS unlikely
Detailed Answer:
I read your question carefully and I understand you are under great distress.
I do not think ALS to be that likely in your case. One simple cause for that is your age. ALS typically appears later on in life. I am not saying it is excluded, cases have have been encountered at any age, but it is very very rare under the age of 40, personally in 7 years dealing with neurological cases haven't had any case under 40. So you being 32 alone doesn't make ALS likely.
The presentation being so strictly unilateral isn't that typical either, it starts unilaterally on one limb, but you mention all three sectors being involved arm, leg and cranial nerves, generally some contralateral involvement would be present. The lack of weakness is important as well, the spasticity in nervous system disorders is somethin which is on top of weakness not isolated. There are other signs as well such as atrophy or abnormal reflexes which your neurologist I am sure tested and didn't find. Also burning is not typical, ALS as the name motor neuron disease indicates involves motor function doesn't cause such abnormal sensations.
So again I do not think ALS likely. Since you are obviously under great distress for this issue you can have get the second opinion and schedule an EMG to put your mind at ease, but in the meantime I hope my answer serves to relieve some of the anxiety you obviously feel on this issue.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Taka:
Thank you for your response and truly appreciate you getting back to me. I guess I need to just put my mind at ease and get back to living my life.
Thanks,
xx
Thank you for your response and truly appreciate you getting back to me. I guess I need to just put my mind at ease and get back to living my life.
Thanks,
xx
Brief Answer:
You're welcome
Detailed Answer:
Pleased to have been of help.
You're welcome
Detailed Answer:
Pleased to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Taka:
I wanted to update you on my progress. Yesterday, I had both an EMG and a 2nd neurological exam, both exams presented normal; however, the stiffness still concerns me primarily due to it being on the left side of my body (neck, hand, and lower leg). Does having a normal EMG and neuro exam rule out the worst that I suggested. I don't know why I am fearful, as Dr. Google has made my life a living disaster these past 4 weeks. I am scheduled for a cervical MRI on next Friday; however, if it doesn't reveal anything, than my mind will suspect the worse. I still have no weakness, but should I expect that to come? The neurologist I consulted with on yesterday indicated that I have no clinical inclinations of this dreaded disease. This was my second opinion; therefore, I am little bit at ease, but I was reading online that some people tend to have normal EMG's prior to deterioration of the disease. I really want to live a long and healthy life and I am just a bit worried that this stiffness indicates not. Sorry about the long diatribe of worry, all my doctors have assured that I am healthy; however, I want the stiffness to go away.
I wanted to update you on my progress. Yesterday, I had both an EMG and a 2nd neurological exam, both exams presented normal; however, the stiffness still concerns me primarily due to it being on the left side of my body (neck, hand, and lower leg). Does having a normal EMG and neuro exam rule out the worst that I suggested. I don't know why I am fearful, as Dr. Google has made my life a living disaster these past 4 weeks. I am scheduled for a cervical MRI on next Friday; however, if it doesn't reveal anything, than my mind will suspect the worse. I still have no weakness, but should I expect that to come? The neurologist I consulted with on yesterday indicated that I have no clinical inclinations of this dreaded disease. This was my second opinion; therefore, I am little bit at ease, but I was reading online that some people tend to have normal EMG's prior to deterioration of the disease. I really want to live a long and healthy life and I am just a bit worried that this stiffness indicates not. Sorry about the long diatribe of worry, all my doctors have assured that I am healthy; however, I want the stiffness to go away.
Brief Answer:
No indication of ALS at all.
Detailed Answer:
Hello again xx and thank you for the update.
I am pleased the EMG came out normal. Well that can only reinforce my initial opinion, if I didn't believe you to have ALS before for the reasons I already explained I naturally am even more convinced now. It's not only the normal neuroexam, as I said it's also your age and the evolution of your symptoms which doesn't either, nothing does, so I do not see why you should think you have that condition really.
It is good you are having a cervical MRI, it will complement the brain one and rule out MS, the one condition I might have feared in your case (thought since you described symptoms in your face responsible lesions for that would've been evident in the brain MRI so unlikely).
The best means to make stiffness go away would be physical activity, relaxation techniques, activities like yoga.
Wishing you all the best
No indication of ALS at all.
Detailed Answer:
Hello again xx and thank you for the update.
I am pleased the EMG came out normal. Well that can only reinforce my initial opinion, if I didn't believe you to have ALS before for the reasons I already explained I naturally am even more convinced now. It's not only the normal neuroexam, as I said it's also your age and the evolution of your symptoms which doesn't either, nothing does, so I do not see why you should think you have that condition really.
It is good you are having a cervical MRI, it will complement the brain one and rule out MS, the one condition I might have feared in your case (thought since you described symptoms in your face responsible lesions for that would've been evident in the brain MRI so unlikely).
The best means to make stiffness go away would be physical activity, relaxation techniques, activities like yoga.
Wishing you all the best
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Taka:
How are you? I wanted to touch base with you, as of yesterday, my left leg, calf, hand, and arms started tightening up. In addition, I am scared that I am loosing some strength in my hand and leg though the EMG and CK lab came back normal with no signs of muscle wasting. It does appear that my left arm looks a bit smaller than my right. I know you said no possibility of ALS; however, I just want to check to see if the EMG may have missed something. The Left side of my face is starting to hurt and become stiff as well. Also, the twitching in starting to happen more throughout my body. My Gluclose/Ser came back at 133 for fasting, thus could diabetes milletus cause those symptoms, as I checked online and indicated that most of those symptoms were related. I also wake up with dry mouth every morning, excessive urination, and burning in my left leg, arm, and hand. I am so scared...in talks with neuro and waiting for a return call.
How are you? I wanted to touch base with you, as of yesterday, my left leg, calf, hand, and arms started tightening up. In addition, I am scared that I am loosing some strength in my hand and leg though the EMG and CK lab came back normal with no signs of muscle wasting. It does appear that my left arm looks a bit smaller than my right. I know you said no possibility of ALS; however, I just want to check to see if the EMG may have missed something. The Left side of my face is starting to hurt and become stiff as well. Also, the twitching in starting to happen more throughout my body. My Gluclose/Ser came back at 133 for fasting, thus could diabetes milletus cause those symptoms, as I checked online and indicated that most of those symptoms were related. I also wake up with dry mouth every morning, excessive urination, and burning in my left leg, arm, and hand. I am so scared...in talks with neuro and waiting for a return call.
Brief Answer:
Read below
Detailed Answer:
Hello xx and thanks for the update.
That glucose level if fasting is indeed high. Also the excessive urination, increased thirst and dry mouth can indeed be a sign of diabetes. So that is an issue which should be pursued, I would suggest by repeating the test and also having Hb1Ac or Glycated hemoglobin test which gives an appreciation of the average glucose concentration over the last 3 months. If those tests confirm diabetes you should be followed by an endocrinologist.
Those values do not explain the other symptoms, metabolic alterations like electrolyte abnormalities can be cause be very high glucose levels, but 133 is not sufficiently high to lead to metabolic alterations.
With a normal MRI, EMG, normal neurological exam by a neurologist, tests which exclude infection, inflammation or nutritional deficiencies I am afraid that there is not any obvious reason to your symptoms other then anxiety.
As for ALS I repeat that it is out of the question. The more you add from one follow up question to the other the less likely it is. ALS is an insidiously evolving condition, progressing over many months, doesn't change so much over a few weeks like you describe, so accompanied with the reasons I have mentioned before it is not your case.
Read below
Detailed Answer:
Hello xx and thanks for the update.
That glucose level if fasting is indeed high. Also the excessive urination, increased thirst and dry mouth can indeed be a sign of diabetes. So that is an issue which should be pursued, I would suggest by repeating the test and also having Hb1Ac or Glycated hemoglobin test which gives an appreciation of the average glucose concentration over the last 3 months. If those tests confirm diabetes you should be followed by an endocrinologist.
Those values do not explain the other symptoms, metabolic alterations like electrolyte abnormalities can be cause be very high glucose levels, but 133 is not sufficiently high to lead to metabolic alterations.
With a normal MRI, EMG, normal neurological exam by a neurologist, tests which exclude infection, inflammation or nutritional deficiencies I am afraid that there is not any obvious reason to your symptoms other then anxiety.
As for ALS I repeat that it is out of the question. The more you add from one follow up question to the other the less likely it is. ALS is an insidiously evolving condition, progressing over many months, doesn't change so much over a few weeks like you describe, so accompanied with the reasons I have mentioned before it is not your case.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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