My husband has been having balance problems, a shuffling walk, difficulty going up & down stairs for about a year. His right leg seems weaker than the left. He has also had problems with his left eye - retina problems, macular degeneration, glaucoma. Recently he started having trouble sleeping. He has had blood tests, MRI's, has seen a neurologist and a neuro-surgeon. No spinal compression; no evidence of stroke. Nerve response in his legs and his reflexes are normal. Neurologist says probably not Parkinson's since he has no signs of palsy. He has no problems with coordinating small movements in his fingers and hands. The neurologist has referred him to a Movement Disorder Clinic to see if they can do something to help but we can't get in there for almost 2 months. What else can we look for or where else can we go to try to find out what the problem is?
I am waiting to see if you come online.
hi are you there?
Hello, I'm here.
so let me ask some questions first ok?
so did he have formal nerve conduction studies/EMG testing?
Yes, in Feb. Everything was normal.
and there is no family history of neurodegenerative disorders which includes alzheimers, picks, parkinson's , lewy body disease,
None that we know of. His father died in an accident when he was around 40. His mother lived to be 88.
Let me tell you my opinion (which I guess is all I can give you without an exam) but by looking at your history and physical exam data that you gave me
there are a few diseases that are parkinson's like, one is called striato-nigral degeneration
hang on and I will get you a webpage on it
this is a complicated disease with many things (symptoms) but they do not all start at once.
you can have the shuffling gait, and the problems sleeping, and good fine finger movements at the beginning
one thing is that there might be blood pressure dysregulation in this disease, does he have problems with dizzyness?
No dizzyness. He takes medication for blood pressure.
does he have any signs of cognitive dysfunction?
That's hard to answer. Sometimes he forgets things, but I do that too.
the other possibility is toxic encephalopathy, believe it or not, carbon monoxide, lead, cadmium, they are all rare but on the list
what kind of work did he do?
He worked in a plant where they manufactures turbo chargers. He made sure the water , power , gas went to all the machines correctly.
were there engines running all of the time?
what about emissions at the plant, where they measured?
I don't know but probably not
well he may need a toxicologist to look at him
and he may need a test called a PET scan, for two different reasons
He worked there from 1958 -1983
that is a long time ago, but what happens in carbon monoxide is that you effect the dopamine producing cells/
we all produce dopamine, and we all start producing less dopamine as we get older,
you can actually plot out the decrease over time
now parkinson's patients have a steeper slope to the line., they make less dopamine faster
carbon monoxide toxicity could be the same thing to your husband
he was fine, but he is now starting to run out
carbon monoxide effects the deep neurons in the nuclei of the brain which is where dopamine is made
that is one possibility, I can't tell you what the chances are, but that would be the first reason to do a PET scan
a pet scan is a way to measure dopamine stores (using one type of tracer 11C raclopride and 18F-Dopa) and also can measure metabolism in the brain, regional metabolism to see if the deep parts of his brain are effected by chronic exposure to carbon monoxide.
that second scan uses a tracer called 18F-FDG
so it sounds like that is what I would get, I will attach a webpage of a place I know in the NYC area that does this testing, hang on
Do you think this Movement Dirorder Clinic will be of any help?
absolutely. the movement disorder guys are the ones that know this stuff, really. they are definitely the people to see
but you must tell them about the work history, did you tell the neurologist?
No I guess not.
We will be sure to tell the next people.
Well let me say one more thing. Parkinson's Disease is extremely difficult to diagnose by exam only
the american academy of neurology did a study where they took the top neurologists in the country,
and brought them a variety of patients with PET scan proven dopamine deficiency, and had them
do the exam, and they were only about 70% accurate
so it is tough, but time will tell for this disease, that I can guarantee you
I had heard that you almost needed to rule out everything else
the balance problem with the shuffling is suggestive of a parkinsonian syndrome, but maybe not parkinsons
yes, that is correct
that is why carbon monoxide is on your list
do you have any more questions about this? any other information you need
do you want some info on Parkinson's?
I think this helps a lot. At least I feel we are still going in the right direction.
I don't think I need any info on Parkinson's at this time.
great, yes, I would say you are, just tell them everything, and thing about the scans as an option, oh
there is also a cheaper scan option using a scanner called SPECT
it is more clinically friendly because it is cheaper, but not as good quality as PET
it is called DATscan
but for the carbon monoxide question, you need a PET scan
hope I didn't confuse you
the movement d/o guys know this stuff
Great. You have been a big help. It just seems like we have been struggling to find out anything.
good luck to you, please come back if you have questions, scan results, anything ok?
Yes, thank you very much.
you are welcome bye oh please rate me as that is how I am compensated , thank Dr Frank T
You are very welcome. :)
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