[27F] With progressive balance problems and multiple neurological symptoms

Patient Description

A 27-year-old female presents with a one-year history of progressive balance problems, muscle weakness, muscle pain and soreness, coordination issues, dizziness, eye pain, blurred vision, difficulty swallowing, fatigue, headache, joint pain, constipation, difficulty emptying bladder, and urinary urgency. The balance issues have led to frequent falls and injuries, and the patient feels unsteady while walking and unable to stand on one foot. Symptoms worsen with quick position changes but are otherwise constant. The patient also reports double vision, progressively worsening hearing, intermittent tinnitus, and numbness or tingling in the limbs. Speech can be affected by muscle fatigue. Medical history includes irritable bowel syndrome with mixed constipation and diarrhea, asthma, gastroparesis, Hashimoto's thyroiditis, dysautonomia, and high blood pressure diagnosed a year and a half ago. The patient has a family history of celiac disease (mother) and is allergic to penicillin. Current medications include Lamictal, Pristiq, Buspar, Synthroid, Xyzal, Zofran, Amlodipine, Naproxen, and Albuterol.

Arora's Assessment

What might be happening

It is likely that your symptoms are related to multiple issues, including existing diagnoses. If you have more questions, we can continue chatting.

Causes of your balance problems, muscle weakness, and coordination issues:

Multiple Sclerosis (MS): MS can cause a wide range of neurological symptoms, including muscle weakness, balance problems, coordination issues, and vision changes. It is an autoimmune disease where the immune system attacks the protective covering of nerves.
Myasthenia Gravis: This is another autoimmune disorder that can cause muscle weakness and fatigue, particularly in muscles that control eye and eyelid movement, facial expression, and swallowing.
Peripheral Neuropathy: This condition can cause numbness, tingling, and weakness, often in the hands and feet, and can affect balance and coordination.

Causes of your dizziness, eye pain, and blurred vision:

Vestibular Disorders: Conditions affecting the inner ear can cause dizziness and balance problems. Examples include benign paroxysmal positional vertigo (BPPV) and Meniere's disease.
Optic Neuritis: Inflammation of the optic nerve can cause eye pain and vision changes, and is sometimes associated with MS.

Causes of your difficulty swallowing (dysphagia):

Neurological Disorders: Conditions like MS or Myasthenia Gravis can affect the muscles involved in swallowing.
Gastroesophageal Reflux Disease (GERD): This can cause inflammation and narrowing of the esophagus, leading to difficulty swallowing.

Causes of your fatigue, headache, and joint pain:

Chronic Fatigue Syndrome (CFS): This condition can cause severe, persistent fatigue that is not relieved by rest, along with headaches and joint pain.
Fibromyalgia: This condition is characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.

Causes of your constipation and difficulty emptying bladder:

Dysautonomia: This condition affects the autonomic nervous system and can cause a wide range of symptoms, including gastrointestinal and bladder issues.
Gastroparesis: This condition can cause delayed stomach emptying, leading to constipation and bloating.

What you can do

Balance problems, muscle weakness, and coordination issues:

See a Neurologist: It's important to get a thorough neurological evaluation to determine the underlying cause of your symptoms. They may recommend tests like MRI, EMG, or nerve conduction studies.
Physical Therapy: A physical therapist can help you with exercises to improve your balance and coordination.
Safety Measures: Use assistive devices like a cane or walker to prevent falls. Ensure your home is free of tripping hazards.

Dizziness, eye pain, and blurred vision:

Vestibular Rehabilitation: This type of physical therapy can help with dizziness and balance issues.
Eye Exam: See an ophthalmologist to evaluate your vision changes and eye pain.

Difficulty swallowing (dysphagia):

Speech Therapy: A speech therapist can help you with exercises to improve swallowing.
Dietary Changes: Eat softer foods and take smaller bites to make swallowing easier.

Fatigue, headache, and joint pain:

Rest and Pace Yourself: Ensure you get adequate rest and avoid overexertion.
Pain Management: Over-the-counter pain relievers like Naproxen can help with headaches and joint pain. Follow the dosage instructions carefully.
Hydration and Nutrition: Stay hydrated and eat a balanced diet to help manage fatigue.

Constipation and difficulty emptying bladder:

Dietary Fiber: Increase your intake of dietary fiber to help with constipation.
Hydration: Drink plenty of water to help with both constipation and bladder issues.
Bladder Training: Try to schedule regular bathroom breaks to manage urinary urgency.

What you should look out for

Given the complexity and severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

Sudden worsening of symptoms: If you experience a sudden increase in muscle weakness, vision changes, or balance problems, seek immediate medical attention.
Severe pain: If you have severe headaches, eye pain, or joint pain that is not relieved by over-the-counter medications, see a doctor.
Difficulty breathing or swallowing: If you have trouble breathing or swallowing, go to the emergency room.

Remember, while I can provide information and suggestions, it's important to consult with healthcare professionals for a formal diagnosis and treatment plan. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.