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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for severe nausea, dizziness and memory loss in an elderly person

Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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Posted on Fri, 26 Aug 2016 in Brain and Spine
Question: I have painful spasms in both thighs and weakness from hips down to ankles for about 2 weeks now and also some nausea feels like I'm going to be sick and usually after I eat and sometimes during eating and have to push my food aside. The spasms get up in my shoulders, arms and neck having to take 1-1/2 pills Mirapex to sleep and still wake up with them though the night. I can't take a nap or even sit down to watch TV and relax anymore during the day. Stay sleepy a lot but have trouble resting. I have been taking Mirapex for a few years now they keep telling me I have restless leg, but the last couple weeks it's been different. Having spells of dizziness some memory loss forgetting things. I looked up signs of MS could I have MS I'm 62 years old now
doctor
Answered by Dr. Dariush Saghafi 5 hours later
Brief Answer:
How was Restless Legs actually diagnosed?

Detailed Answer:
Good evening. I've read your paragraph of symptoms and can't help but notice you are on Plaquinil. Therefore, my guess is that you're being treated for Systemic Lupus Erythematosus (SLE) or Rheumatoid Arthritis. Of course, I suppose some rogue mosquito from Southeast Asia could've made to Indiana and the plaquenil is your ticket to cure a case of malaria....but I doubt that one. :)

I believe that in order to diagnose with any precision what's been going on the last few weeks in the thighs and hips you will need a solid neurological examination that can look at your distribution of power and strength. The possibilities are a metabolic/chemical/hormonal problem being the cause of your symptoms or some type of compressive or pressure related irritation of spinal nerve roots or perhaps spinal canal stenosis affecting a segment of the spinal cord in general which might explain why you have diffuse symptoms over the entire body on both sides.

If Mirapex is not helping and if you really don't have the salient features to fulfill the criterion for Restless Legs Syndrome then, I might question how that diagnosis was arrived at and whether or not it is being addressed optimally if the Mirapex is no longer really working.

I have an extremely low threshold for suspecting demyelinating disease such as MS being anywhere close to the top choices for your primary problem. 62 years old would be a reportable case of MS if being discovered and picked up for the first time. Having said that, I will tell you that during training I can remember caring for a patient we diagnosed with MS who did not develop even her first symptoms until she got off an airplane on a trip! She was 72 years old!

But that is the ONLY patient I can remember in 17 years who was in an age group that was simply ridiculously advanced for MS but she ended up clearly having it since we did imaging studies as well.

With your symptoms I would definitely consider an MRI of the brain with GADOLINIUM CONTRAST but my guess is that when it's said and done this problem will be firmly grounded in a musculoskeletal issue and not a demyelinating one. Age 62 is truly reportable in the medical literature for a first time diagnosis of MS with atypical symptoms to boot. Tough sell in my opinion.

If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 44 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Dariush Saghafi 1 hour later
I want to think you for the answer, I' ve been saying for last couple of years that I didn't believe I had restless leg. I've been to 2 different Neurologist and they both say it was restless leg and all they want to do is prescribe more pills or a higher dose of miroplex. I'll see my family doctor in 2 days for my A1C I'll have a talk with him and I'll sbow him your answer. It b as gotten really bad these last couple of weeks I'm in bed now and been having spasms for a couple hours. It's going to bbe a long night
doctor
Answered by Dr. Dariush Saghafi 14 hours later
Brief Answer:
Sorry you're having to stay tied to the bed

Detailed Answer:
Thanks for your clarification. Well, I really am in a disadvantaged position being here in XXXXXXX OH and having you way out yonder in Bloomfield, IN. We're actually not that far away......you'd love XXXXXXX ...we are very progressive these days and of course, after the filming of Spiderman, Capt. XXXXXXX A Christmas Story, and the RNC....well, I guess....we're just a little FA-MOUS! LOL....

It sure would be nice to be hands on with you since that's the medicine should be but the thing is...your symptoms just don't strike me as RLS by your description. I'm surprised to hear that 2 neurologists thought for sure you had that.....The most common constellation of symptoms are the following:

•Unusual itching
Tingling on skin
•Crawling sensations deep in the legs
•Very intense, irresistible urge to move legs to relieve sensations
Restlessness when resting or attempting to sleep
•Desire to rub legs, constantly changing position in bed, and pace

Also, getting up and walking about calms down the symptoms while stopping the movement and lying down brings them on like gangbusters. XXXXXXX cramping and pain is not really what I hear when it comes to RLS...Now, can restless legs syndrome be found in the upper extremities and torso as well? YES IT CAN....but again, not in the form of radiating spasms and pain coming up from the legs.

In my opinion, I think they need to do some imaging studies since RLS is a diagnosis of EXCLUSION which means everything else has to be looked at and ruled out. If you're having spasms then, one wonders if you've got a metabolic derangement so I would run some labs on you looking for thyroid hormones, perhaps a cortisol, electrolytes, Magnesium, Total serum Calcium and Magnesium, and IONIZED calcium as well. Have they done their iron panels on you yet? If the diagnosis is RLS then, many docs would consider getting an entire panel to include Ferritin, serum iron levels, and total body iron concentration. If iron is low (particularly the Ferritin) then I would also check a serum Zinc level to see if it were LOW, I would probably also do a parathormone and Vitamin D. If you're diabetic (you say that your A1C gets checked every few months) then, there's one more thing I would consider checking on you and it's called STIFF PERSON SYNDROME.

A doctor will have to run some parameters and get your history to believe that you could possibly have this but if so there are a couple of additional tests that can ferret out what's going on:
•Anti-GAD antibodies, •Anti–pancreatic islet cell antibodies, •Anti-amphiphysin antibodies

If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 63 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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