[32F] Experiencing multisystem symptoms including neurological sensations

Patient Description

A 32-year-old female presents with a complex array of symptoms that have been progressively worsening since 2019. She reports severe fatigue that is not alleviated by rest, and in fact, rest makes her feel worse. She has experienced significant itching, primarily on her face, which has been persistent for about two years and results in a burning sensation upon contact. Additionally, she suffers from lightheadedness rated 7/10 in severity, with a sensation of her head spinning, especially with quick movements. This symptom lasts for days at a time before resolving. She describes constant full-body aches with a daily pain level of 4-5, which can spike to 8-9 on some days. Unusual sensations include a feeling of wet skin when it is not wet, a tickling or crackling sensation inside her head, and a warm water sensation coming out of her ears, all of which started two weeks prior. She also experiences tremors in her hands that worsen with specific tasks and has been dealing with these since 2019. She has a noted brain lesion, initially suspected to be a stroke but later ruled out due to her age. She is currently on 20mg of Abilify since 2017 and 20mg of Adderall since 2021, taken daily. She also reports hot flashes, extreme sensitivity to heat, and symptoms exacerbated by warm showers. There is no known family history of autoimmune diseases, and she has no known drug allergies. The patient's complex symptoms suggest a need for thorough neurological evaluation and possibly a review by a rheumatologist or immunologist given the multisystem involvement and potential autoimmune component.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, several conditions could be considered:

  • Multiple Sclerosis (MS): MS is a chronic disease that affects the central nervous system, which includes the brain and spinal cord. MS can cause a variety of symptoms, including fatigue, difficulty walking, numbness or tingling, muscle weakness, pain, and problems with coordination and balance. The sensation of wetness you described could be related to a symptom known as "phantom sensations," which are abnormal sensations or pain that can occur in people with MS. The lesion on your brain could also be a sign of MS, as the condition often causes lesions or areas of damage in the brain and spinal cord.

    • The diagnosis of MS is usually made by a neurologist and involves a combination of clinical evaluation, imaging studies (like an MRI), and sometimes a lumbar puncture (spinal tap). The treatment of MS typically involves medications to manage symptoms and prevent disease progression.
  • Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. It is often considered when there are multiple sites of pain in the body and fatigue, as you described.

    • Diagnosis is usually made by a rheumatologist based on a clinical evaluation. Treatment typically involves a combination of medications, physical therapy, and lifestyle changes to manage symptoms.
  • Chronic Fatigue Syndrome (CFS): This is a complex, long-term illness that affects many body systems, causing severe fatigue that doesn't improve with rest. The fatigue often worsens with physical or mental activity. CFS can also cause a variety of other symptoms, including pain, difficulty thinking, and a range of flu-like symptoms.

    • Diagnosis is usually made by a primary care doctor or a specialist in chronic illnesses, based on a clinical evaluation. Treatment typically involves a combination of medications, physical therapy, and lifestyle changes to manage symptoms.
  • Thyroid Disorders: Both hypothyroidism (low thyroid function) and hyperthyroidism (high thyroid function) can cause a variety of symptoms, including fatigue, weight changes, and sensitivity to cold or heat. Hyperthyroidism can also cause tremors and palpitations.

    • Diagnosis is made by a primary care doctor or endocrinologist, based on blood tests. Treatment typically involves medications to correct the thyroid hormone imbalance.
  • Autoimmune Disorders: Given your mother's history of chronic pain, it's possible that an autoimmune disorder could be contributing to your symptoms. Autoimmune disorders can cause a wide range of symptoms, including fatigue, pain, and skin changes. Some autoimmune disorders can also affect the nervous system, potentially causing symptoms like the ones you're experiencing.

    • Diagnosis typically involves a combination of clinical evaluation, blood tests, and sometimes other diagnostic tests. Treatment typically involves medications to manage symptoms and control the body's immune response.

Please note, these are potential explanations based on the symptoms you've described, but they are not exhaustive. It's also possible that your symptoms could be due to a combination of different conditions, or they could be side effects of the medications you're taking.

What you can do

Given the range and severity of your symptoms, it's important to seek medical attention. Here are some steps you can take:

  1. Schedule an appointment with your primary care doctor. They can perform an initial evaluation and may refer you to a specialist, such as a neurologist, rheumatologist, or endocrinologist, for further evaluation and treatment.
  2. Keep a symptom diary. This can help your doctor understand your symptoms and their patterns, which can be helpful in making a diagnosis.
  3. Try to maintain a balanced diet and engage in gentle physical activity, such as walking or stretching, as tolerated. This can help manage symptoms like fatigue and pain.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Sudden worsening of any of your symptoms
  • New symptoms, such as severe headache, sudden weakness or numbness, difficulty speaking or swallowing, or loss of vision
  • Symptoms that interfere with your ability to eat, drink, or sleep

Remember, while I strive to provide accurate and helpful information, I'm an AI and not a doctor. Always consult with a healthcare professional for accurate information.

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9 mo ago


People Also Ask


What could be causing severe fatigue that doesn't improve with rest?

Severe fatigue that doesn't improve with rest could be caused by conditions such as Chronic Fatigue Syndrome (CFS), Multiple Sclerosis (MS), or thyroid disorders. It is important to consult a healthcare professional for a proper diagnosis.


What are phantom sensations and how are they related to neurological conditions?

Phantom sensations are abnormal sensations or pain that occur without an apparent physical cause. They are often associated with neurological conditions like Multiple Sclerosis (MS), where nerve damage can lead to these unusual sensory experiences.


How can tremors in the hands be related to neurological or other disorders?

Tremors in the hands can be related to neurological disorders such as Multiple Sclerosis (MS) or Parkinson's disease, as well as other conditions like hyperthyroidism. A thorough evaluation by a neurologist is recommended to determine the underlying cause.


What steps should be taken if experiencing a combination of symptoms like fatigue, pain, and unusual sensations?

If experiencing a combination of symptoms like fatigue, pain, and unusual sensations, it is important to seek medical attention. Keeping a symptom diary, consulting with a primary care doctor, and possibly seeing specialists such as a neurologist or rheumatologist can help in diagnosing and managing the condition.

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