I suppose im new to this. Im a pretty thick headed individual (the kind that would nail jello to a tree for hors rather than admit it just wont work ) well heres the scoop 2020 to 2021 i started noticing i couldn’t keep up with my then 5 year old i was becoming so esaysted and felt this horrid joint pain and mustle cpain in the left side of my neck. Then comes the pain behind my left eye . Well i kept being told i was fine (i live in rural maine) and i have many md’s that flow throu the practice not including er visits (this will be relevant).fast forward to last october and i got drop foot i went to the er they wanted scanns yadda yadda they say im fine . I week later i woke up with a tremor that hasnt gone away since. I got a great pain management dr that has been trying to fight for me but its not working . My diagnosis out of boston after my recorded 22 minute appointment where this man did not even have access to my scanns (they arnt usable in the first place,due to movement ) told me i have fnd and now no other neurologist wants to contradict him. I havent had a new scan since i got the tremor. Could this be potentially structural insted of neurological?
Physical Symptoms:
Exhaustion and irritability
Inability to complete workouts
Sensitivity to temperature (heat worsens tremors, cold increases pain)
Abdominal tenderness (left upper quadrant)
Other Observations:
Symptoms began a week after getting married.
Improved involuntary movements with Topamax (but stopped due to suicidal ideation).
Laboratory Findings:
Blood Test Results:
Low BUN
Low ALT
Low Vitamin D
Low Folate
High Chloride
IgA: <1.2 (Normal: 65-450 mg/dL)
Tissue Transglutaminase Ab IgA: <1.2 (Normal: <4 U/mL)
White Blood Cell Differential:
Basophils Percent: 1
Eosinophils Percent: 1
Immature Granulocytes Percent: 2% (October 2023, Normal: <1%)
Cerebrospinal Fluid (CSF) Results:
CSF WBC Differential: Lymphocytes: 92%, Monocytes/Macrophages: 8%.
Protein Level: 27 mg/dL
Culture Result: No growth
Gram Stain Results: No squamous epithelial cells, no PMNs, no recognizable bacteria seen
Kappa Free Light Chain: <0.0083 mg/dL (Normal: <0.1000 mg/dL)
Autoantibody Tests (CSF) - All Negative:
AMPA-R
Amphiphysin
AGNA-1
ANNA-1, ANNA-2, ANNA-3
Substance Use Test (October 26, 2023):
Amphetamine Screen: DETECTED (LOD: 500 ng/mL)
Cocaine Metabolite Screen: NOT DETECTED (LOD: 150 ng/mL)
Opiate Screen: NOT DETECTED (LOD: 100 ng/mL)
Benzodiazepine Screen: NOT DETECTED (LOD: 150 ng/mL)
Phencyclidine Screen: NOT DETECTED (LOD: 25 ng/mL)
Barbiturate Screen: NOT DETECTED (LOD: 200 ng/mL)
Methadone Screen: NOT DETECTED (LOD: 200 ng/mL)
Oxycodone Screen: NOT DETECTED (LOD: 100 ng/mL)
Buprenorphine Screen: NOT DETECTED (LOD: 10 ng/mL)
Tricyclic Antidepressants Screen: NOT DETECTED (LOD: 300 ng/mL)
Imaging Findings:
MRI - Cervical Spine:
C2/C3: Normal intervertebral disc; mild bilateral facet joint arthropathy; no significant central or foraminal stenosis.
C3/C4: Minimal intervertebral disc degeneration; mild bilateral facet joint arthropathy; no significant central or foraminal stenosis.
C4/C5: Normal intervertebral disc; no central or foraminal stenosis.
C5/C6: Mild intervertebral disc degeneration; suspected bilateral uncovertebral joint arthropathy; disc material extends into the left-sided neural foramen; correlation with left C6 distribution radicular symptoms recommended.
C6/C7: Normal intervertebral disc; mild right-sided uncovertebral joint arthropathy; no significant central or foraminal stenosis.
C7/T1: Normal intervertebral disc; no significant central or foraminal stenosis.
MRI - Lumbar Spine:
L1/L2, L2/L3, L3/L4: Normal disc height, morphology, and signal characteristics; no significant central or foraminal stenosis.
L4/L5: Mild to moderate intervertebral disc degeneration; diffuse annular disc bulging; borderline effacement on the ventral thecal sac; moderate bilateral facet joint arthropathy; synovial cyst (7 mm) posterior to the right facet joint; no significant stenosis.
L5/S1: Moderate intervertebral disc degeneration; mild annular disc bulging; small annular fissure at the midline; moderate bilateral facet joint arthropathy; no significant central or foraminal stenosis.
SI Joints:
Intact