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I've had a rapid progression of hip weakness over a few days…

I've had a rapid progression...
I've had a rapid progression of hip weakness over a few days and I'm afraid that I might have Guillen Barre syndrome or myasthenia gravis. I finally got an appointment in three days with my neurologist and I'm just wondering if that's too long to wait?
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Answered in 10 hours by:
8/22/2017
Dr. Ravoof
Dr. Ravoof, Doctor
Category: Neurology
Satisfied Customers: 6,755
Experience: Experienced Physician in the field of Medicine and Surgery.
Verified

Dear customer,

Thank you for the question.

How old are you? When did the weakness begin? Please describe your symptoms.

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Customer reply replied 11 months ago
52, i've had neurological symptoms since I was 21 after having the flu and having my silver fillings removed and I got very weak on my right side and lost some vision in my left eye. So for 30 years they thought MS or CFS and all the test are negative until this past March when gliosis showed up on my MRI of the brain and C6 radiculopathy because I was having paresthesias in my right hand which of disappeared. In late July I started feeling weak in my legs and then last week I had major stress and started feeling weak in my hips and couldonly walk a short distance and could hardly go up steps and by Friday of last week started feeling my eyelid drooping on the left and my left thumb was fasciculating all day and then progressed into my back muscles at night. I've rested for the past couple days and feel a little better but still very weak. I've taken Lyrica and Requip for years for fibromyalgia and restless leg syndrome. Recently I was put on a clonidine for anxiety but had been on Xanax and Ativan. I've had a lot of stress in the past couple weeks . My fears are having myasthenia gravis, ALS or Gillian Barre syndrome. Oh, I also have difficulty getting out of the chair and squatting and have hyperreflexia of my knee-jerk response.Please tell me what tests I need to have done.

Dear customer,
Thank you for replying.
I'll open your question to other Experts so that they can help you with this issue. Please wait for another expert to reply.

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Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Neurology
Satisfied Customers: 9,943
Experience: Experience of Neurology of over 4 years, well versed in EEG, NCS and EMG alongwith MRIs and CT scans
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Hi,

The other expert has opted out.

Now regarding your symptoms, first off this is NOT Gullian Barre Syndrome or GBS, the reason being GBS has a very rapid onset of symptoms and usually would cause progressive SYMMETRICAL weakness which occurs in an ascending fashion which means that the distal muscles (of the lower and upper limbs) would be involved first and then later on the weakness would involve the proximal muscles such as the muscles around the hip. Secondly GBS does NOT cause hyperreflexia as it is a disease of the peripheral nerves. Lastly GBS would have caused you to be unable to walk and basically be confined to the bed by now.

Regarding myasthenia gravis, this again is UNLIKELY to be myasthenia as that also effects almost all the muscles of the body and NOT only the legs or the arms or cause drooping of just one eye. It is a generalized disorder which would affect all the muscles and usually the symptoms are worse in the evening and improve the next morning. Your symptoms dont fit in with myasthenia as well.

Regarding ALS, that again is less likely because ALS would cause weakness which does NOT improve and would actually progress over time. The improvement that you had after resting is NOT characteristic of ALS either, secondly ALS would not cause the drooping of the eyelid. This is why i dont think this is due to ALS either.

However that being that your patchy involvement of various muscle groups etc does indicate that this may be a disorder of the muscles and that is why you should get a complete set of muscle enzymes done which would include CPK, LDH and aldolase levels in the blood. At the same time you should also get a EMG/NCS test done. I would concentrate on looking for myositis, which is inflammation of the muscles which leads to weakness etc and it can occur because of many causes including autoimmune diseases. At the same time i would also consider myopathies which would present in the same way as well. The anxiety that you have could be worsening the underlying problem

But i think the next best step here is a complete neurological examination, muscle enzymes and a NCS/EMG test.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/

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Customer reply replied 11 months ago
Thank you. The weakness is symmetrical and I still feel profound weakness even though I've rested for three or four days. Since I had neurological symptoms back when I was 21 and have had different diagnosis attempts over the years, could this be connected to what happened when I was 21? For the first time I had gliosis show up on an MRI in March and my platelets were elevated also in March. I didn't get any explanation about this but I still feel muscles jumping and it moves around first started in my left thumb then it moved to my back muscles then to my right quadriceps and more recently to my right hamstring's.
Customer reply replied 11 months ago
Can I wait for two more days to see my neurologist since my primary care doctor is out until the end of the week? Does the neurologist to bloodwork in their office?

Again fasiculations are not common in GBS, secondly as i said GBS rapidly progresses and if this was GBS then by now you should have been almost completely paralyzed. Secondly, the other reasons for this not being due to GBS still hold, the ptosis etc. Also when we talk about weakness, we are specifically talking about power of the muscles and not the generalized, fatigue, weakness that you feel. Decrease power in the muscles is what we are more concerned about, this means your power has decreased on a neurological examination by atleast two grades, down from 5 to 3 for example.

Also i dont think this si connected to what you had at age 21, simply because if this was then it would have progresses rapidly in the last 30 years or so or should have been picked up on previous examinations at your doctors office.

I still think the muscle issues should be considered first and YES you can wait two days to see your doctor at the moment. A neurologist would order the bloodwork but usually they dont do it in the office.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/

Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Neurology
Satisfied Customers: 9,943
Experience: Experience of Neurology of over 4 years, well versed in EEG, NCS and EMG alongwith MRIs and CT scans
Verified
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Customer reply replied 11 months ago
Thank you for you're amazingly thorough answers! Do all neurologist do EMGs /NCV tests? The neurologist I'm seeing this week says that he doesn't do these tests and he's board-certified. That doesn't make any sense, correct?

No actually it does, not all neurologists do the tests as this is a sub speciality of neurology known as neurophysiology. Those who are trained in neurophysiology would be able to do these tests while other neurologists would not.

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Customer reply replied 11 months ago
Now, That definitely makes sense but there's two neurologist there and one of them does EMGs but I thought it be good to see the other one to have fresh eyes looking at my symptoms. Now I realize I have to go see the other one when he's available. (Sigh)

Unfortunately that is the way things are, neurophysiology is actually a very complicated field and infact it requires an additional 1-2 years of training in order to specialize in it. Not all neurologists go for it.

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