What causes muscle weakness, facial droop, fine motor skills difficulty and double vision?
Thank you for writing on health care magicc
Well the sort of symptoms you are having are related to the Central Nervous system and Humira( Adalimumab) can at times cause demyelinating lesions in the brain. Although it is not a common side effect, it is still known and hence precautions are taken in giving it to patients with disease like Multiple Sclerosis or GBS.
But yes, I would advise you to get a Lumbar Puncture done to rule out any subclinical infections like a viral one. The most common being JC Virus. It normally will show up on the MRI, but if it hasnt either a repeat MRI or a lumbar puncture is needed.
Secondly, Anti TNF agents can produce ANA positivity and cause drug induced lupus. But nuerological symptoms are very rare in drug induced lupus.
I would like to know how are your symptoms currently since it has been a month. Are they getting better or is it still the same or worse?
My differential would be a viral infection first and then the rest.
Do let me know these queries and further doubts. Would be happy to answer you further
? Demyelinating Lesion
Well, that is good that you are feeling better. I am not too sure about the diagnosis of complex headache or conversion especially if the history is quite typical of episodes starting after Adalimumab. Seizures can also do this, but the episode doesnt last so long with it. If you are feeling better, it is a good sign and we can wait for the Lumbar puncture. Normally a Neurologist only carries out the procedure, that is if they think it is some infectious cause.
But yes, let your rheumatologist know the problems you experienced. They will be more versed with the complications of the medications and will be careful not to choose the same class of drugs in the future. Also, just discuss with your neurologist regarding a viral infection triggered by Adalimumab.The good part, you are getting better.
Hope the information was useful
Do let me know for more queries
Well, mostly yes..The symptoms a person has normally collaborates with the lesions in the brain in Multiple Sclerosis. One ends to see multiple spots around which gives us a clue. Rarely, one may not pick up MRI findings which can then be ruled out with Lumbar puncture to look for oligoclonal bands. Plain MRI may not pick up a viral infection unless done with Contrast or one has a high suspicion for meningitis.
It is definitely an Usual case to have such side effects after Adalimumab. I have only read about it as of now, but never got to see it yet in our daily practice.
Do let me know about your queries
Would be happy to help out
? Conversion disorder
Well conversion disorder is more of a diagnosis of exclusion, that is we have done all the tests and they are negative so we label it as a Conversion disorder. But as you said you are not under any stress or anything, it may be less likely a possibility as Stress is a major factor which causes this disorder. Secondly, if there is a link between Adalimumab and your symptoms it again decreases the possibility of conversion disorder. It can still be, but yes after we are fully sure there is nothing serious going on.
The symptoms you have described do not fit in with myopathy , as myopathy usually presents with muscle aches and difficulty in getting up from squatting position.You have more of the motor and sensory symptoms along with history of loss of balance.
Early MS does have initial examination findings but it can disappear with time. There are 4 variants of MS and the most common being Relapsing REmitting( i.e. You have a single episodes, it disappears with time and then you are normal in between the episode, but it reappears again few months or years later). Others are progressive ones, and we dont expect that you will improve from it without treatment( if the diagnosis is really MS). They have already ruled out the possibility of Myaesthenia Gravis as well.
As for the pictures, I received only 1 and the other was a MRI report. Could you please re attach it again, so I can have the look.
But yes, if you are improving I would like to wait and repeat a scan later on to look for any new findings if they crop up.
Do let me know when you attach the pictures
Sorry for the delayed reply. Was on emergency duty. Well I have read the ct findings. It is a very non specific thing which they didn't focus on. As mentioned it is just a hyper intensity. As such it does not collaborate with the symptoms you had. As you know everyone part of brain manifests as a different clinical features. Since your symptoms didn't fit in with the area involved it wasn't given much importance
Secondly it is always better to repeat the MRI after a couple of months to know how the other disease intensity is.
My other school of thought was ..was it a transient ischemic attack, as you have mentioned the doctor saw you in a very distressed state. It is a self.limiting thing with no residual defect and quick recovery with hardly any MRI findings. You can discuss this out as well and get worked up for ANA and antiphospholipd syndrome. This is just another school of thought.
Do let me know for more queries
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