I am an adult neurologist, and will attempt to answer your question. You are offline, so please review the following information and ask questions if you have them , or if you are asked to answer my questions, please do so and I will return to reply. If you feel you have recieved enough information and are satisfied, please hit the accept button as that is how I am compensated for my work. If you have additional questions, even after you have hit the accept, for example you now have lab results, please return and I will be glad to answer your questions. Please be aware that as a physician I cannot make a diagnosis without an examination, so this is for information purposes only and does not adhere to the role of a patient-physician relationship. Ok?
I am waiting to see if you come online..
Well you remain offline, so I will give you my answer. I a male age 62, the big question in someone that presents with monoparesis, or weakness in one leg, is a history of lower back pain. Our motor system is comprised of two seperate motor systems that communicate at the spinal level, the upper and the lower motor neuron
hi are you there?
please type something, do not use the reply button as it sometimes doesnt work
just type something and hit your enter key
Hello, sorry I got cut off.
no problem. so do you have a history of lower back pain?
and have you had an MRI of your lumbar spine?
a long time ago. i had a disc bulge but I have been doing well for many years now. This weakness has come on fairly suddenly with no significant back pain.
which muscles are effected?
I can ask you questions to determine that if you want to do it that way
My knee kind of buckles backward when I walk and I have a hard time controlling it. I can't pull my ankle upward past neutral.
so you have a foot drop, which is a L5 radiculopathy and also quads weakness which is an L4 radiculopathy.
are the muscles on the front part of your calf melting away?
and the front part of your thigh?
and where is it numb?
The side of my lower leg below the knee and my foot.
so that is your L5 radiculopathy
not across your knee?
and do you get a lot of twitching in those front calf muscles?
Sometimes after prolonged use
so it says here you have seen a rheum and a neuro, recently, do you have any rheum diagnosis?
no significant findings
so have you had an EMG of that leg from the neuro?
yes, some nerve damage found, gave me a diagnosis of hemihypoesthesia
so is it in your back or the lumbosacral plexus? did he needle your back muscles?
no, more my leg
so did he talk about the common peroneal Nerve? do they have you on a ankle foot orthotic? do you have a family history of neuropathy?
do you drink alcohol? what meds are you on?
Not really about the peroneal nerve. No orthotic. No family history. No alcohol or meds. I do have slight diabetes.
so just PT for your foot drop?
yes, not really helping for that.
so this is a monoparesis from an diabetic neuropathy?
did he talk about mononeuritis multiplex?
no chance of lupus here?
did not mention that. Not sure about Lupus. Can those cause my symptoms?
lupus can give you an isolated inflammation of a single nerve with motor and sensory symptoms, like you have that would be a mononeuritis multiplex
did the rheum check an ANA?
Not sure. I will ask. Would that be from a blood test?
I think the blood test was normal but not sure if he tested for Lupus specifically.
sometimes this specific nerve goes bad for unknown reasons, it is called a foot drop and the work up is for the most part negative, although the diabetes could have played a role
hang on, i will get you an article on it
So there could be no specific cause for my weakness? Will it resolve on its own or is there anything I can do?
believe it or not, the nerve passes on the lateral side of your knee, through a groove called the fibular neck, and sometimes it get compressed there and gives you the foot drop, there are a lot of reasons, like cancer can cause it, or multiple myeloma, many things, check out that article I left for you, there is a list of causes.
it usually gets better on its own with time. what you do not want to do is get contractures of the achilles tendon behind your ankle by letting your foot drop too much, that is why I asked about the FAO or foot ankle orthotic that keeps your foot up.
you need to do the PT every day
there is also a electrical device to help in the repair of the nerve, hang on
here is an article that says it helps, and a company that sells the device
Thank you for the articles.
Should I my doctor to test my back to see if it is coming from my old back problem (even though I don't have back pain)? Should I also ask to get checked for Lupus specifically?
well that is what the EMG is for, he should have put some needle electrodes in your back to test the muscles there, which would not be affected if you had the foot drop problem and not an L5 radiculopathy, do you understand. the conduction numbers where he gave you the shocks probably told him that the problem was your nerve and not your back
you can ask the rheum if he checked an ANA and/or a dsANA
I will switch this to the Q and A and you can print this out if you want to.
I understand. So if the workups are all inconclusive, I should just try to keep working it to get stronger?
do you have any more questions? Absolutely, it will never hurt you to work it out. unless you have ALS but you would not have numbness there
No. That was great info! Better than going into the office. You are a wealth of information and I truly appreciate your time.
no problem. Please hit the accept button if you feel I answered your question, you can always come back if for example you get your blood work and want to discuss it, ok? or your EMG numbers, i will go through it with you
Thank you so much. God Bless you.