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DrBrain
DrBrain, Neurologist
Category: Neurology
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Experience:  Diplomate, American Board of Psychiatry & Neurology
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High LDH levels and symptoms of peripheral neuropathy

Resolved Question:

Hello, my mom was diagnosed five years ago with malignant spinal cord compression (NH-lymphoma). She had a great neuro surgeon who removed the tumor and treatment included rehab and radiation. She regained full mobility but about four months ago she started having mobility issues with one leg. Symptoms are consistent with peripheral neuropathy (severe muscle weakness, vibrations, burning, pain). Bloodwork shows her LDH is at over 700 with isoenzymes showing highest with #3 and #4. Her oncologist has only done MRI testing from her pelvis up but not her lower body. Tests showed an enlarged lymph node in her underarm but nothing else. She will get it removed in May. Could this enlarged lymph node be the cause of her peripheral neuropathy symptoms? Also, I've read that lymphoma patients can create paraproteins that result in demyelination. Could this be an issue as well? Any guidance or direction would greatly be appreciated since she has not been able to get a referral yet to see a neurologist. Many thanks!
Submitted: 2 years ago.
Category: Neurology
Expert:  DrBrain replied 2 years ago.

Dr. Amit M. Shelat : Cancers can result in auto immune diseases. Autoimmune diseases can lead to developing peripheral neuropathy. Lymph node would not cause peripheral neuropathy.
Dr. Amit M. Shelat : Your second theory is correct that lymphoma patients can create paraproteins resulting in demyelination.
Customer:

What specific tests would you recommend? Also, is there a treatment to stop demyelination?

Dr. Amit M. Shelat : EMG studies are best for the diagnosis of neuropathy. In terms of treatment, there 2 types of treatments that are most frequently used to treat autoimmune disease. The first is plasmapheresis in which the plasma is filtered so that the offending antibody is filtered out. The other option is IV IG which is used to absorb the offending antibody.
Dr. Amit M. Shelat : As opposed to attack the nerve, it will attack the IV iG molecule.
Customer:

thank you

Customer:

Any suggestions for how to expedite the referral process or get a specialist's attention in this matter? Her oncologist seems to be more concerned about removing the enlarged lymph node? Is it possible that the periph neuropathy symptoms could be elevating her LDH levels?

Dr. Amit M. Shelat : I do not think the neuropathy is affecting the LDH levels. You should ask your mom's PCP to refer her to a neurologist for an evaluation of the neuropathy. There is no reason that the neurological evaluation and the lymph node biopsy cannot happen together.
Customer:

I appreciate your help.

Dr. Amit M. Shelat : You're welcome. If you do not have any more questions, please press the accept button.
DrBrain, Neurologist
Category: Neurology
Satisfied Customers: 3262
Experience: Diplomate, American Board of Psychiatry & Neurology
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