Nerve Pain and Tingling: Possible Rare Disease Insights

Numbness and pain in the hands and feet?

Hello Doctor, I am a 43-year-old male.
Eight years ago, I underwent an MRI that showed compression at the cervical intervertebral discs C3-4-5-6, which caused mild left arm pain, slight weakness, and numbness in the left fingers.
After physical therapy, my symptoms improved by about 80% and have remained stable since then.
Additionally, I had an X-ray of my lumbar spine, which indicated mild compression or slippage at L3-4-5 and L5-S1.
For the past 2-3 years, I have occasionally experienced tightness and pain in the left side of my lower back, mild pain in my left thigh and calf, and occasional tingling in my left toes.
Sometimes, my arms or legs have a slight prickling sensation.

After being diagnosed with COVID-19 in June of this year, my symptoms suddenly worsened in July and August, lasting for about 1-2 weeks before easing up.
Recently, I have started to feel discomfort again, particularly in my right arm and right leg, with similar symptoms of soreness or skin prickling.
My fingers and toes feel odd at times, and occasionally, my arm or calf muscles twitch (more frequently and noticeably).

Additionally, at the end of September, I underwent a biopsy for a unilateral nasal polyp, after which I began to experience occasional dizziness and a feeling of heaviness in my head, although I can walk normally.
Sometimes, when I move my head, it feels strange, but it’s not vertigo.

After recovering from COVID-19 in June, I unexpectedly had petechiae on my feet due to vasculitis, which later resolved.
I was incidentally found to have cryoglobulinemia, and I am currently being monitored.
There are no significant symptoms, and most of my immune values are normal, with a slightly elevated RF, but my doctor believes monitoring is sufficient.

I am concerned about the possibility of multiple sclerosis or polyneuropathy.
I ask this because I was diagnosed with mild ulcerative colitis last year, which is currently stable and the mucosa has healed.
I have seen a neurologist, who said it is not likely, and I have an electromyography and nerve conduction study scheduled for December.

Wang, 40~49 year old female. Ask Date: 2023/11/14

Dr. Chen Shunsheng reply Rare Disease

Hello,
1.
It is evident that you require a comprehensive neurology consultation, which cannot be resolved online.

2.
This is unrelated to multiple sclerosis.

3.
Concurrently, there are multiple cervical and lumbosacral radiculopathies that need thorough investigation for underlying causes: occupational diseases, spinal pathologies, vascular sclerosis, and many other potential reasons to explore.

4.
Electromyography (EMG) and nerve conduction studies can confirm the presence and location of nerve damage, but they cannot determine the underlying cause.

5.
In Taiwan, it is essential to rule out hepatitis C in cases of cryoglobulinemia before considering autoimmune diseases, as it can be associated with multiple sensory neuropathies.

6.
Conclusion: Please seek a senior neurologist for proper diagnosis and treatment as soon as possible.

Reply Date: 2023/11/14

More Info

Understanding nerve pain and tingling can be complex, especially when considering the possibility of rare diseases such as multiple sclerosis (MS) or multifocal neuropathy. Based on your detailed history, it appears that you have experienced a range of neurological symptoms over the years, which have been exacerbated following your COVID-19 infection.
Your previous MRI findings indicated cervical disc herniation at multiple levels (C3-4-5-6), which can certainly cause nerve compression leading to symptoms such as arm pain, weakness, and tingling. The fact that you experienced improvement with rehabilitation suggests that your symptoms may have been primarily mechanical in nature. However, the recent onset of symptoms in your right arm and leg, along with the history of left-sided symptoms, raises the question of whether there is a more systemic issue at play.

The tingling and pain in your extremities, along with muscle twitching, could indicate peripheral nerve involvement. Conditions like peripheral neuropathy can arise from various causes, including diabetes, vitamin deficiencies, autoimmune diseases, or even infections. Given your history of COVID-19, it is worth noting that some patients have reported neurological symptoms following viral infections, which may include neuropathic pain or exacerbation of pre-existing conditions.

Your mention of cold agglutinin disease (cold agglutinin syndrome) is also significant. This condition can lead to various symptoms, including peripheral neuropathy, due to the formation of antibodies that can affect blood flow and nerve function. The fact that you have experienced episodes of skin changes, such as bleeding points, could be related to this condition or other vascular issues.

As for the potential for multiple sclerosis, it is characterized by demyelination in the central nervous system, leading to a variety of neurological symptoms. While your neurologist has indicated that MS is not a concern, it is essential to continue monitoring your symptoms and undergo the planned electromyography (EMG) and nerve conduction studies. These tests can help assess the function of your nerves and muscles, providing valuable insights into the nature of your symptoms.

Additionally, the presence of unilateral nasal polyps and your history of ulcerative colitis may suggest an underlying autoimmune process. Autoimmune diseases can sometimes overlap, and it is crucial to consider this when evaluating your symptoms.
In summary, while your symptoms could be attributed to a combination of mechanical issues from your cervical spine and peripheral nerve involvement, the possibility of an autoimmune condition or a post-viral syndrome should not be overlooked. It is advisable to maintain close communication with your healthcare providers, continue with the recommended diagnostic tests, and consider a multidisciplinary approach that may include rheumatology or immunology consultations if your symptoms persist or worsen.
In the meantime, managing your symptoms with appropriate pain relief and physical therapy may provide some comfort. Keeping a symptom diary can also be beneficial, as it may help identify triggers or patterns that could inform your treatment plan. Remember, early intervention and a thorough evaluation are key to addressing complex neurological symptoms effectively.

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