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I have been having numbness in my arms, legs and tongue for…

I have been having numbness...
I have been having numbness in my arms, legs and tongue for 2 years now. I have had probably every test done and all come back negative.
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Customer reply replied 1 month ago
Since I have tested negative for EMG nerve conduction AND small fiber I am wondering if you could explain what this could mean. Does this point in the direction of a central nervous problem?
Answered in 7 minutes by:
1/22/2018
Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 12,088
Experience: Neurosurgeon - Brain, spine, and peripheral nerve surgery
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This sounds tough.

Your EMG did not show evidence of neuropathy (I'm assuming)?

And you've had MRI imaging of your brain, and cervical / thoracic / lumbar spines?

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Customer reply replied 1 month ago
negative on all.

Do you have numbness in your thorax region (e.g. chest and abdomen)?

And I assume they've done all kinds of bloodwork as well?

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Customer reply replied 1 month ago
I have had chest symptoms, pain in my upper chest (middle and outer edges if that makes any sense) and have felt tightness around my abdomen at times. I do not believe this to be anxiety, I never have rushing heart rate and can not make a connection. I have tried anxiety meds with no luck. Thank you for your time.
Customer reply replied 1 month ago
I have never had a lumbar puncture. I am wondering does the negative emg and small nerve rule out MS or rule in?

Well, this obviously is a tough case, as you've had many things already ruled out.

Often times when people have numbness throughout -- you have an issue with a neuropathy.

But you've had a number of tests done, which do not seem to point to a specific cause.

Your doctors presumably have ruled out many of these causes, and looked into other diagnoses which can contribute to neuropathy, such as hepatitis C, complex regional pain syndrome, lupus, thyroid problems, amyloidosis, HIV, and most commonly diabetes.

The EMG and small fiber biopsy do not rule out MS. Your negative brain MRI ruled out MS for the most part. While your neurologist can do a lumbar puncture to look for other causes for inflammation in the spinal fluid, they may have done the other tests to rule out conditions already (like your MRIs).

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The fact that your tongue seems to be involved would suggest more of a "brain" issue rather than a peripheral nervous system issue (like the small fiber neuropathies).

But if your tongue is involved, then typically the rest of your face would also have numbness (if it were a brain related issue). But tumors, strokes, etc that affect the brain would typically affect specific areas (usually just one side or the other), not both sides at once. The same goes for MS -- typically symptoms are patchy and can involve one side or another, but typically not symmetric in nature.

Perhaps revisiting with the neurologist to see if lumbar puncture would be helpful in your case could be the next step.

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Customer reply replied 1 month ago
Does the negative emg/small fiber rule out amyloidosis?

Yes, they should have figured this out with an abnormal EMG and on the skin biopsy.

They could also do a nerve biopsy to look at one of the larger nerves itself, to see it this was a problem.

Dr. Mark
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