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Suggest Treatment For Swelling In Lymph Nodes And Pain In Arms
Brief Answer:
Needs a detailed description.Please add these details.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If you would have presented to me as an outpatient with these complaints,I would have told you that the details you have shared so far are inadequate to make a clinical impression to arrive at a diagnosis.Please add these specific details as I ask:
1)Which is the chief complaint out of these-tremors or pain?What do you mean by flinching spasm?
2)Regarding tremors-
Are they at rest or while doing something?like holding a cup of tea or doing some other task with hands?
Are they asymmetrical(in one hand or early onset in one hand) or symmetrical(onset in both hands at the same time)?
For how many years or months you are having them?
3)Regarding pain-
Is there any type of pain ,except bone pain?If yes,please describe?
4)What other neurological issues?
5)What are the lymph nodes which are involved-cervical or axillary?Did you get any lymph node biopsy or Fine needle aspiration cytology(FNAC) done?Are the disorders which can have bone pain as well as lymph nodes like hematological malignancies ruled out,because they can have neurological manifestations also?
I have seen your MRI report.It reports some white matter hyperintensities but nothing conclusive out of it.
Please upload all your medical documents with reports,especially the ones on which the neurologist and the rheumatologist noted down history and examination findings.
Please upload the lab reports.
If possible,please tell your history in chronological order of complaints.
Waiting for your follow-up question.
Dr.Ajay Panwar,
MD,DM(Neurology)
Needs a detailed description.Please add these details.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If you would have presented to me as an outpatient with these complaints,I would have told you that the details you have shared so far are inadequate to make a clinical impression to arrive at a diagnosis.Please add these specific details as I ask:
1)Which is the chief complaint out of these-tremors or pain?What do you mean by flinching spasm?
2)Regarding tremors-
Are they at rest or while doing something?like holding a cup of tea or doing some other task with hands?
Are they asymmetrical(in one hand or early onset in one hand) or symmetrical(onset in both hands at the same time)?
For how many years or months you are having them?
3)Regarding pain-
Is there any type of pain ,except bone pain?If yes,please describe?
4)What other neurological issues?
5)What are the lymph nodes which are involved-cervical or axillary?Did you get any lymph node biopsy or Fine needle aspiration cytology(FNAC) done?Are the disorders which can have bone pain as well as lymph nodes like hematological malignancies ruled out,because they can have neurological manifestations also?
I have seen your MRI report.It reports some white matter hyperintensities but nothing conclusive out of it.
Please upload all your medical documents with reports,especially the ones on which the neurologist and the rheumatologist noted down history and examination findings.
Please upload the lab reports.
If possible,please tell your history in chronological order of complaints.
Waiting for your follow-up question.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Yogesh D
1. The tremors and pain arent connected, i dont think. Itsmore on the right side, than the left arm hands and head, legs when im sitting and resting. The pain is everywhere arms hands legs eyes hhead, the lymph nodes in my neck go up and down.
There are no new labs, going for xray and abdominal ultrasound this week, i was hoping the last labs would say something.
There are no new labs, going for xray and abdominal ultrasound this week, i was hoping the last labs would say something.
Brief Answer:
Parkinsonian/Essential tremors.Needs neurological evaluation.
Detailed Answer:
Hi,
Thanks for being in follow-up and providing further details.
Based on your medical history,I am summarising your clinical case as:
Asymmetric tremors mainly at rest along with diffuse body pains with cervical lymphadenopathy(possibly reactive as it is of waxing and waning in clinical course).
The possible causes to be considered are:
1)Parkinsonian syndrome-Asymmetric rest tremors are characteristic features.
2)Essential tremors-You also have head tremors which are a part of essential tremors.Though asymmetry is not a feature of essential tremors but uncommonly,these may have ,mild asymmetry.
3)Thyroid disorder
4)Anxiety
So far,you have uploaded only MRI brain report which show some white matter hyperintensities which are non-contrast enhancing, not conclusive of any pathology and can be observed in normal individuals also.So,if there are any lab reports,please upload them.I suggest you to get thyroid function tests and share the results here.
You need to be put on a trial of Beta blockers like propranolol for essential tremors.At the same time ,you need to be examined for other parkinsonian features like cog-wheeling and parkinsonian gait.
I suggest you to get examined by a neurologist for the possibility of parkinson's disease or parkinsonian syndrome and starting you on the therapeutic trial of beta-blockers.Simultaneously,anti-anxiety drug(if you have a history of anxiety) like clonazepam may be of help.
Pain does not appear to have a specific etiology,so far.It may have some psychosomatic component.However,it is too early to comment before having a look at the lab reports.
Please upload the medical documents and reports in the follow-up question.
Waiting for your follow-up.
Dr.Ajay Panwar,
MD,DM(Neurology)
Parkinsonian/Essential tremors.Needs neurological evaluation.
Detailed Answer:
Hi,
Thanks for being in follow-up and providing further details.
Based on your medical history,I am summarising your clinical case as:
Asymmetric tremors mainly at rest along with diffuse body pains with cervical lymphadenopathy(possibly reactive as it is of waxing and waning in clinical course).
The possible causes to be considered are:
1)Parkinsonian syndrome-Asymmetric rest tremors are characteristic features.
2)Essential tremors-You also have head tremors which are a part of essential tremors.Though asymmetry is not a feature of essential tremors but uncommonly,these may have ,mild asymmetry.
3)Thyroid disorder
4)Anxiety
So far,you have uploaded only MRI brain report which show some white matter hyperintensities which are non-contrast enhancing, not conclusive of any pathology and can be observed in normal individuals also.So,if there are any lab reports,please upload them.I suggest you to get thyroid function tests and share the results here.
You need to be put on a trial of Beta blockers like propranolol for essential tremors.At the same time ,you need to be examined for other parkinsonian features like cog-wheeling and parkinsonian gait.
I suggest you to get examined by a neurologist for the possibility of parkinson's disease or parkinsonian syndrome and starting you on the therapeutic trial of beta-blockers.Simultaneously,anti-anxiety drug(if you have a history of anxiety) like clonazepam may be of help.
Pain does not appear to have a specific etiology,so far.It may have some psychosomatic component.However,it is too early to comment before having a look at the lab reports.
Please upload the medical documents and reports in the follow-up question.
Waiting for your follow-up.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
I thought you received all my bloodwork I'll upload it again. Thanks
Just uploaded thx look forward to your response,
Just uploaded thx look forward to your response,
Brief Answer:
A trial of steroid therapy.Oligoclonalbands report.Immunologist's opinion.
Detailed Answer:
Hi,
Thanks for being in follow-up.
I have gone through all your lab reports.There are some definite abnormalities.
CSF IgG index is raised -3.3,which in view of MRI hyperintensities may be associated with Multiple sclerosis(MS).
However,lab reports indicate other immune cells abnormalities also as suggested by CD19,CD8 and CD3 cells.
I suggest you to consult a hematologist/clinical Immunologist for opinion regarding abnormalities of your immune cells.
Simultaneously,I suggest you to visit a neurologist(so that he can do a meticulous neurological examination) and discuss regarding starting steroid therapy as a trial for MS,keeping in mind MRI changes and serum IgG index.At the same time,Please upload OCB(Oligoclonalbands) report in CSF,which must have been done as a part of your evaluation.
Hope I have answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
A trial of steroid therapy.Oligoclonalbands report.Immunologist's opinion.
Detailed Answer:
Hi,
Thanks for being in follow-up.
I have gone through all your lab reports.There are some definite abnormalities.
CSF IgG index is raised -3.3,which in view of MRI hyperintensities may be associated with Multiple sclerosis(MS).
However,lab reports indicate other immune cells abnormalities also as suggested by CD19,CD8 and CD3 cells.
I suggest you to consult a hematologist/clinical Immunologist for opinion regarding abnormalities of your immune cells.
Simultaneously,I suggest you to visit a neurologist(so that he can do a meticulous neurological examination) and discuss regarding starting steroid therapy as a trial for MS,keeping in mind MRI changes and serum IgG index.At the same time,Please upload OCB(Oligoclonalbands) report in CSF,which must have been done as a part of your evaluation.
Hope I have answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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