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Do Muscle Cramps With Weakness In The Hands And Legs Require Medical Attention?

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Posted on Mon, 13 Nov 2017
Question: my brother is 80 years old, healthy until a few months ago. He started having muscle cramping in his arms and legs along with weakness in his hands. Having difficulty holding a tennis racket.,glass. etc.
His doctor sent him to a neurologist who did a mri ,lab work and an emg test. he only came back low in
B12. All other values were normal. They found spinal stenosis in C3 to C5. He was sent to a spine surgeon
who told him he could operate, but it may not help the problem. He went to and ortho surgeon for a second
opinion. He told him he may not need spinal surgery but on examination found his fat pad by his thumbs
had atrophied. He recommended a neurosurgeon for further treatment. The neurosurgeon thought them mri
results could be a red herring. And didn't think that surgery would correct the cramping and weakness.
He was told to go back to his neurologist. which he did. The neurologist sent to a colleague for a second
look at the symptons. After the second neurologist did a thorough exam, he too felt that surgery was not the
answer and recommended a second emg which will be done on the 26th. He is very frustrated and told
me that the weakness is getting worse.
I work in an O.R. and have asked someof surgeons, but no answers. I feel bad I can't help.
Could you help ? Thank you
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Without reports it is difficult to make recommendations.

Detailed Answer:
I read your question carefully and I understand your concern.

Judging from that description the most likely diagnoses would be a peripheral nervous system disorder such as ALS (amyotrophic lateral sclerosis) or a cervical myelopathy, damage of the spinal cord in the neck as the neurologist has suggested. Vitamin B12 deficiency is also a possible cause, but depends on how low it is and whether there are permanent changes to the cord.

While your worry and frustration is justified given the contradictory answers given to you by different specialists and me or my colleagues would dearly like to help, the distinction is a little difficult with the current information. Diagnosis is based on findings on physical exam which is impossible in this virtual setting and the results of the tests. Since we do not have any test reports of the neck MRI it is hard to judge whether the changes noted there are responsible, some changes are expected to be found at that age, the issue is whether there is spinal cord compression. We do not have at our disposal EMG report which furthermore is also dependent on the expertise of the examiner.

So tough to provide a diagnosis. If cervical MRI changes are not considered enough to justify symptoms then another EMG is recommended as a peripheral nervous system such as peripheral neuropathy or motor neuron disease (ALS) would be the remaining main hypothesis.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3674 Questions

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Do Muscle Cramps With Weakness In The Hands And Legs Require Medical Attention?

Brief Answer: Without reports it is difficult to make recommendations. Detailed Answer: I read your question carefully and I understand your concern. Judging from that description the most likely diagnoses would be a peripheral nervous system disorder such as ALS (amyotrophic lateral sclerosis) or a cervical myelopathy, damage of the spinal cord in the neck as the neurologist has suggested. Vitamin B12 deficiency is also a possible cause, but depends on how low it is and whether there are permanent changes to the cord. While your worry and frustration is justified given the contradictory answers given to you by different specialists and me or my colleagues would dearly like to help, the distinction is a little difficult with the current information. Diagnosis is based on findings on physical exam which is impossible in this virtual setting and the results of the tests. Since we do not have any test reports of the neck MRI it is hard to judge whether the changes noted there are responsible, some changes are expected to be found at that age, the issue is whether there is spinal cord compression. We do not have at our disposal EMG report which furthermore is also dependent on the expertise of the examiner. So tough to provide a diagnosis. If cervical MRI changes are not considered enough to justify symptoms then another EMG is recommended as a peripheral nervous system such as peripheral neuropathy or motor neuron disease (ALS) would be the remaining main hypothesis. Let me know if I can further assist you.