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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35754
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Here are my symptoms: deep pain in calves, neck pain, middle

Customer Question

Here are my symptoms: deep pain in calves, neck pain, middle back lain, numbness tingling all over, now I have muscle spasms all over. Blood work was clear. Mri of brain showed 4 lesions, neck was clear and lumbar puncture clear for MS.
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello,
I am Dr. Arun and will be helping you today.

I am sorry that your question was unanswered for long.

Could you please write the MRI report for the 4 brain lesions.

Thank you.

Customer: replied 1 year ago.
4 vague T2 signal abnormalities within periventricular white matter oriented perp to the lateral ventricles which maybrepresent demyelinating focci of MS given patients history. No abnormalities identified within the infratentorial structures. None of these lesions demonstrate concomitant enhancement to suggest active demyelination.These symptoms started in May and have progressed. I have never really been to a doctor before then. I was an avid runner. Pain started in my left ankle...thought it was nerve entrapment from running. Then pain moved up lef then to other leg then to my arms. I feel pulling in my arms and fingers. I had a nerve test and was told I have developed peripheral neuropathy in my feet. I have not done another nerve test but feel it has moved to may hands since they are drawing up.Thank you...
Expert:  Dr. Arun Phophalia replied 1 year ago.

You are very welcome.

I am writing you an answer. This may take 5-10 minutes.

Thanks for your patience.

Customer: replied 1 year ago.
Thats ok...you dont have to call. It just offered me that.
Expert:  Dr. Arun Phophalia replied 1 year ago.

MS would be diagnosed on a very specific criteria called McDonald criteria. The criteria consist of a combination of clinical, imaging, and paraclinical tests (CSF, evoked potentials). This is the reference;

Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011 Feb. 69(2):292-302. [Medline]. [Full Text].

Traditionally, MS could not be diagnosed after only a single symptomatic episode, as diagnosis required repeat attacks suggesting the appearance of lesions separated in time and space.

Unfortunately, I cannot talk to you on phone.

I am adding further to my answer in couple of minutes.

Expert:  Dr. Arun Phophalia replied 1 year ago.

With your vastly distributed symptoms and investigations done, neuropathy should be the diagnostic consideration. Following investigations should be done by your primary care physician or a neurologist (I understand that many have been already done);

1) Electromyography/nerve conduction studies (EMG/NCS)

2) MRI of the spine and brain

3) blood glucose, glucose tolerance test and glycosylated hemoglobin

4) serum B12 level with methylmalonic acid (with or without homocysteine),

5) serum protein electrophoresis

6) Anti-nuclear antibody

7) Lyme testing

8) Rheumatoid factor

9) Sjogren's syndrome testing (Anti-Ro, Anti-La Antibodies)

Skin and nerve biopsy may be recommended after the results of these investigations.

This should give the diagnosis and guidelines for the management.

Following are the causes of neuropathy (many times cause is not known);

1) Diabetes

2) An underactive thyroid gland

3) Excessive use of alcohol

4) Thiamine deficiency

5) Vitamin B 12 deficiency (pernicious anemia)

6) Vitamin B 6 (pyridoxine) taken in excessive amounts

7) Drugs, medications, herbs

8) Autoimmune diseases

9) Heavy metals such as lead and mercury.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Customer: replied 1 year ago.
Thank you for your response. All of thise tests have been done and all were clear. Theybhave not done nerve or muscle biopsy. I see another nehrologist on Friday and hope they will do that. It is like my central nervous system has gone haywire. Shooting pains...like ants all over . It was just in my legs and then spread. I have also been told possible autoimmune but not any of my extensive blood work shows that. Thank you.
Expert:  Dr. Arun Phophalia replied 1 year ago.

You are very welcome.

Nutritional neuropathy is another diagnostic consideration.

Investigations to ascertain the nutritional neuropathy;

Thiamine (vitamin B 1 ) deficiency: A serum thiamine (vitamin B 1 ) level

Pyridoxine (vitamin B 6 ) level

Folate deficiency: Serum folate levels .

Niacin (vitamin B 3 ) deficiency: Urinary excretion of N -methylnicotinamide

Cyanocobalamin (vitamin B 12 ) level

Pantothenic acid deficiency: Excretion is less than 1 mg/d.

Alpha-tocopherol (vitamin E) deficiency: The serum α -tocopherol (vitamin E) level

Hypophosphatemia: Serum phosphate level

Biotinidase levels.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating.

Thank you.

Wishing you all the very best in life.

Customer: replied 1 year ago.
Thank you again
Expert:  Dr. Arun Phophalia replied 1 year ago.

You are most welcome.

Best wishes,
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Expert:  Dr. Arun Phophalia replied 1 year ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited and paid for my work.

Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.

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- if you would like to schedule a new, private email session or to ask me directly a new question. It's up to you.

Thank you.

Expert:  Dr. Arun Phophalia replied 1 year ago.

My goal is to provide you with the best service possible. If you feel I have done so, then an "Excellent Service" rating is greatly appreciated! If not, please click "Reply" to let me know how I can better assist you with any additional information or clarification.

Thank you very much for the opportunity to be of help!