Hi, I am a 36 year old woman (RN) with seems like some neurological symptoms. I have Chiari type 1 malformation which was treated in 2002 with a post fossa decompression. Before surgery I had numbness tingling in my extremities, vertigo, and nausea, some fatigue, and headaches. I did not have a syringx. Most of the symptoms went away after surgery except the occasional tingling and numbness. Lately I have been having some neurological symptoms reappear: numbness tingling in extremities, weakness in arms and legs (not severe), some headaches, but a new symptom seems to be fine tremors or shaking which my husband cannot see or feel but I do. I can anxious at times and wonder if this is anxiety related or a reoccurrence of symptoms or something new. I did read scar tissue can form at the surgical site and cause some reoccurrence. I do not take it anymore but I did have some clonazepam left (prescribed a couple of years ago for post partum anxiety) and tried a small dose 0.5 mg to see if my symptoms were related to anxiety. It did decrease a bit but they are still present. Can you give some advice on what I should do. Do you think it could be my chiari or maybe the start of MS. MY doctor is sending me for some basic blood work which includes TSH levels and glucose.Thanks ahead of time for the info.
Hello. Can you tell me a little more about this new symptom you're having? Where do you get the tremors? Are they constant or intermittent?
Fine tremors can sometimes turn out to be tremulousness from anxiety or hyperthyroidism, or fasciculations from fatigue or stress. If you hold your hands out in front of you with the fingers spread, do you see both hands trembling or just certain fingers?
I do not even see it sometimes. It can even feel like a vibration or like when you have jitters from coffee. I can feel it in both hand. I can sometimes feel it throughout my body as well. Usually accompanied in my legs by tingles. They are intermittant.
The only other thing I forgot to mention that my periods have become very short in duration (7 down to 3 days) and heavy to lighter, some irregularity which it very unusal for me. I had an US done and it was clear of any tumors fibroids.
Well, you can rest assured...This does not sound like a complication of CM1 or MS.
Hopefully, the blood tests will rule out any systemic process that might be contributing to your symptoms. In the meantime, I would suggest 2 things:
One, if you feel your anxiety or stress level has been particularly high during this period, you should ask your doctor for a trial of a daily anti-anxiety medication. Clonazepam is rather short-acting and not a good long-term solution. You would likely do much better with something like Zoloft, Effexor, or Buspar. These meds address the underlying chemistry of anxiety more directly. If effective, your symptoms might resolve and you would have both a solution and a diagnosis.
Second, you should have a follow up MRI of your brain and C-spine, if not done recently. Given your history of CM1 and surgical decompression you cannot be completely sure that something hasn't changed in this critical area, and this would be a good time to reassure yourself that everything is OK.
If your periods have changed, you should ask your doctor to add an FSH and LH to your blood tests to assess your hormonal status, and then follow up with a GYN specialist. This could certainly be related to your state of mind and any resulting tremulousness.
Thank you for your answers. There is much to consider. I did just start on Ciprolex just a few days ago. I can understand when you suggested that my state of mind could cause the tremulousness but what about the weakness and numbness and tingling. I have had anxiety related numbness and it is does not feel the same nor do my arms even when typing this note. I presume it would be rare to have MS and chiari at the same time and with a condition already known. The difficulty is the waiting. We are in Canada and the wait times here are long. It will be coming up to 10 months that I have been waiting to get an appointment with the neurologist and then she is the one who has to send me for a MRI after (which is another long wait). In the mean time I hope my symptoms go away or at least stay the same.
Yes, things are done differently here in the US. You would likely have already been seen by neuro and had the MRI.
It would be nice, for example, to get the CM issue out of the way, especially if the numbness, tingling and weakness feels the same as it did before the surgery. Recurrence of symptoms is always possible, or a complication such as the appearance of a post-surgical syrinx.
Granted, symptoms would most likely be more or less continuous and not intermittent, but this would still be high on the list for someone your age with no other plausible explanation. And a symptomatic syrinx would require surgery at some time, so the sooner it is found the better.
MS does not present this way, and as you suggest, would be statistically very improbable. An important part of the work up for MS is an MRI of the CNS, so again, as improbable as it might be, an MRI would be done for the added benefit of ruling out other such processes.
The weakness is probably the most concerning of your symptoms, particularly if you feel it is progressing. The blood tests and cipralex should be helpful in terms of diagnosing and treating numbness and tingling, but the weakness is less easy to dismiss.
My suggestion would be to contact your GP and impress upon him or her the unusual circumstances and risks inherent in your case, and the need for your referral and/or MRI to be expedited. While this is happening the remainder of your work up can continue on pace, and the Cipralex can be given time to do its thing.
Neurology & Int Medicine (US Trained): 20 yrs experience