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Weakness in legs and tingling all over the body

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Hello Doctor,

I've been suffering from lightheadness, imbalance, weakness in legs and tingling all over the body for almost a year.
I get well some days and then it comes back and hit me at anytime, while driving, laying in bed, at my desk, or even when watching my comedy series.
I have constant bloating, gas, cramping, diahera
I checked the following:
- brain MRI ... Clear
- CBC ... Clear
- B12 ... Clear
- Vit. D ... Low ... Now taking 45,000 IU on a weekly basis
- all minerals are ok in blood
- thyroid ok
- I found a herniated disc in my neck ... 3 mm out to the rear ... C4 - C5
- stool analysis was good, only color was green.

I'm not getting better and I am very frustrated ... What should I check more ... What could it be?
I took down my caffeine intake to 1 cup per day
However, I still smoke almost a pack a day

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello,

Thank you for asking your query at DoctorSpring.

I have discussed your concern with our team Neurologist. We would like some additional information from you so that we can provide out best opinion. You can reply as a followp.

1. Could you explain bit more about the weakness ? Do you mean general weakness or weakness of any limbs or arms ?
2. Do you have any difficulty in raising your arms above your head, combing your shirt, buttoning shirts, wearing slippers , sitting up from squatting position ?
3. Also do you have numbness all over the body ? or in a particular area?
4. I assume that you get episodes of these weakness and numbness. How long does that last, on what interval.?Can you describe a particular episode ?

Thank you


Patient replied :

Thank you for your reply.
1. Weakness is general, however it hits most of the time in my legs ... Like while standing brushing my teeth it is hard to stand right while making the hand movement. I feel my legs are bending.
2. Not difficult to do any of these actions, just the annoying tingling burning sensation.
3. The tingling is all over the body sometimes, then it disappears however it stays only in biceps, hands, feet, and thighs. Then it comes back to all body even in my tongue, scalp, and neck.
4. The flares are most of the day nowadays, it disappeared last week for few days then came back. I was sitting working on my computer and it attack me like a slap on the head from the left side, I went completely numb for few seconds, my head went foggy and light then tingling started. After 1 minute, the numbness went away leaving me with tingling and lightheadness. It was really hard to walk to the car and drive home and since then I feel very tired, tingling and cramps in my back and neck.
I just went yesterday to make ultrasound on the veins in my neck, however it shows very clear strong blood flow.
I'm going crazy, not knowing what the reason easy.
One more thing that have been having since this started ... Don't know if related or not.
I have red spots near my feet, very itchy, sometimes I wake up and they are bleeding. Maybe I scratch them while sleeping. While awake I hold myself from scratching and I put anti dermatitis cream, it got better but never went away. Same thing is now on my cheeks, red bumps and the skin is very dry and pieces of skin are coming out.
Also 3 days ago, I found behind my ears painful lumps, one behind each ear.

Let me add this as well, my stool most of the time, has bubbles and get stuck to the toilet bowel.
Sorry to bother you with a lot of details, but i think it might help


Hello,

Thank you for providing the detailed description. The skin symptoms and the sticky stool seem to be unrelated as of now. The major concern here is the leg weakness. It needs to be tested whether it is organic or not, and where is the origin of the weakness. If you are under the care of a Neurologist he/she should have already tested for it. You will require a complete Neurological examination and a MRI of the spine.

Once the cause (and localisation) of the weakness is found out,we can get more clarity on other symptoms. You have mentioned that a MRI has been done. You might want to get a MRI with contrast if symptoms persists. Do not worry about the numbness and tingling and episodic symptoms. Even though they are disturbing it should not do any immediate damage. The episodic nature of the symptoms also raises a suspicion of a Seizure activity (although not typical). You should discuss this with your Doctor.

Hope this helps
Please feel free to ask followup query.
Thank you


Patient replied :

The brain MRI was ok
The neck MRI showed herniated disk C4-C5
I just checked with a doctor here, he said the herniated disk might be touching a nerve and this causes dizziness, tingling and it seems inflamed my nerves. He gave a lot of medicine including muscle relaxants since my neck and shoulders are very cramped.
My question was to him and let me ask you as well. Could a disk in neck affect the legs nerves as well.
If it is not organic, what could it be? U mean it is depression, stress related?
My most important question is ... Could it be brain related? MS?
Could it be because of smoking? Like nicotine intolerance?
Now I'll be taking ...
- arcoxia 90mg 1X daily
- neurontin 300mg 2X daily
- vitamin B12 2X daily
- relaxon 2cap ... 2X daily
- voltaren gel

Am I on the right path?


Hello,

Only if the disc herniation at C4-5 level is very large, it will affect the legs. If that was the case you should be having significant hand symptoms also. So I do not think it is the reason for the leg weakness. Yes Non organic illness means stress /anxiety. But as I said earlier the other causes should be ruled out, with focus on weakness of the legs. Smoking, Nicotine will not cause this.

MS is a distant possibility. It is unlikely, but can be ruled by a contrast enhanced MRI and Neurological examination. If not done you should ask for Neurology referral. Treatment wise you are on right path.

Hope this helps
Thank you


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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