As you are a very experienced Neurologist I would be honored if you would look over my case and give me any suggestions.
37 y/o female, married with 2 children, work as a Home Health RN, No major stresses.
No smoking, alcohol or illicits
symptoms began 1 1/2 years ago with numbness and tingling in left arm, left face, severe fatique, mild tightening in chest. I got scared and went to ER after 12 hours. Had full cardiac work up all was grossly normal. they diagnosed me with anxiety attack, I spoke with my PCP and told him that my mother probably had depression in her 30s but never sought treatment, she slept alot, left my dad, was very moody. (she was killed in car accident at 47) He opted to put me on Lexapro. I became less moody and nicer to my husband but that was about it for me.
3-4 mos later began getting extremely sleepy during the day to the point I would have to pull my car over and rest before continueing to my next patient. It was almost like a pain med reaction without the med. I had some memory problems like forgetting appts, forgetting to run errands, turn things in etc..., words would get jumbled and my speach was slow at times (my friends tell me).
I saw my PCP when I had an episode of vertigo followed by weakness and altered sensation on my R side. I was admitted and work up was done for CVA including D-dimer, carotid u/s, MRI of brain w/ contrast, MRI of carotids, cardiac work up with stress test, and much blood work. All was normal. He said I had a beautifully normal appearing brain and had no evidence of stroke, tumor, MS or any injury. He also said it was stress related and sent me back to my PCP. My PCP was not convinced but increased my lexapro to "prove" it was not stress and referred me to neurolgy dept at Vanderbilt university. Another MRI of Brain done and ANA, CRP, and coag studies. again all is normal with the MRI but my coag was abnormal and my CRP was elevated to 14 (I think). They suggested an ASA daily. And I also had the DNA test for lupus which was normal. This was the stroke specialist, I don't know why I ended up seeing him but we both agreed I probably didn't need to.
since then my flare ups are more predictable, starting with a numb feeling in my R knee joint, jerky or double vision, floaters, words won't come, progresses to extreme weakness in R leg and knee "gives" out, more pronounced neuropathy in hands and feet which is migratory severe indescribable fatique and sleepiness, Also had vertigo very badly during this past flare up. Medrol dose pack always makes my symptoms go away. Most of the time symptoms are brought on by physical stress and heat.
I forgot to mention that he changed me to Cymbalta also to r/u fibromyalgia, I do not have the tender points but I did have major muscle aches every night that are gone now.
My PCP is now thinking possibly polymyocitosis or RA but my symptoms don't really fit. He did another CRP, CPk, and thyroid study this week, I don't have the results yet.
Is it possible that I have MS and don't have lesions? 2 neuros say it is unlikely with the severity and frequency of my symptoms, My PCP and a neurosurgeon friend tell me it is possible but I have to prove it.
Any suggestions for me??
Thanks for sharing your timeless wisdom and experience.
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