Systemic Neuropathy: Symptoms, Diagnosis, and Next Steps

Q: Systemic Neuropathy: Symptoms, Diagnosis, and Next Steps

Hello： You mentioned symptoms of "burning in the feet, sometimes extending to the thighs, or sensations that fluctuate between warmth and coolness." These symptoms may indicate peripheral nerve issues. <br>Common characteristics of peripheral nerve symptoms include： 1. <br>Pain t

Systemic neuropathy

Hello Doctor, I received the AZ vaccine on August 9th last year and experienced redness, swelling, heat, and pain in my knee.
Then on September 8th, I had a burning sensation in my palms and soles, followed by numbness and electric sensations in my hands.
This electric sensation extended to my armpits, tongue, and lips, with prickling sensations throughout my body.
On October 8th, I experienced weakness in my hands and feet and went to the emergency department at Chang Gung Hospital.
At that time, blood tests and nerve conduction studies were normal.
The doctor prescribed Lyrica and advised me to monitor my condition.
By the end of November, I began to experience frequent muscle twitching, and by the end of December, I felt a cooling sensation from my knees to my waist, which sometimes would move around.
In February, I underwent another nerve conduction study, which indicated a slight slowing in the speed of my left hand.
Since then, the sensations of prickling, numbness, electric feelings, and cooling sensations have continued to recur until mid-May when I was diagnosed.
The intensity of the prickling and numbness reappeared, and on August 30th, I experienced burning sensations in my feet, sometimes extending to my thighs, or alternating between burning and cooling sensations.
Additionally, when I have a fever, my legs feel weak and shaky.
What further tests can I undergo? Thank you.

Jean, 40~49 year old female. Ask Date: 2022/11/05

Dr. Jiang Junyi reply Neurology

Hello: You mentioned symptoms of "burning in the feet, sometimes extending to the thighs, or sensations that fluctuate between warmth and coolness." These symptoms may indicate peripheral nerve issues.
Common characteristics of peripheral nerve symptoms include: 1.
Pain that is burning or electric in nature.
2.
Symptoms that have a specific dermatomal distribution, which can be triggered by touch or pressure.
3.
Accompanied by muscle weakness or fatigue.
The sensation of "heat extending to the thighs" may suggest nerve compression due to a herniated disc.
Diagnostic evaluations for peripheral nerve issues typically involve electrophysiological studies.
Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves.
Electromyography (EMG) evaluates muscle responses in the affected nerve distribution areas.
I recommend that you visit a neurology clinic for further examination and follow-up.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Hospital, cares about you.

Reply Date: 2022/11/05

More Info

Understanding systemic neuropathy involves recognizing its symptoms, diagnosis, and potential next steps for management. Based on your description, it appears you have been experiencing a range of neurological symptoms following your vaccination, which has raised concerns about possible neuropathic conditions.

Symptoms and Their Implications
Your symptoms began with knee joint pain and swelling, which progressed to burning sensations in your palms and soles, followed by tingling and electric sensations that spread to other parts of your body, including your armpits, tongue, and lips. The development of weakness in your hands and feet, along with muscle twitching and varying sensations of warmth and coolness, suggests a complex neuropathic process.
These symptoms can be indicative of several conditions, including:
1. Peripheral Neuropathy: This is a common condition that affects the peripheral nerves, leading to symptoms such as tingling, burning sensations, and weakness. It can be caused by various factors, including diabetes, infections, toxins, and autoimmune diseases.

2. Post-Vaccination Neuropathy: In rare cases, vaccines can trigger autoimmune responses that lead to neuropathy. This is often seen in conditions like Guillain-Barré syndrome, where the immune system mistakenly attacks the peripheral nerves.

3. Multiple Sclerosis (MS): Although your symptoms may not fit the classic presentation of MS, the presence of neurological symptoms that fluctuate can sometimes suggest demyelinating diseases.

4. Complex Regional Pain Syndrome (CRPS): This condition can occur after an injury or vaccination and is characterized by severe pain, changes in skin color, temperature, and swelling.

Diagnostic Steps
Given your ongoing symptoms and the results of your previous tests, further evaluation is warranted. Here are some recommended diagnostic steps:
1. Comprehensive Neurological Examination: A thorough neurological assessment by a neurologist can help identify specific deficits and guide further testing.

2. Electromyography (EMG) and Nerve Conduction Studies (NCS): Since you have already undergone NCS, repeating these tests may provide additional insights into the function of your nerves and muscles, especially if symptoms have progressed.

3. Magnetic Resonance Imaging (MRI): An MRI of the brain and spinal cord can help rule out demyelinating diseases like MS or other structural abnormalities that may be contributing to your symptoms.

4. Blood Tests: Comprehensive blood work, including tests for autoimmune markers, vitamin deficiencies (such as B12), thyroid function, and inflammatory markers, can help identify underlying causes of neuropathy.

5. Lumbar Puncture (Spinal Tap): If MS or other inflammatory conditions are suspected, analyzing cerebrospinal fluid (CSF) can provide valuable information.

6. Skin Biopsy: In cases of small fiber neuropathy, a skin biopsy can assess nerve fiber density and help confirm the diagnosis.

Next Steps
Given the complexity of your symptoms and their impact on your quality of life, it is essential to work closely with a neurologist. They can help coordinate the necessary tests and interpret the results in the context of your clinical picture. Additionally, if a specific diagnosis is made, treatment options may include medications for neuropathic pain (such as gabapentin or pregabalin), physical therapy, and lifestyle modifications to manage symptoms.

In conclusion, while your symptoms are concerning and warrant thorough investigation, a systematic approach to diagnosis and management can help identify the underlying cause and guide appropriate treatment. It is crucial to maintain open communication with your healthcare provider and advocate for the necessary evaluations to address your ongoing symptoms effectively.

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