Brief Answer:
36 MONTHS???? To See a neurologist? They must be RICH!

Detailed Answer:
Good morning sir. My name is Dr. Saghafi and I am a neurologist from the XXXXXXX Ohio region.

Did I read 36 months correctly....Seriously? Nahhh... Really???....I've dealt with Aussies before over telemedicine channels and nobody's told me that long. Now, I've heard a couple of people tell me that they'd probably NEVER get to see a neurologist because their GP's just won't send them.....but where is this guy stationed? Alpha Centauri?? LOL......

So let's get to your issue. It really comes down to just a couple of possibilities. Something's amiss in either your LEFT cervical spinal cord anywhere from the C6-C8 level which is also somehow simultaneously hitting lateral columns of the fibers in the spinal cord coming up from the legs and that's why you're getting these nasty electrical zings in both places at once.

If we could really hook up sensitive enough equipment and timing devices to see the order of things then, we'd likely see the arm being activated just a nanosecond or so before the leg but because it's electricity it's pretty quick and you feel it as simultaneously. So what could be doing that? Could be a lesion in the cervical spine at that level or a bit of a herniated disk protruding and nicking the spinal cord itself. Or it could be a single lesion placed strategically within the cord that is able to hit both limbs at once as in something which is demyelinating as might happen in MS or sarcoidosis.

Other things that can cause this are lesions in the brain itself either in the thalamus or other areas where white matter tracts exist containing both arm and leg fibers bundled together or very close together. In this case the lesion would necessarily need to be on the right side of the cerebral hemispheres or perhaps the lesion is more in the brainstem area, the medial longitudinal fasciculus to be precise and again in an area where fibers from the left arm and left leg are in close proximity. Either demyelinating lesions (i.e. areas where the myelin covering of the white matter tracts have been denuded for some reason) or vascular lesions such as a small arteriovenous malformation or a small aneurysm very strategically placed....or perhaps the residual scarring from a viral infection (unlikely since you have not referred symptoms of an ENCEPHALITIS which would be the most likely explanation of disease for that issue).

Other things that can do this which are not primarily based in structural abnormalities of the brain or spinal cord would be metabolic disorders such as thyroid gland dysfunction, vitamin B12, Vitamin D, and folate deficiencies. I would, however, place these possibilities much farther down my list of candidates based on the fact that the zings are just so specific for dermatomal tracts in the arm and leg and since they are both on the same side. If it were a general metabolic derangement of some sort such as B12 or folate deficiency then, I'd expect there to be much more widespread affectation of the body and certainly I'd expect that your complaints would be on BOTH sides not just one.
Nevertheless, we always recommend the standard laboratory workup because you JUST NEVER EVER KNOW how things find a way of becoming known without anybody intentionally thinking they would find them...and certainly if we can correct several problems (even if they're mild or relatively insignificant) you just can't predict with certainty which of the problems you uncover will be the Key to the Magic Kingdom and you don't scoff at any possibility or opportunity to correct things if they can be corrected.

Whether or not they result in noticeable improvements in the symptoms lies in the hands of Mother Nature and the Universe because she's always sitting back and sort of chuckling to herself as we do all sorts of things...thinking we know what we're doing...when we are really just a little bit ahead of where most patients are at with respect to curing these sorts of ailments....and of course, SHE KNOWS the score....but she loves watching us fight to grab the bone! LOL.....ahhh....you gotta' love that Mother Nature don't you?

So what you need good sir from Down Under are a couple of things in my opinion:

1. A NEUROLOGIST who is closer than XXXXXXX (I am much closer than 36 months to my next appointment....if you hop a bird just point her in the direction of XXXXXXX Ohio and come on in...I will open the office up on either a Sunday or Federal Holiday for your troubles! LOL!). You can even tell me if the water in the toilet bowl here in XXXXXXX drains in the opposite direction from down there! HAHA!

2. An MRI and an MRA (looking at blood vessels) with gadolinium contrast of the cervical spine and the brain.

3. If you see absolutely nothing there then, I'd get all the blood work I'd mentioned.

That would be my initial workup to see what we can find and if none of that pans out...well then, laddie....it's back to the drawing board as we scratch our heads a bit more because then, you're hiding a doozy and we'll have to write you up in a journal.....you sure you haven't been fighting some XXXXXXX in the backyard and just got your bell rung without remembering??? LOL!

Anyways, if this answer to your question has helped in some small measure would you do me the great favor of providing written feedback and a STAR RATING? As well, by closing the query on your end, if you have no further comments or questions, allows the system to credit this transaction as quickly as possible and also archives the question and response so that others may use the information to their benefit.

And as I've said before I'm a neurologist so if you'd like to ask me additional questions about this or any other topic of interest then, please visit me at:

bit.ly/drdariushsaghafi and send me your questions.

All the best.

This query has required 49 minutes of physician specific review, research, and final draft documentation for envoy.

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