Neurological Symptoms: From Limb Weakness to Dizziness

Weakness and soreness in the limbs, unilateral symptoms progressing to bilateral, along with headache, dizziness, and nausea?

Hello, doctor.
I will first describe my medical history.
At the end of May, I experienced a severe impact on the left side of my left knee, so on May 26, I visited the rehabilitation department of a hospital in Kaohsiung.
The doctor diagnosed me with left leg iliotibial band syndrome and administered an injection of dexamethasone.
That night, around 9 PM, while I was in my dormitory going to the bathroom, I began to feel soreness, numbness, and pain (like electric shocks) starting from the left side of my left calf, radiating to my left hip, left shoulder, left neck, and above my left ear near the temple.
Then, I started to feel swelling and pain on the left side of my head, accompanied by dizziness, and I blacked out.
When I regained consciousness, it was around 10:40 PM that night, and I felt dizzy, nauseous, and vomited once.
I felt extremely fatigued.
That night, I distinctly felt the bed shaking, and I thought there was an earthquake.
I checked my phone, but there was no earthquake; however, it seemed like my phone was shaking in my hand.
The next day, since I couldn’t drive, I had a remote video consultation with a doctor, who said there shouldn’t be any major issues and suggested I rest, indicating it might be hysteria (overthinking).
However, in the following days, I continued to experience dizziness and gradually developed weakness and numbness in my left lower limb, which then spread to my left upper limb and neck.
I had to ask a colleague to take me to see a neurologist.
I underwent an EEG (awake) and sensory nerve conduction studies.
The summary of the nerve conduction velocity (NCV) report states: 1.
Decreased amplitude of compound muscle action potentials in the left peroneal nerve.
2.
Slowing of motor nerve conduction velocity in the left tibial nerve.
3.
F-waves and H-reflex were borderline normal.
Interpretation: The NCV suggests 1.
axonal motor neuropathy in the left peroneal nerve; 2.
demyelinating motor neuropathy in the left tibial nerve.
Clinical correlation is advised.
This is the content of the examination report from the health insurance app (which I do not understand).
Today, I also started to feel weakness and numbness in both upper limbs and my left lower limb (when I raise my arms, I feel soreness and tightness near my armpits and back).
I have not yet had a follow-up appointment with the doctor to review the report and have to wait until next Tuesday.
Should I wait until next Tuesday for the appointment, or should I go to the emergency room first? By the way, I had Japanese encephalitis, meningitis, and peritonitis when I was a child.
Is this related? How should I take care of my health?

Xiao Wu, 30~39 year old female. Ask Date: 2022/06/04

Dr. Jiang Junyi reply Neurology

Dear Mr.
Xiao Wu,
You mentioned "1.
axonal motor neuropathy in the left peroneal nerve; 2.
demyelinating motor neuropathy in the left tibial nerve." These results indicate that there is neuropathy affecting the motor nerves in your left lower limb.
However, they do not seem to explain your symptoms of "weakness and numbness in the left lower limb as well as both upper limbs." If the numbness is rapidly extending upward, it may suggest acute demyelinating polyneuropathy, which is considered a neurological emergency.
You should seek immediate medical attention in the emergency department.
Thank you for your inquiry.
If you have any further questions, feel free to discuss them.
Wishing you good health and peace.
Dr.
Jiang Junyi, Neurology Department, Taoyuan Hospital, cares about you.

Reply Date: 2022/06/04

More Info

Based on your detailed account of symptoms and medical history, it appears that you are experiencing a complex set of neurological symptoms that warrant careful evaluation. Your symptoms, including left leg pain, numbness, and weakness, along with the episodes of dizziness and fainting, suggest that there may be underlying neurological issues that need to be addressed.

The findings from your nerve conduction velocity (NCV) tests indicate potential issues with the left peroneal and tibial nerves. Specifically, the decreased amplitude of compound muscle action potentials in the left peroneal nerve suggests axonal motor neuropathy, while the slowing of motor nerve conduction velocity in the left tibial nerve points towards demyelinating motor neuropathy. These findings can be associated with various conditions, including peripheral neuropathy, which can result from a variety of causes such as diabetes, vitamin deficiencies, autoimmune diseases, or even previous infections like the ones you mentioned (Japanese encephalitis and meningitis).

Your symptoms of dizziness and the sensation of your body swaying could be related to several factors. It is possible that they are a result of neurological disturbances, but they could also be linked to vestibular issues or even anxiety, especially if you are feeling overwhelmed by your symptoms. The fact that you experienced a fainting episode after a significant injury to your knee raises concerns about potential complications such as postural hypotension or even a transient ischemic attack (TIA), especially given your history of neurological infections.

Given the complexity of your symptoms and the potential for serious underlying conditions, it is advisable not to wait until your scheduled follow-up appointment next week. If you are experiencing worsening symptoms, such as increased weakness, persistent dizziness, or any new neurological signs (like difficulty speaking, severe headaches, or changes in vision), you should seek immediate medical attention. Visiting the emergency department would allow for a more comprehensive evaluation and potentially expedited treatment.

In terms of self-care and health maintenance, it is essential to focus on a balanced diet rich in vitamins and minerals, particularly B vitamins, which are crucial for nerve health. Regular physical activity, as tolerated, can help maintain muscle strength and improve overall circulation. Additionally, managing stress through relaxation techniques, such as mindfulness or yoga, can be beneficial, especially if anxiety is contributing to your symptoms.

Lastly, it is important to keep an open line of communication with your healthcare providers. Make sure to discuss all your symptoms in detail during your next appointment, and do not hesitate to ask questions about your test results and potential next steps. If necessary, consider seeking a second opinion from a neurologist who specializes in peripheral nerve disorders or neuromuscular diseases to ensure you receive the most accurate diagnosis and appropriate treatment plan.

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