52 yo healthy male with ascending leg numbness and weakness x 1 month. Mild LFT 52 and HA1C 6 elevation? Differential diagnosis ?? Treatment? No disk s/s, seen by chiropractor .
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With the symptoms of leg weakness & numbness there are mainly 2 possibilities.
This could be a type of peripheral neuropathy (peripheral nerve damage) or a spine problem.
GB syndrome (Guillain-Barre syndrome) is one neuropathy that can present with ascending weakness & numbness, starting in the legs.
There is a chronic variant of it called as CIDP (Chronic Inflammatory Demyelinating polyneuropathy) that too can present like this, however unlike GB syndrome it is generally a progressive neuropathy and that diagnosis is made only if the symptoms are progressive even after about 2 months.
There are few spine conditions that can present like this.
Myelopathy, generally in the thoracic spinal cord area, Conus medullaris syndrome (damage to the lower end of the spinal cord, it is also a type of myelopathy), or Cauda equina syndrome (damage to the lower lumbosacral spinal nerve roots) etc, all these spine conditions can cause above symptoms.
Spine conditions generally present with bowel and/or bladder symptoms too.
I assume you meant no signs/symptoms od disc (by s/s), and that might mean no back pain etc.
But some of these above conditions like myelopathy etc may not always present with much back pain. If there is disc problem then back pain is common, however myelopathy may be caused by non-disc conditions too - and without back pain, so spine conditions still need to be ruled out.
Other than GBS the peipheral neuropathy may be caused by vitamin deficiencies, thyroid diseases, autoimmune connective tissue disorders, medication side effects, exposure to toxins etc.
Rarely brain conditions, especially in the medial frontal lobe area can cause leg symptoms.
HbA1c = 6 is a mild elevation, this may be considered a prediabetic range, although prediabetes can cause neuropathy however unlikely to produce a rapidly progressive neuropathy like this (within 1 month in this case).
Elevated LFT at 52 may indicate certain viral illness. Some viral illnesses may be associated with peripheral neuropathy.
Elevated LFT may indicate alcoholism too (if alcohol history is truly present), however alcoholism generally causes slowly progressive neuropathy, not rapidly progressive neuropathy like in this patient.
As you see there are myriad possibilities. I am not sure how far this has been evaluated & investigated. If not done yet then patient needs to be seen in a neurology clinic and undergo a thorough clinical evaluation/examination followed by an EMG/Nerve conduction test, possibly an MRI of the spine too. After obtaining these above tests it will be clear whether this is peripheral neuropathy or spinal condition, and after that additional investigations may be necessary to find out the exact cause for the neuropathy or spinal conditions.
American Board Certified Neurologist, Internal Medicine