[20F] Experiencing a wide array of symptoms including hives and restless leg syndrome

Patient Description

A 20-year-old female presents with a complex symptomatology including restless leg syndrome, insomnia, TMJD, myoclonus, blurry and non-focused vision, poor balance, constipation, lack of libido, blood pressure changes upon standing, heart palpitations, forgetfulness, trouble focusing, anxiety, shakiness, hyperhidrosis in hands and feet, headaches, random hives, and frequent nausea. The patient has been struggling with insomnia for the past five months, which does not follow a specific pattern and is not influenced by daily activities, though it is exacerbated by restless legs. The patient has a history of anxiety and depression since middle school, with recent cessation and resumption of antidepressants, which may be contributing to the current lack of libido. The patient also reports a history of TMJD due to anxiety-related teeth grinding, leading to jaw pain and ear problems. Myoclonus has been present since age 15, manifesting as random full-body shivers and frequent hiccups. The patient has been experiencing constipation, which may be diet-related, and has not noticed any significant weight changes. The patient reports near-fainting episodes, heart palpitations predominantly at night, and a recent outbreak of hives treated with over-the-counter antihistamines. Medications include fluoxetine and trazodone for insomnia, and Benadryl and Zyrtec for hives. The patient has a history of allergies but is unsure about autoimmune diseases in the family. There is no recent use of alcohol or weed, which were previously used to aid sleep.

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Arora's Assessment

What might be happening

Based on the information you've provided, the following conditions could be contributing to your symptoms:

  • Anxiety and Depression: You've mentioned a history of anxiety and depression, and many of your symptoms can be associated with these conditions. Anxiety can cause symptoms like heart palpitations, shakiness, and trouble focusing. Depression can cause symptoms like insomnia, forgetfulness, and lack of libido. Both conditions can also cause physical symptoms like headaches and gastrointestinal issues (e.g., constipation).

    • Treatment typically involves psychotherapy (talk therapy), medications, or both. It's important to work with your healthcare provider to find the best treatment approach for you.
  • Restless Leg Syndrome (RLS): This is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you're sitting or lying down.

    • Treatment for RLS is targeted at relieving symptoms. In some cases, treating an underlying cause, such as iron deficiency, greatly relieves symptoms of RLS. Medications also help many individuals.
  • Temporomandibular Joint Disorder (TMJD): This condition affects the joint that connects your jaw to the temporal bones of your skull. It can cause pain in your jaw joint and in the muscles that control jaw movement.

    • Treatment options include pain relievers, antidepressants, oral splints or mouth guards, physical therapy, and in severe cases, surgical procedures.
  • Myoclonus: This condition causes quick, involuntary muscle jerks. They're often not a cause for concern, but they could be a symptom of a nervous system disorder.

    • Treatment usually involves medications, but treating an underlying cause can sometimes eliminate myoclonus.
  • Orthostatic Hypotension: This is a form of low blood pressure that happens when you stand up from sitting or lying down. It can cause symptoms like dizziness and fainting.

    • Treatment involves lifestyle changes and, if necessary, medication.
  • Allergic Reaction: Hives are often a sign of an allergic reaction. They can be caused by a variety of substances, including certain foods, medications, and insect stings.

    • Treatment typically involves avoiding the allergen and taking antihistamines to control symptoms.

What you can do

  1. Consult with a healthcare provider: Given the range and severity of your symptoms, it's important to consult with a healthcare provider. They can provide a formal assessment and order relevant tests if necessary.

  2. Maintain a healthy lifestyle: Regular exercise, a balanced diet, and good sleep hygiene can help manage many of your symptoms.

  3. Monitor your symptoms: Keep track of your symptoms and note any patterns or triggers. This information can be helpful for your healthcare provider.

  4. Follow your treatment plan: Continue taking your prescribed medications as directed by your healthcare provider. If you're experiencing side effects or your symptoms aren't improving, let your healthcare provider know.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe headaches or migraines
  • Sudden vision changes
  • Severe abdominal pain
  • Blood in your stool
  • Severe or worsening depression or anxiety symptoms
  • Any other severe or concerning symptoms

Please remember that this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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9 mo ago


People Also Ask


What are the common symptoms of Restless Leg Syndrome (RLS) and how is it treated?

Restless Leg Syndrome (RLS) typically causes an uncontrollable urge to move the legs, often accompanied by uncomfortable sensations. These symptoms usually occur in the evening or nighttime when sitting or lying down. Treatment may include addressing underlying causes like iron deficiency, medications, and lifestyle changes such as regular exercise and good sleep hygiene.


How can anxiety and depression contribute to physical symptoms like heart palpitations and insomnia?

Anxiety and depression can lead to physical symptoms due to the body's stress response. Anxiety can cause heart palpitations, shakiness, and trouble focusing, while depression can lead to insomnia, forgetfulness, and lack of libido. Both conditions can also cause headaches and gastrointestinal issues. Treatment often involves psychotherapy, medications, or a combination of both.


What are the treatment options for Temporomandibular Joint Disorder (TMJD)?

Treatment options for TMJD include pain relievers, antidepressants, oral splints or mouth guards, physical therapy, and in severe cases, surgical procedures. Managing stress and avoiding habits like teeth grinding can also help alleviate symptoms.


What lifestyle changes can help manage orthostatic hypotension?

Lifestyle changes to manage orthostatic hypotension include staying hydrated, avoiding alcohol, standing up slowly, wearing compression stockings, and increasing salt intake if advised by a healthcare provider. Regular exercise and small, frequent meals can also help stabilize blood pressure.

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