Question: My 23 year old daughter has a 2 month history of right sided weakness, balance problems and fatigue. The episode started with paresthesias and cramping in her leg for about 1 week before the other symtoms started. A trigeminal neuralgia headache followed with some loss of field of vision (opthamologist just confirmed loss of visual field in right eye). She had profound weakness on her right side and used a walker or cane. She was sensitive to heat and at times would get hot flashes where her temperature would go to just around 100 degrees. Her weakness is subsiding and she can walk short distances without a cane. She has urinary frequency and urgency. She has been treated twice for UTI''s (Bactrim and Macrobid) However, with the last treatment, no bacteria grew - the only abnormality was WBC and some blood in the urine. This week, she became short of breath and required emergency treatment in the ER, where they found t-wave inversions on her EKG. Chest x-ray was unremarkable. O2 sat was slightly lower 95% and responded to oxygen therapy. During her first episode of weakness, she responded to a steroid taper pack. Other lab results are : normal brain and C-spine MRI, LP not indicative of MS but did show decreased gamma globulin. We do have a family history of Familial Hemiplegic Migraine Syndrome. however this is unlike anything she or I have every experienced before with that.

Thank you very much for your thoughts. I would like to ask you specifically:
1) What would lead you to consider seizures? (Her younger sister also has FHM precipitated by a seizure-like aura but we never considered seizures for her)
2) Could a tick-born virus cause the radiculoneuritis that you mentioned (we live in an area endemic to tick-born viruses) or would it be a self-limiting virus that you would consider?

Thank you very much for your help!