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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Migraines diagnosed. Took medrol. Sweaty hands, fatigue, double vision, muscle weakness.Positive ANA. Lupus or MG?

In 2009 I started to have bad headaches. If you were to split my head into quarters, the pain was on my left front side across forehead and behind eye. Neuro dx migraines. Aprox 1 month later L eye lid droopy and was unable to open. I went to a Nerooptic: treated with medrol dose pack. surgery for inflammation of the lacrimal gland. Since then my eye twitches and mild ptosis. I also have these "migraines" several times per wk. I began to feel fatigue often with SOB. I just associated this with me not getting enough sleep, not eating healthy, just normal things that come as you get older. However, I am only 29. I started to have to take breaks/rest between chores/tasks.  I am 5'6 and weigh 146lbs I get light headed/double vision/see spots if I stand too long ex: in line at a store, or if I am in extreme heat outdoors or hot shower/bath. Palms sweaty/clamy often. If I push myself too far or stand in place for a length of time I get burning sensation and red cheeks. I get light headed, blurred vision and often arms get weak and "heavy" w/ overhead activities , ex. Hanging clothes, putting dishes away, etc.  In the last six months I feel as if my muscle weakness and fatigue has gotten progressively worse. I was having to take breaks just to blow dry my hair. I went to my PCP with these complaints, as I felt something was not right. She ran a CBC and basic metabolic panel which came back normal. She said I was not getting enough sleep and always on the go. I also have a good bit of physical and emotional demands as I have an Autistic child. I tried to slow down and get more sleep. However, I just kept getting weaker needing more breaks. I feel the best first thing in am, sometimes just sitting with eyes closed for 10-15min "recharge" for a short period of time. Three wks ago severe ptosis in L eye. The orig neuro optic was out of town. Therefore I had to see someone else.  He did not think ptosis caused by inflammation of lacrimal gland. He started me on augmentin as a precaution in case of infection. Two days later when the ptosis did not improve started 80mg of prednisone. Within three days I was so weak that I could barley walk. I could not get up from a laying position, stand from a seated position etc without the use of my arms. At times I was so weak that I could not even lift a gallon of milk. I started having problems talking, my speech sounded very low and slurred. The neuro optic did a CT scan of sinus and orbits and blood work.  CT was negative. The basic MG antibody test came back neg but positive ANA. One wk from starting the prednisone i was so weak i could not stand well unassisted, I was having bad dysarthria to where my speech was very slurred and hard to understand.  The neuro optic stated he still felt I had MG and was going into crisis. He sent me to the ER. The Neuro at the hospital said that it was not MG as if it is impossible to have MG without testing positive. (he did not do a MuSK Antibody test or a CT of my thymus) He immediately said he felt as it was somatization disorder. He was able to see both my son and my medical records as we use the same hospital for all specialist. I had also been taking Wellbutrin and adavan for anxiety. He consulted rheumatology for the positive ANA. They suspected Lupus or another autoimmune disorder and ran a bunch a blood panels. I had two MRIs of my head, one MRI of my leg (looking for muscle inflam) a xray of my chest, and a pulmonary function test. The MRIs were all neg except for leg Which noted slight increased hyperintense signal on axial stir sequences along the medial compartment although this may be secondary to artifact. It also noted cystic lesions within both axenia. (I do have endometriosis w/ removal of right ovary/tube in 2005). The pulmonary function test showed mild pulmonary restriction suggested by the decrease in residual volume. Max inspriatory pressure is normal. Max expiratory pressure is decreased. The blood levels that were abnormal are as follows
BUN 23
Alkaline Phosphate 54
Carbon Dioxide 22
WBC 23.56
Myelos 2
Segs 92%
lymphs 5%
aldolase 26.5
Trace of leukocytes in urine
These antibody were neg
Anti Nuclear
HIV/Hepatitis/Drug Neg
EMG showed carpal tunnel and chronic cervical C5/6 radiculopathy
RNS on bilateral nerves no consistant decremental or incremental responses. Increased insertional and abnormal spontaneoud activity present in mid level cervical paraspinals, deltoid, supraspinatus. RNS studies not conclusive in establishing a NMJ disorder. Repeat study at a later time may,should be considerd if clinical symptoms indicate.

Do you have any suggestions? I have an apt with new neuro at MDA clinic next week. I do not like that neuro at hospital just dismised me and was so quick to say it was stress/somatization. What could these test/symptoms be caused from? Could this all just be stress related? I do not feel my stress levels are that high. Yes, some mild anxiety, but who doesnt have that? 
Sat, 8 Jun 2013
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What is your sed rate, CRP level, levels of ANA and pattern of ANA? These answers will determine if there is a possibility of lupus and whether if it is active.
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