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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest remedy for weakness in legs, low BP and dizziness

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Tue, 7 Jun 2016 in Headache and Migraines
Question: My Dad started with his left leg giving all the time feeling like it was his knee and weakness in leg. This has now progessed to the right leg which I think is because right leg been compensating for left leg. When dad tries to stand unaided he falls. He has literally gone overnight from a normal walking person to using a zimmer frame and aides by one person to walk. Blood tests CT scan have all been reported as normal. He has had a hospital stay with many tests and all tests are normal. Any ideas please my dad is only 68 and I hope he can get his mobility back and drive again. The falls worry me as he keeps hurting himself. He says his legs ache and feel very weak examination shows power 4/5 right leg and 3/5 left leg. He can sit and move leg on his own his thigh is tender like muscular (been told this is like muscle wasting) and says his knee feel like it gives way but not sure if it is his knee or leg he cant pinpoint it. Knee xray shows mild osteoarthritis nil else and doppler scan is entirely normal. Physio is not helping. Please please help I just want my dad back what else can I do? Stroke has been ruled out. I am worried sick it is something like motor neurone disease please help me. Physio says he has quadriceps problems weakened and muscle tone weak
Dad also has developed low blood pressure and dizziness.

Do you think the above relates to motor neurone disease?

GP thinks it could be diabetic neuropathy? If it is can dad get any of his mobility back please and if so how?


doctor
Answered by Dr. Olsi Taka 3 hours later
Brief Answer:
Several possibilities....

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

Whether motor neuron disease can cause weakness in both lower limbs....in theory yes it can, however that is certainly not enough to say that.
First of all more info on reflexes, appearance of abnormal reflexes, muscle atrophy is needed to be obtained by neurological exam.
Second more diagnostic tests are needed. You mention blood tests and CT but have to be more precise on what type of blood tests were taken (blood count, electrolytes, thyroid function, vitamin B12, creatine kinase, liver and kidney function are the most essential initial tests). Also was it a CT of the head or the spine? Weakness of both lower limbs calls for a spine evaluation. Even if it was a spine CT I do not think it was the most appropriate exam, it gives good information on the bones, but doesn't visualize well the spinal cord, a MRI is a much more appropriate exam.
Apart from the imaging, electrodiagnostic tests are needed. If the GP thinks it is due to diabetes (could be, diabetes causes peripheral neuropathy) was any test conducted such as nerve conduction studies and electromyography? Such a study is necessary both for the possibility of peripheral neuropathy as well as motor neuron disease and should be scheduled if spine MRI is normal.

So I am afraid some more probing is needed in order to reach to a diagnosis. Many possible causes such as spinal compression, peripheral neuropathy, nerve root neuropathy, motor neuron disease, metabolic or endocrine neuropathy etc.

I will be glad to discuss on other questions you have, but in the meanwhile a neurological consult and some tests are necessary.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 27 minutes later
All reflexes are normal. CT scan was of head as Dad wont have MRI scan due to be claustrophobic. This was normal. If it is peripheral neuropathy can it be reversed? I know motor neurone there is no going back
doctor
Answered by Dr. Olsi Taka 31 minutes later
Brief Answer:
Read below.

Detailed Answer:
As I said when there is a deficit of both lower limbs the part of the central nervous system to look at is the spine rather than the head. If MRI is impossible at least CT should be done, that would apply to any patient with such weakness, even more to someone with recurrent spinal osteomyelitis where a peridural abscess should be considered.
As for peripheral neuropathy that depends on the cause as they can be so many. If the cause is diabetes then it is a chronic issue which can be slowed/stopped with good diabetes control but not reversed. It is not directly life threatening though as with motor neuron disease.
That being said though this doesn't sound like typical diabetic neuropathy judging by the symptoms and normal reflexes. That is why the nerve conduction studies and electromyography I mentioned would be vital to make the distinction.

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