Weakness in Limbs: Could It Be Autonomic Nervous System Issues?

Weakness in the limbs (autonomic nervous system)

Hello Doctor, I have been experiencing a sense of weakness for the past month (it's a strange feeling, not that I can't exert force), with episodes occurring at unpredictable times, lasting anywhere from 1-2 hours to as long as 9 hours, about 1-2 times a day.
The weakness primarily affects my limbs, and during these episodes, I find it difficult to concentrate.
I have a lack of appetite during the episodes, but my appetite is good when I'm not experiencing them.
My heart rate tends to be elevated during these episodes (between 90-110 bpm), and my blood pressure is higher (systolic over 140, diastolic between 90-110).
Additionally, sometimes I feel a stiffness in my abdomen (even a stabbing pain, but this doesn't only occur during episodes).
I typically use the restroom 2-3 times before noon, and aside from the first time, the others are always diarrhea.
Regarding my sleep, I generally sleep from 10 PM to around 5:30-6:00 AM without interruptions, and I do not take naps.
The weakness mostly occurs in the morning, especially right after I wake up.
If I immediately engage in exercise (like jogging), even after resting for 20-30 minutes, my heart rate does not drop below 90 bpm (it remains above 90-100 bpm).
It only decreases below 90 once the symptoms subside.
My weight has not changed much over the past month (around 77 kg).
The whites of my eyes at the corners are red.
I have already tested my thyroid, and the results are normal.
Could this possibly be an issue with my autonomic nervous system? What direction should I take to address this? Thank you for your response, Doctor.

Xiao Mi, 30~39 year old female. Ask Date: 2020/07/20

Dr. Cai Zongzhang reply Neurology

"Could it be a problem with the autonomic nervous system?" It is possible.
Symptoms of autonomic dysfunction can range from head to toe and may be mild (dizziness, headaches, dry and blurry eyes, poor sleep, dry mouth, throat discomfort, difficulty breathing, palpitations, gastrointestinal issues with poor appetite, weakness in the limbs, frequent urination, etc.).
If tests show no disease, another clinical diagnosis could be psychosomatic disorder, and it may be advisable to consult a psychosomatic medicine specialist.

Reply Date: 2020/07/20

More Info

Based on the symptoms you've described, it appears that you may be experiencing a complex interplay of issues that could indeed be related to autonomic nervous system dysfunction. The autonomic nervous system (ANS) regulates involuntary bodily functions, including heart rate, blood pressure, digestion, and respiratory rate. When the ANS is not functioning properly, it can lead to a variety of symptoms, including those you have mentioned: weakness in limbs, difficulty concentrating, increased heart rate, elevated blood pressure, gastrointestinal disturbances, and feelings of internal stiffness or pain.

Your description of experiencing weakness primarily in your limbs, particularly in the mornings, along with episodes of increased heart rate and blood pressure, suggests that your body may be reacting to stressors or changes in your physiological state. The fact that these episodes occur intermittently and can last for several hours indicates that there may be triggers involved, which could be related to your daily activities, sleep patterns, or even dietary habits.

The autonomic nervous system is divided into two main branches: the sympathetic nervous system, which prepares the body for 'fight or flight' responses, and the parasympathetic nervous system, which promotes 'rest and digest' functions. An imbalance between these two systems can lead to symptoms like those you are experiencing. For instance, if your sympathetic nervous system is overactive, it could explain the increased heart rate and blood pressure, as well as feelings of anxiety or restlessness.

Your gastrointestinal symptoms, particularly the diarrhea and abdominal discomfort, could also be linked to autonomic dysfunction. The gut is heavily influenced by the autonomic nervous system, and disturbances can lead to motility issues, resulting in diarrhea or constipation. The fact that you experience these symptoms primarily in the morning may suggest that there is a connection to your body's circadian rhythms or your body's response to waking up.

Given that you have already ruled out thyroid issues, it would be prudent to consider other potential causes. Conditions such as anxiety disorders, chronic fatigue syndrome, or even postural orthostatic tachycardia syndrome (POTS) could be relevant. POTS, in particular, is characterized by an abnormal increase in heart rate when transitioning from lying down to standing, and it can also cause symptoms of weakness and fatigue.

To address your concerns, I recommend the following steps:
1. Consult a Specialist: It would be beneficial to see a neurologist or a specialist in autonomic disorders. They can perform specific tests to evaluate your autonomic function, such as tilt table testing or heart rate variability assessments.

2. Lifestyle Modifications: Consider implementing lifestyle changes that promote overall health and well-being. This includes regular exercise (as tolerated), a balanced diet, adequate hydration, and stress management techniques such as mindfulness or yoga.

3. Monitor Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their duration, and any potential triggers. This information can be invaluable for your healthcare provider in diagnosing and managing your condition.

4. Evaluate Sleep Quality: Since you mentioned that your sleep is generally uninterrupted, it may still be worth evaluating the quality of your sleep. Poor sleep quality can significantly impact autonomic function and overall health.

5. Follow-Up Testing: If symptoms persist or worsen, further testing may be warranted, including blood tests to check for other underlying conditions, imaging studies, or additional autonomic function tests.

In conclusion, while your symptoms could suggest autonomic nervous system involvement, a thorough evaluation by a healthcare professional is essential to determine the underlying cause and appropriate management strategies. It’s important to address these concerns proactively to improve your quality of life and overall health.

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