Left Arm and Leg Weakness: Seeking Answers for Neurological Issues

Weakness in the left arm and difficulty lifting the left leg, leading to trouble walking?

Hello Doctor,
As per the title, my mother has been experiencing weakness in her left hand and left leg for over a year.
Both her left hand and leg have muscle atrophy, and her condition is worsening.
In August of this year, due to the urgency of her condition and without a confirmed diagnosis, she underwent lumbar decompression and fusion surgery at Chang Gung Memorial Hospital.
However, more than a month after the surgery, there has been no improvement.

She then had an ultrasound and MRI of her cervical spine and brain at Chang Gung, which suggested that the hand issues might be due to cervical spine compression, but no cause could be found for the leg weakness.
Initially, we suspected it might be a minor stroke or some brain lesion causing pressure, but the brain MRI did not reveal any abnormalities.

She was previously able to walk to the bathroom with the aid of a walker, but now she is unable to walk at all and can only sit in a wheelchair.
I am wondering if you have any recommendations for further tests or directions we could pursue.
Thank you.

Cai Xiansheng, 40~49 year old female. Ask Date: 2021/10/05

Dr. Jiang Junyi reply Neurology

Dear Mr.
Tsai,
You mentioned that your mother was previously able to walk to the bathroom with the aid of a walker, but now she is unable to walk and can only sit in a wheelchair.
I am not sure if the doctor has any recommendations for further examinations.
I wonder if your mother may be experiencing issues such as sarcopenia and osteoporosis.
These conditions could potentially lead to nerve compression, which can be diagnosed using a DXA bone density analysis.

For nerve compression issues, common tests include nerve conduction studies (NCS) and electromyography (EMG).
Nerve conduction studies measure the speed of electrical signals traveling through specific nerves; when a nerve is compressed or entrapped, the conduction speed will slow down.

I recommend that you consult a neurologist for further evaluation.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to new pandemic prevention measures before and after your medical visits.

Thank you for your inquiry, and feel free to discuss any related questions further! Wishing you and your mother good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2021/10/05

More Info

It sounds like your mother is experiencing significant and concerning symptoms with her left arm and leg weakness, which have persisted for over a year. Given the complexity of her situation, it's essential to approach this with a thorough understanding of potential neurological issues.

Based on the information you provided, it appears that your mother has undergone lumbar decompression surgery, which typically aims to relieve pressure on the spinal nerves. However, the lack of improvement after surgery raises questions about the underlying causes of her symptoms. The fact that she has muscle atrophy and increasing weakness in her left arm and leg suggests that there may be ongoing nerve compression or damage that has not been addressed.

The neurological examination and imaging studies, including MRI of the brain and cervical spine, are crucial in ruling out conditions such as strokes, tumors, or other structural abnormalities. Since the brain MRI did not reveal any issues, it is less likely that a central nervous system problem is causing her symptoms. However, the potential for cervical spine issues remains, especially if there is evidence of nerve root compression at the cervical level.

Given that your mother is experiencing muscle atrophy and weakness, it is also essential to consider the possibility of peripheral neuropathy or radiculopathy. The symptoms you describe could be indicative of conditions such as cervical radiculopathy, where nerve roots exiting the cervical spine are compressed, leading to weakness and sensory changes in the corresponding arm and leg. Additionally, if there is any involvement of the lumbar spine nerves, it could explain the weakness in her left leg.

To further investigate her condition, I recommend the following steps:
1. Neurological Consultation: A follow-up with a neurologist is essential. They can perform a comprehensive neurological examination and may recommend additional tests, such as electromyography (EMG) and nerve conduction studies (NCS), to assess the function of the nerves and muscles more closely.

2. Imaging Studies: If not already done, consider obtaining MRI scans of the lumbar spine to evaluate for any residual compression or other abnormalities that could be affecting the lower extremities. Sometimes, issues in the lumbar region can manifest as weakness in the legs.

3. Physical Therapy: Engaging in a structured physical therapy program may help improve strength and mobility. A physical therapist can design a rehabilitation program tailored to her needs, focusing on strengthening exercises and mobility training.

4. Assessment for Other Conditions: Conditions such as myasthenia gravis, multiple sclerosis, or other neuromuscular disorders could also present with similar symptoms. A thorough evaluation by a neurologist can help rule these out.

5. Nutritional and Supportive Care: Ensure that your mother is receiving adequate nutrition, as malnutrition can exacerbate muscle weakness and atrophy. Additionally, supportive devices, such as wheelchairs or walkers, may be necessary to enhance her mobility and safety.

In summary, your mother's situation is complex and requires a multidisciplinary approach to diagnosis and management. Prompt follow-up with a neurologist and possibly additional imaging studies will be crucial in determining the underlying cause of her symptoms and guiding appropriate treatment. It’s important to remain proactive in seeking answers and advocating for her health.

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