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What causes leg weakness and speech difficulty after few hours of waking up?

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Posted on Mon, 23 Nov 2015
Question: I have been on Amantrel, Ptemipexal and Clopitab for more than 1.5 years. I had TIA 2 years back which led to some hypoxia of basal ganglia.

Currently and for a long time now, I feel extreme weakness in my legs and have some speech problems 4 - 5 hours after I wake up from sleep.

Can you tell me what might be causing this and possible treatment options.
doctor
Answered by Dr. Ajay Panwar (14 hours later)
Brief Answer:
Please tell a few details.

Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com. I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I would surely like to answer this with my best concerns but I need to know a few details beforehand-
1)Are you having Parkinson's disease as well?For what reason you are being kept on Amantrel and Pramipexole?
2)Does your weakness in legs and speech problems start 4-5 hours,after you rise up in the morning?For how long does these symptoms last?Do they keep improving and worsening intermittently?
3)Any history of tightness in limbs and slowing of daily activities?

Please follow up with details so that I can answer this well.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Sonia Raina
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Follow up: Dr. Ajay Panwar (1 hour later)
I was put on these medicines more than 1.5 yrs back. On my complaint of weekness and speech issues.

Few months back another doctor doubted that this may be slight Parkinson but later on said may be not but continued these medicines. Told me to focus on exercising and gyming and practice reading to improve speech problems. The weakness starts 30 mins after I wake up and speech issues after 3 - 4 hrs. No tightening of limbs but some slow movement at times due to weakness. My arms are also weak as compared to before the TIA incident.
Symptoms last throughout the day.
doctor
Answered by Dr. Ajay Panwar (5 hours later)
Brief Answer:
What do you mean by weakness?

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up with details.

However,with this much information,clinical picture is not very clear.Please clarify the following points-
1)What do you mean to say by weakness?Weakness in legs can cause the following symptoms-
Inability to stand up from the squatting position as in toilet.
Knee buckling while walking
Difficulty in making grip on the footwear or slipping of footwear while walking

Weakness in arms/hands can cause-
Difficulty in breaking bread crumbs
Difficulty in holding spoon,buttoning or unbuttoning
Difficulty in raising hands above the shoulders

Does your weakness show any of the above symptoms?

Can you make a small video clip of your speech difficulty and post it on google drive(and obviously share the link here in the follow-up question) which may help me to have a better idea that what sort of speech difficulty you have because different neurological conditions can result in different types of speech?

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Ajay Panwar (13 hours later)
My weekness in legs - calf muscles feel a bit heavy, feel quite week while walking or standing in one position for a ling time. Feel i shiuld just sit down

My weekness in arms - unable or diffucukt to pick the same kind if weight i used to pick earlier with ease. Like heavy suitcase. Get tired quickly if i have to raise my arms above my head for some time.

Speech - becomes a but garbked , have diffuculty speaking loudly and clearly. This mostly happens after 3 - 4 hrs of waking up or after i have had to speak for sometime in meetings. Gifficult for others to makeout mostly but i feel quite challanged. May be because of hypoxia in basal ganglia just after the TIA attack 2.5 yesrs ago .
doctor
Answered by Dr. Ajay Panwar (22 minutes later)
Brief Answer:
Old Basal ganglia TIA is the unlikely cause /Neurological examination

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up with details.

Old basal ganglia hypoxia(2.5 years back) is the unlikely cause of these symptoms.
However,this medical history at so far,is not pointing towards a specific neurological diagnosis.Your speech has to be listened to make a proper interpretation,which may be of immense help towards the diagnosis.That's why,I asked you to post-up a video clip demonstrating your speech.If that's not possible for you,I suggest you to please get yourself,in person,examined by a neurologist.

Meanwhile,you should be on supportive therapy with multivitamins and anti-oxidants,as their deficiency can very well cause these manifestations.

Besides,your symptoms of speech difficulty,after 4 hours you wake up,is definitely atypical and must be evaluated for.Such a type of variation(though it is not a classical fatiguability history) can be observed in Myasthenia gravis.On the other hand,parkinsonism can also be a cause.However,to establish anything,physical examination is a must.

Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.
Please get back to me in case you have any query in future.

You can also put up a query directly to me on HCM address- http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69273

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ajay Panwar

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What causes leg weakness and speech difficulty after few hours of waking up?

Brief Answer: Please tell a few details. Detailed Answer: Hi XXXX, Thanks for being on healthcaremagic.com. I am Dr.Ajay Panwar,a neurologist,here to answer your query. I would surely like to answer this with my best concerns but I need to know a few details beforehand- 1)Are you having Parkinson's disease as well?For what reason you are being kept on Amantrel and Pramipexole? 2)Does your weakness in legs and speech problems start 4-5 hours,after you rise up in the morning?For how long does these symptoms last?Do they keep improving and worsening intermittently? 3)Any history of tightness in limbs and slowing of daily activities? Please follow up with details so that I can answer this well. Regards Dr.Ajay Panwar, MD,DM(Neurology)