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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5657
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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I have asked questions here before I've had a number of

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Hi I have asked questions here before
I've had a number of neuro type symptoms starting with lhermittes in December which has remitted, then tingling hands and burning feet wjch come and go but not as bad as intiially
Also arm pains and leg muscles paind including the muscles getting tight and crampy
I have had b12 checked twice was 350 now 450
Nmo test negative
Cervica and brain mri in Jan and April both normal, lumbar puncture last week that's come back clear with no oligoclona bands
Also had three neuro exams all normal
The only things shown up have been disc bulges and degeneration at c3/4 c4/5 c6/7 T5 T8
With one cervical and two thoracic impinging on the cord a bit
What could be causing all these issues? Also does all the negative testing rule out Ms?
Hi Kri. I worked with you before on these issues. Would you like my assistance again, or would you prefer to wait a bit longer for another expert?
Customer: replied 2 years ago.
No I apprecisre your help
I've also had the Lumbar puncture results now too which were clear
The only issue I have is I have started having shooting pains on one side of my face, it started with a burning but now I get sharp aching pains, I'm worried it's trigeminal neuralgia
I have earache and and ache in gland under jaw too so hoping it's an ear thing
It sounds like the trigeminal nerve. It could be trigeminal neuralgia or a more transient neuritis. There are several conditions to consider that could do this. One would be an impacted wisdom tooth, or infection in a back molar. Similarly, an infection in the back of the throat or ear. Even TMJ. Your doctor should be able to help you diagnose this.
Customer: replied 2 years ago.
I do have tooth pain on that side?
Also what is the likelihood of Ms now with normla mri and normal neuro exams along with clear Lumbar puncture results? Or is this common early on in the disease?
Also could the bulging thoracic discs cause the leg pain tight stiff muscles when walking and tingking burning sensations in legs and feet
Hi Kri,
Definitely check in with a dentist as tooth issues can cause face pain and headaches. Treatment is usually easy and effective.
I don't think you need to worry about MS given the negative tests. When there are symptoms, there are usually signs on the tests. Just keep in touch with your neurologist about any new symptoms that arise over time.
The bulging discs could be causing your leg symptoms if there is pressure on the cord or nerve roots. NCV/EMG testing should reveal whether this is going on, so that might be your next move. :-)
Customer: replied 2 years ago.
Hi thanks Dr bob
I have that booked in for next Wednesday, what about the odd pinching pains in my legs I keep getting? It's weird it's in calf then hamstring then bicep then forearm? Also the tight leg muscles when walking?
They feel supple when I'm relaxing they don't feel tight to touch
And then burning in my left foot that comes with pain almost like a bruising pain? Could that all be discs?
Also wondered about finromyalgia or cfs/me? Or even a lot of it being because of anxiety?
Customer: replied 2 years ago.
Hi thanks Dr bob
I have that booked in for next Wednesday, what about the odd pinching pains in my legs I keep getting? It's weird it's in calf then hamstring then bicep then forearm? Also the tight leg muscles when walking?
They feel supple when I'm relaxing they don't feel tight to touch
And then burning in my left foot that comes with pain almost like a bruising pain? Could that all be discs?
Also wondered about finromyalgia or cfs/me? Or even a lot of it being because of anxiety?
I also keep reading how Ms can have clear mri and limbar punctures early on in the disease etc
That's true about MS but it's not clear if that's because odd precursor symptoms can occur before the MS shows on testing or because a certain % of persons with burning and pinching pains and cramping from some other causes go on to develop MS later in life coincidentally. Either way, it sounds like your clinical picture does not currently meet the criteria for the diagnosis of MS, and you should probably not give up on looking for other possible etiologies.
Anxiety is a very complex and variable condition, and can cause or amplify almost any symptoms. This would remain on the list of possibilities, of course, and might rise in probability as more organic causes are ruled out. But it remains a diagnosis of exclusion in many cases, particularly in those who have no history of anxiety or other mood disorders.
That said, I don't think your work up is complete. If your nerve conduction tests are normal, seeing a rheumatologist and having an auto-inflammatory or auto-immune condition ruled out would make some sense. Fibromyalgia and cfs/me, while often difficult to pin down, would be 2 such possibilities.
Customer: replied 2 years ago.
What other conditions could it be? The lumbar thoracic mri came back showing nothing other than some reactive end plate changes at two levels.
I've had the gad antibodies that were clear too
I have a history of anxiety and ocd over 15 years sometimes quite severe, and before all this had a huge stressful event that brought on bad anxiety and depression again, not sure if that makes a difference.
But then this morning I woke up with burning pinching pains in ankles both legs, calfs both sides, left shoulder, pain in thighs, it is all over sometimes and that worries me, but again does that make ms less or more likely in the long run
Customer: replied 2 years ago.
I want an answer to what I asked please Dr Bob thanks
This makes MS much less likely... and the probability is already quite low given your negative tests. :)
See a rheumatologist. They can work you up for fibro or some other inflammatory disorder. In the meantime, make sure your anxiety and OCD are under excellent control.
Customer: replied 2 years ago.
Hi Thanks Dr Bob
I appreciate it, IVE been taking pregabalin for the anxiety and getting aaway on holidays to relax, walkings been great but have pain and issues all over, someone mentioned Guillaume barre syndrome? Also
Anxiety and me as a cause of the all over pains
Is this possible? All this did come on after a virus I had for three weeks with cough and throat issues
This could be a post-infectious auto-immune syndrome. They can result in unusual sensory, motor, even psychiatric symptoms, laying weeks to months. A rheumatologist or neurologist could confirm this for you and treat it if present.
Customer: replied 2 years ago.
Hi Dr Bob
Thankyou for that no one has mentioned this before? I keep
Getting the same sore throat one side ear pain, even last night woke up coughing sore chest and sweating heavily with no energy
How can they test for this? Is There anything specific to look for?
It's mainly a clinical diagnosis based on history and exam. There are some non-specific markers they could check for including sed rate (ESR), C-reactive protein (CRP), CBC, etc.
Customer: replied 2 years ago.
Ok thanks Dr Bob
I've had more issues with tingking in foot when coughing and Lhermittes that now causes tingking in the same foot? Where it used to be hand, is this indicative of Ms or more to do with the cervical issues? I didn't think cervical bulges could cause foot tingling with lhwrmittes
Customer: replied 2 years ago.
Also could it be CIPD with lhermittes?
Technically, it could be any of these conditions...or it could be none of them. There's obviously an irritated nerve or two somewhere, but this is usually temporary. CIDP or a variant would be a consideration, though this is not too common. If your neurologist or a rheumatologist thought this wasa possibility, they could offer you a trial of immunomodularity therapy such as oral prednisone or IVIG. Seems reasonable to ask about this.
Customer: replied 2 years ago.
Ok thanks DrBob
You're welcome, Kri.
Let me know of there is anything else I can help you with.
Customer: replied 2 years ago.
Hi Dr Bob
This flu issue has become a sinus problem I think where I have lost my sense of smell? Is that normla or a possible Ms issue? I can't shake the thought that it is Ms and is not showing yet, but the nature of it all is so weird with the come and go symptoms. Also the fact the symptoms are almost mirrors of each other on both sides?
The mirror image quality is not typical of MS, nor is the rapidity with which the symptoms come and go, so I would scratch that of your list of worries.
Sinus infections often do result in loss of might need a decongestant and/or course of antibiotics.
If the symptoms seem to be post-infections you should ask your doctor about a trial course of prednisone.
Customer: replied 2 years ago.
Hi thanks dr Bob
It's the lhwrmittes that worries me with regards ***** ***** but then I have sisc bulges at c3/4 c4/5 c6/7? Sorry to be a nuisance I really appreciate be help, it's really odd some issues come and go for periods at a time almost it's really weird

Has the L ' hermittes been confirmed by a neurologist? I would suggest it is related to the cervical disc disease. MS doesn't make sense, given what you've told me.

Customer: replied 2 years ago.
Hi DrBob
Lhermittes was the first issue I had it was very painful all in my left arm to my hand, then went away after about 2-3 months, now when I cough I get it in my foot a bit but nothing major
I see. Well the arm symptoms sound discogenic to me. :)
Not sure about the leg tingling...
Customer: replied 2 years ago.
Hi thanks Dr
I'm hoping that is the case I really am, it's not the MS thing that worries me as much as it is the speed of all the issues I have had
As in no problems to all this in four months! The arm lains are literally same spot both sides, there's little fatty lumps under skin where it hurts but I assume that's coincidence?
The onset and course do sound consistent with a post-infectious process. This is still not a well understood phenomenon. Doctors don't always think of it. .. and symptoms can persist for months or even become permanent. I think you need to see an academic neurologist. Look for one at the nearest medical center.
Customer: replied 2 years ago.
Thanks Dr Bob
What is the easiest way to test for a post infectious process? Is there anything specific to look for or anything I should tell me neurologist?
The most important thing is to mention it to him and have a conversation. He or she will guide you as to what steps can be taken to support the diagnosis, or what treatment might be tried. There really is no specific test for this, unfortunately. It is a clinical diagnosis based on history and physical exam.
Here is a link that describes a rather rare (possibly underdiagnosed) post-infectious condition that sometimes mimics MS:
Hope all works out for the best.
Customer: replied 2 years ago.
Hi Dr Bob
I have read about this however It has been 4 months of sumptoms getting worse so I don't think it matches that, IVE also had a lhmbar puncture which I thought would explain if it was that?
I am almost convinced of Ms, I had bad glandular fever as a child, followed by ocd which they have linked to glandular fever, same with Ms, I also as you can tell struggle bad with anxiety ocd and now depression, which I read makes Ms worse, it's a horrible vicious circle
The tingling etc I was ok with, it's not the leg and arm pains and tight muscles that worry me as it looks like ppms and for someone at 30 and for it to be this violent worries me
I also suffer with sweating a lot when sleeping I wake up with sweat all over? And stil have the sinus issue
Customer: replied 2 years ago.
Also adem that you spoke about shows up on mri l
Don't be so sure about what you read. ADEM only shows up on MRI in the most extreme cases. Like most diseases, it is a spectrum disorder, meaning that the inflammatory lesions may be too tiny to show up on MRI (or they might be very large and obvious). The LP is sometimes normal in this condition as well, so that is not a reliable way to exclude it.
I have had many patients that suffered needlessly because doctors waited for "hard signs" on tests instead of making the diagnosis based on clinical history and exam. Also, consider that ADEM and MS are related, having a similar pathophysiology, with some ADEM sufferers going on to exhibit MS. As for your childhood glandular fever and OCD, this too could be from another related condition known as PANDAS.
Customer: replied 2 years ago.
Hi Doctor
I have read about pandas! And that sounds like what I had!! That's amaxing how it wasn't noticed before, could this be the cause of what I am experiencing now too? It's imlossible to know where to go as no one will take me serioisly because of anxiety and all seem to have their own agenda, what In your opinion should be the next course of action
These conditions have a similar etiology. They are all auto-immune conditions. Your best bet would be to see an academic neurologist or rheumatologist. They will be familiar with your condition and have the confidence to treat it even if your tests are normal.
Hope all works out for the best for you.
P.S. A positive rating would be appreciated at this time. You can follow up, of course, anytime.
Dr. Bob and other Neurology Specialists are ready to help you
Customer: replied 2 years ago.
Hi Thanks Dr B
I've seen two neurologist now both have dismissed Ms whih I think they're wrong about and have put issues down to disc problems and or anxiety whichc I think is a bit out of order
I'll get into see a rheumatologist asap, what's the reason for a rheumatologist? Any blood tests that should be run? I'm seeing my gp tomorrow
Rheumatologists specialize in autoimmune and autoinflammatory conditions. I think you would do better with a neurologist who appreciates the possibility of an autoimmune condition here, but a good rheumatologist should also be able to help along these lines. In the meantime, ask your GP to check your sed rate and CRP.