Discussions By Condition: I cannot get a diagnosis.

Mystery Illness

Posted In: I cannot get a diagnosis. 19 Replies
  • Posted By: Anonymous
  • January 8, 2009
  • 00:55 AM

Hello everyone!
I really hope someone might be able to help.
My 38 yr old husband who has been in perfect healt for many years, last June started having mysterious symptoms. He has tremors in his left arm, he has elevated BP, he gets extremely tired very fast, even to the point of sleeping hours a day. he can hardly walk on his own, he has short term memory trouble, and speech problems. His symptoms almost look like that of someone who has had a stroke. He has had numerous blood tests and MRI, Head CT and nothing shows abnormal. 4 doctors cannot tell us what is wrong. They have ruled out parkinson's and MS because his onset was so fast. We have NO CLUE what this could be. If anyone can help at all, please reply!
Thanks for listening,
Jan

Reply Flag this Discussion

19 Replies:

  • Okay, I need for you to be very specific for me. Tell me about the speech problems. Exactly what kind of speech problems is he experiencing? Describe changes in intonation, articulation, arrested speech patterns and any departure from normal that is being experienced. Is there any difficulty controlling saliva secretions? Has he experienced any choking episodes or had difficulty swallowing? Tell me specifically about the tremors in the left arm. Does it appear that the skin is dancing about? Is it experienced in his whole arm, or primarily in his hand and does he demonstrate a pill-rolling tremor of the thumb and index finger? When you say he can hardly walk on his own, what type of gait has he assumed? Is he tripping over objects or has he developed a slow, shuffling gait? Does he easily lose his balance and does he demonstrate festination(starting out slow and gradually speeding up to keep his balance?) Tell me specifically about all departures from normal that he is experiencing in this regard. Tell me about the cognitive problems, citing specific examples. How does he describe the short-term memory problem or was it noted by others and brought to his attention? If so, does he agree with the assessment? Have there been any personality changes? I can help you find direction in this instance, but you'll need to provide me with as much information as possible. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 8, 2009
    • 01:16 AM
    • 0
    Flag this Response
  • Hi JLM. Can you start from the last time you remember your husband feeling well and describe what has happened? When did you decide to see a doctor? Did he ever take medicine? Does he now? You said his blood pressure was elevated, when? how much? take medicine for it? Talk about the hand tremor. It is in his left arm, but is he left handed? Does it happen all the time? Can he hold a glass? Can he steady his hand if he thinks about it? Anyone else in his family have a tremor? Are some days more tremulous than others? What 4 doctors have you been to? Did you see doctors in the emergency room? What have they told you? Are you still worried but doctors are not concerned about changes that you notice?.... The difficulty when asking for help or information in this type of forum, especially when symptoms are vague or potentially hold a great deal of information (I would include every subjective account of tremulousness in this category), is that the time and space needed to report everything going on can be cumbersome. In general, the more information that you can give about the evolution of your husbands symptoms and his course up until this point, the easier it will be for someone to offer an informed opinion.
    fewd4thought 126 Replies
    • January 8, 2009
    • 01:23 AM
    • 0
    Flag this Response
  • Okay, I need for you to be very specific for me. Tell me about the speech problems. Exactly what kind of speech problems is he experiencing? Describe changes in intonation, articulation, arrested speech patterns and any departure from normal that is being experienced. Is there any difficulty controlling saliva secretions? Has he experienced any choking episodes or had difficulty swallowing? Tell me specifically about the tremors in the left arm. Does it appear that the skin is dancing about? Is it experienced in his whole arm, or primarily in his hand and does he demonstrate a pill-rolling tremor of the thumb and index finger? When you say he can hardly walk on his own, what type of gait has he assumed? Is he tripping over objects or has he developed a slow, shuffling gait? Does he easily lose his balance and does he demonstrate festination(starting out slow and gradually speeding up to keep his balance?) Tell me specifically about all departures from normal that he is experiencing in this regard. Tell me about the cognitive problems, citing specific examples. How does he describe the short-term memory problem or was it noted by others and brought to his attention? If so, does he agree with the assessment? Have there been any personality changes? I can help you find direction in this instance, but you'll need to provide me with as much information as possible. Best regards, J Cottle, MD Thank you so much for responding!The changes in his speech are as follows: he struggles to get a word out, sometimes you can see him working really hard to get the word or phrase out. Other times, he slurs his words and speaks really slowly like he is struggling to get each word out. He says he knows what he wants to say but he cannot say it. The tremors are in his arm just below the left elbow. And yes it does look like his skin is "dancing" as you put it. It looks like his muscles are quivering just below and above his left elbow and he is left handed. His hand shakes because his muscles are quivering. He also holds his arm at a 90 degree angle and his hand appears to be frozen at times like in a semi clenched position. I asked him why he does this and he says it is because his arm muscles get so fatigued. he described it to me (and I did try it myself) as if you clench your forearm really tight until your muscles quiver. That is what he says he feels almost all the time. As for the walking, he says his right knee is weak and feels like it "buckles" on him ( I think he means it gives out). He also has some trouble with balance, he gets very tired when he walks, he uses a cane for stability and a wheelchair if we have to go far. When he gets really tired, his left foot look like it drags and he has to pick it up exaggeratedly high to walk. To give a picture , it looks like he staggers like a drunk.The short-term memory problem is a recent thing that I and some family members have noticed and he has agreed that it is a problem.As for the behaviour issues, we are not sure if the anger is a result of not being able to work since June ( he is a police officer ) and having to have people take care of him now when he was always used to taking care of others. We think it is a pride issue at this point, because he may not be able to work again and that is taking a toll on him now. I hope I have provided you with enough data now, if you need anything else just ask again. Thank you so much,Jan
    Anonymous 42789 Replies
    • January 8, 2009
    • 02:08 AM
    • 0
    Flag this Response
  • Hi JLM. Can you start from the last time you remember your husband feeling well and describe what has happened? When did you decide to see a doctor? Did he ever take medicine? Does he now? You said his blood pressure was elevated, when? how much? take medicine for it? Talk about the hand tremor. It is in his left arm, but is he left handed? Does it happen all the time? Can he hold a glass? Can he steady his hand if he thinks about it? Anyone else in his family have a tremor? Are some days more tremulous than others? What 4 doctors have you been to? Did you see doctors in the emergency room? What have they told you? Are you still worried but doctors are not concerned about changes that you notice?.... The difficulty when asking for help or information in this type of forum, especially when symptoms are vague or potentially hold a great deal of information (I would include every subjective account of tremulousness in this category), is that the time and space needed to report everything going on can be cumbersome. In general, the more information that you can give about the evolution of your husbands symptoms and his course up until this point, the easier it will be for someone to offer an informed opinion. He was at work in June when he started to feel ill. Someone took him home , I rushed him to ER because I thought he was having a stroke or heart attack. He was cold and clammy , weak, could hardly walk or talk and had chest pains.They did stress test and MRI , both of which were clear. No cardiac enzymes present in blood work to indicate heart attack. About 2 weeks or so after, his tremors started. We were sent from his PCP to a cardiologist who said his heart function was normal. We also were sent to a neurologist who noticed his High BP and put him on Propanolol. His highest BP was 170/110 with a 118 pulse rate, sitting down . Needless to say he blacked out and was taken to the ER in an ambulance. This was before the BP meds. He is still somewhat high on the med but he does not have black outs anymore. We have seen a PCP, two neurologists , a toxicologist and a rheumatologist, and nobody knows what it is or how to treat him.All they can tell us is what it is not. Yes his tremors are in his left hand and he is left handed. He can control it if he sets his mind to it, cannot write well anymore he says it is too much strain to try to stop shaking.If you look at my other reply I describe the tremor there too.Thank you for responding!Jan
    Anonymous 42789 Replies
    • January 8, 2009
    • 02:21 AM
    • 0
    Flag this Response
  • Okay, thank you for providing the detail. The constellation of symptoms you've described are demonstrative of several disorders or diseases. I'm concerned that the tremors on the skin may be the result of fasciculations, which represent a breakdown in communication between the nerve endings and the tissues. The changes in speech could represent the prodrome of semantic aphasia, common in some particular neurological disorders. Changes in gait, together with personality changes, would also support the presence of a neurological disease. My thoughts at this point would be to obtain an EMG. Because of his age and the rapid onset of symptoms, including the drag foot, I am suspicious that this may constitute early onset Motor Neuron Disease. The early form of the disease can strike as early at late 30s, with rapid progression observed moreso than is typical of the late-onset variant. You should have him formally evaluated by a neurology department team, including a neuropsychologist who can peform the necessary neuropsychological batteries to determine the presence of aphasia and other cognitive deficits observed in this type of disease. Neurology should perform a full spectrum exam and evaluation, making record of all clincial exam results, including EMG results from several tests over time, and they should be looking for signs associated with Motor Neuron Disease. The neuropsych tests should also be repeated monthly if it turns out that signs would tend to suggest MND. They also need to run clinical labs and would be looking for any signs of change in thyroid values that at first might represent thyroiditis and then revert to a euthyroid status. This has been observed in a number of cases involving MND. If this indeed turns out to be MND, his course will progress rather rapidly so he will need to be closely followed by neurology for signs of change. There are other conditions which can be responsible for the symptoms as well and in the absence of direct evaluation, my concerns are based entierly upon my experience with evaluating the disease in other patients and I spent several years working in one of the most premiere centers for diagnosis and treatment of this spectrum of diseases. So while I'm not suggesting that it's definitely the cause, the symptoms would certainly warrant the disease being ruled out. Also, there is some strong evidence that variants of the disease run in families, so if there are any instances where strange symptoms or disease with similar features are known within his family history, this would be important for the neurology folks to note. It should, however, also be noted that over 90% of the cases arise for no reason. I have even noted several cases where the disease ensued following trauma to the head, but no evidence could support whether it was a causal factor. Incidentally, I believe the incident in which he was rushed to the hospital was related more to an panic threshold, associated with anxiety, which is another sign common to many cases of MND. Please keep me informed on any progress and test results. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 8, 2009
    • 02:54 AM
    • 0
    Flag this Response
  • Thank you for the information. We do have an EMG scheduled for March and a spinal tap in February.
    Anonymous 42789 Replies
    • January 8, 2009
    • 03:00 AM
    • 0
    Flag this Response
  • You are an amazing historian to remeber BP and HR from the ER all that time ago. Your husband is lucky to have you. Good luck finding your diagnosis.
    fewd4thought 126 Replies
    • January 8, 2009
    • 03:05 AM
    • 0
    Flag this Response
  • I would hesitate to say that the language problems described: "he struggles to get a word out, sometimes you can see him working really hard to get the word or phrase out. Other times, he slurs his words and speaks really slowly like he is struggling to get each word out. He says he knows what he wants to say but he cannot say it. "Result from any aphasia. As written, the disturbances seem due to incoordination and failure of the musculature and motor function of speech, rather than mapping to areas of the brain responsible for a particular characteristic of speech. That said, if one were to characterize speech that was decreased in fluency, and interpret the description as word finding difficulty, then the description would not fit with a semantic (wernicke's) aphasia, as stated previosly, but would resemble something closer to a Broca's (non fluent) aphasia. A slightly more compelling argument could be made for the presence of a subcortical aphasia (lesion of the internal capsule and putamen) that would affect fluency and articulation. This involvement might account for other deficits on exam.
    fewd4thought 126 Replies
    • January 8, 2009
    • 08:55 AM
    • 0
    Flag this Response
  • I don't agree at all. Many times what is described by family members may not be what the patient is actually experiencing and I am basing my opinions on the entire constellation of symptoms rather than merely the speech problem. I am here to address questions, not open a debate. If you believe your opinions to be more accurate, address the person posting the question. I'm entirely disinterested in what you may think of my analysis concerning the issues and as Kathy Bates once remarked, "I'm older and I have more insurance." Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 9, 2009
    • 01:57 AM
    • 0
    Flag this Response
  • This is an open forum. You need not feel the responsibility to moderate any debate taking place on the boards. While I agree family members may inaccurately report some symptoms, picking and choosing those that they report correctly and choosing to base your conclusions upon a select few in this type of forum is a ridiculous practice. Motor neuron disease seems entirely plausible, but I was surprised that you suggested the presence of a Wernicke's. Your medical knowledge is stipulated, but the differences between Broca's and Wernicke's aphasias are very basic. In a forum where microwaves and radio towers are often cited as major causes for disease, I think every opportunity should be taken to correctly characterize dialogue when possible. I have self corrected in the past, and will continue to do so. I'm certain that a clinician of your advanced age, who keeps such a close eye to the journals and developments in medicine. In the future I hope you will have a more collegial attitude toward... consults.
    fewd4thought 126 Replies
    • January 9, 2009
    • 03:34 AM
    • 0
    Flag this Response
  • To Fewdforthought: As I understand the nature of this forum, it does not represent a debate forum but rather a medium through which the general public can seek answers to medical questions. You generally speak as though you're the standard by which my professional medical opinions are judged. Your retort, and comments in general, in no way constitutes a "consult" by any stretch of the imagination whatsover. This is not a professional environment. I'm not seeking consult here and address questions based upon my experience as a physician. If your own opinion differs, then share it with the individual seeking answers. Over the years, I've run up against persons with your brand of strivings before, mostly in the form of medical students and residents and I'm constrained to point out that you stand alone in the arena. I've more than spent my years on the proving grounds and generally never do battle with unarmed persons. As for my advanced age, I can more than guarantee that I've forgotten more about medicine than you'll ever live to achieve. Pick on someone your own size. Regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 9, 2009
    • 06:35 PM
    • 0
    Flag this Response
  • Complications of Crohn’s Disease

    Recognize the risks associated with Crohn’s disease.

    8 Surprising Facts About Cholesterol

    Did you know that one in six US adults has high cholesterol?

  • With regard to fairness to everybody, please do not argue over who is right or wrong at my husband's expense. We came here for answers , not to start a war. I take everyone's advice into consideration because we have no idea what this could be and if it is even fixable.Thank You.
    Anonymous 42789 Replies
    • January 9, 2009
    • 11:05 PM
    • 0
    Flag this Response
  • Jeezus! The consult thing was a joke. And of course you seem to know tons of medicine!Count yourself among the many who know more than I, the group is by no means exclusive.And no more debate, I apologize. I will direct all future commentary on the inaccuracies of your observations to the original poster.Solemn regards,F4t
    fewd4thought 126 Replies
    • January 10, 2009
    • 00:37 AM
    • 0
    Flag this Response
  • Sorry for hijacking the thread there JLM, You are absolutely right. I can certainly be sidetracked at times, and will curb that tendency. Please do keep us posted on further developments in your husband's course.
    fewd4thought 126 Replies
    • January 10, 2009
    • 01:15 AM
    • 0
    Flag this Response
  • Please let us know what you find out. I just posted on this forum, above yours "trying to get help for my husband". He is 40 and has a lot of the same symptoms. He still gets around pretty good even though you can tell it is painful at times. He has spells that come and go.
    arkansan 3 Replies
    • January 10, 2009
    • 03:26 AM
    • 0
    Flag this Response
  • Could this be a form of MS?I cannot get a straight answer from anyone on this. Is it possible?
    Anonymous 42789 Replies
    • January 18, 2009
    • 04:37 AM
    • 0
    Flag this Response
  • Has he had a MRI that shows radiographic evidence of MS? Has he had lumbar puncture? The diagnosis of MS can be made from a single MRI (w. gadolinium) but must demonstrate dissmenation of lesions in time and space, so must demonstrate multiple lesions in various stages of resolution. Otherwise serial MRIs can demonstrate lesions in the brain or spinal cord. LP results would demonstrate oligoclonal bands. White mater lesions would correlate to clinical findings. I don't know what type of straight answer you are looking for, but if your husband has had the same symptoms for a long time and has a clear MRI of the CNS and a clear LP, then he doesn't have MS.
    fewd4thought 126 Replies
    • January 18, 2009
    • 07:48 AM
    • 0
    Flag this Response
  • Hello everyone!I really hope someone might be able to help.My 38 yr old husband who has been in perfect healt for many years, last June started having mysterious symptoms. He has tremors in his left arm, he has elevated BP, he gets extremely tired very fast, even to the point of sleeping hours a day. he can hardly walk on his own, he has short term memory trouble, and speech problems. His symptoms almost look like that of someone who has had a stroke. He has had numerous blood tests and MRI, Head CT and nothing shows abnormal. 4 doctors cannot tell us what is wrong. They have ruled out parkinson's and MS because his onset was so fast. We have NO CLUE what this could be. If anyone can help at all, please reply!Thanks for listening,Jan Has he had "Nerve Conduction Studies test yet?"If it wasn't so extreme I would say that "Chronic Fatigue Syndrome" hit him hard and fast after a bout of flus and sicknesses I had before it hit me!Some of the symptoms sound really familiar....scary really Pete :)
    Luciddreamer1966 8 Replies
    • January 18, 2009
    • 09:00 AM
    • 0
    Flag this Response
  • Two possibilities that can cause most or all of the syptoms are leaky gut syndrome and mercury toxicity. Mercury toxicity is commonly a factor in leaky gut syndrome as well as in chronic neurological and motor neuron diseases. www.flcv.com/leakyghg.html Does your husband have several mercury amalgam dental fillings or metal crowns over amalgam? If so there are tests such as for immune reactivity (www.melisa.org) and for metabolic effects (urine fractionated porphyrin test). Dental amalgam is the largest source of mercury in most with several amalgam fillings and a common cause of symptoms such as those described here. www.flcv.com/damspr1.htmlBut there are other factors that can cause such conditions, including bacterial and other toxins related to root-canal teeth or cavitations www.flcv.com/damspr11.html , pesticides www.flcv.com/pesticid.html and other cumulative toxic exposures.
    berniew1 37 Replies
    • January 18, 2009
    • 02:38 PM
    • 0
    Flag this Response
Thanks! A moderator will review your post and it will be live within the next 24 hours.