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Post-viral neuropathy and tremor

Post-viral neuropathy and tremor

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Posted by Douglas Theobald on December 05, 2000 at 18:39:16:

Dear Drs,

I have some questions about this post-viral thing, and I apologize in advance for the length. If you want to avoid the details of my personal health history, please skip to the bottom where you will find my questions. I am a thirty year old male who used to be in exceptional health, very active, running ~15 miles a week, hiking, weight lifting, and rock-climbing. Never had a neurological problem before, ever. On Sept. 16 of this year I began to feel like I was coming down with a cold/flu. Thus began three weeks of one of the strangest infections I’ve ever had, with low-grade fever the entire time, severe muscle and tendon aches in back, legs, and hips, chills, night sweats, etc. I was just starting to feel much better, when on Oct. 4 I was rapidly hit in the evening by ascending paresthesia/dysesthesia which began initially in the hands. By the next morning my entire arms were burning (especially the forearms), I had fasciculations over my entire body, I felt weak, and I had cognitive problems (trouble thinking, concentrating, and finding words). I had difficulty with precise hand movements involving finger coordination (like tying my shoes or doing buttons), I was short of breath, and I had developed a noticeable fine intention/postural tremor. Additionally, I had vision abnormalities including persistent negative afterimages (ghost images), foggy flashes, and light sensitivity.

Over the next three weeks things got gradually worse, with headache, vertigo, buzzing toes and feet, muscle cramps, bizarre bouts of tachycardia (120 bpm for three hours or so while reading and “relaxing”), GI problems, and extreme drowsiness/fatigue thrown into the picture. When I walked, it felt as if by balance was slightly off. A few nights were particularly bad with some sort of “crisis” that felt like what I’ve read about anxiety attacks, except that mine lasted several hours. However, I strongly feel that my episodes are not anxiety related, as taking an Ativan does not relieve the symptoms (although it does make me feel better about them :)) My symptoms are all bilateral and get worse in the evening. My tremor is increased by heat, although my other symptoms do not seem to be heat sensitive. In fact, I can instantaneously and markedly increase or decrease my hand tremor by simply running them under hot or cold water. Exercise, such as walking, hiking, or lifting weights seems to improve my symptoms overall.

The past three weeks I have been getting better gradually, although I have pronounced ups and downs (good days and bad days, better weeks and worse weeks). My neurologist has done tons of blood work and a brain MRI, all of which were negative or normal (B12, CBC, metabolic stuff, thyroid, CPK, Lyme ELISA, Folate, ASO titer, anti-nuclear Ab, extractable nuclear AG, anti-cardiolipin Ab, Lupus anticoagulant). She tells me my neurological exam is actually rather normal (ironically to me!). The only “objective” symptom I think she picks up is the fine tremor. She has told me that her best hypothesis for what I have is an acute post-viral polyneuritis, perhaps a mild and atypical case of Guillain-Barre. She has decided to forego further diagnostic tests (e.g. lumbar puncture) as long as I appear to be improving.

What I want to know is:

(1) If this is really post-viral neurological trauma, where can I read more about it? All of these neurological sites on the web have sections on *everything* except “post-viral” illnesses. Many sources of information appear to conflate Chronic Fatigue Syndrome with post-viral neuropathies, while I don’t seem to have the classic symptoms of CFS (e.g. my fatigue, initially severe, is actually one of my more minor symptoms now and seems to be ever improving).

(2) How common are post-viral polyneuropathies, esp. compared to things like Lyme or MS? From the number of responses to post-viral related posts in this forum, it seems that they are relatively common, but this does not seem to be reflected in the medical literature that is available to me. Are most idiopathic polyneuropathies suspiciously post-viral?

(3) Is it “normal” for post-viral related symptoms to wax and wane throughout the day, or from day to day, or even week to week?

(4) Has anyone here been diagnosed with a post-viral illness and recovered?

And finally, (5), is MS a likely alternate possibility in this case? My neurologist doesn’t appear to suspect MS at all – she hasn’t been real good at explaining why not, besides stating that my symptoms “did not present like MS.”

Sorry again for so many questions, but I am suffering from a lack of information, whether etiological, empirical, or epidemiological - I am a PhD biochemist and thrive on technical biological details ;).

Thanks for your time and patience in answering our questions –

Douglas Theobald
theobal@colorado.edu




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