[33F] With multiple neurological and systemic symptoms
Patient Description
A 33-year-old female presents with a variety of symptoms, including right hand weakness and tremor that has been ongoing for about a year but has worsened in the last 24 hours. The weakness is particularly noticeable when trying to grab or grip things or make a fist. Minor tingling in both hands is noted when running them under water, but not consistently. Fatigue is present, worsened by heat, which also causes drowsiness, headaches, and issues with vision and balance. Constipation began 2-3 days ago, with a bowel movement today that was hard/firm and consisted of small round pellets. This type of constipation typically happens 1-2 times a month and lasts less than a week. Irritability has been more pronounced over the past week, causing tension in interactions, particularly with her husband. Tinnitus, described as a high-pitched ringing in both ears, has been present for 6-8 months, with fluctuating severity, currently severe. No head injuries or exposure to loud noises are reported. Headaches have been occurring for several years, varying in nature—sometimes sharp and stabbing, other times dull, throbbing, or tension-like, with severity reaching 8 or 9 on a scale of 1-10. Vision issues like blurriness and black floaters are noted, particularly with severe headaches or heat exposure. Eye pressure comes and goes, with the most recent episode being less than 24 hours ago. Knee stiffness has been an on-and-off issue for 4-5 years, with occasional shakiness and buckling, leading to feelings of unbalance and uncoordination. The patient has a history of overactive bladder, migraines, hiatal hernia, kidney stones, high cholesterol, anxiety, and ADHD. Allergies include ciprofloxacin, and prednisone causes irritability, bloating, and excessive appetite. Current medications include Adderall XR, Sprintec (oral birth control), Trazodone for sleep as needed, Excedrin for headaches as needed, vitamin D3 daily, biotin gummies daily, and multivitamin gummies daily.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, here are some possible explanations:
Right Hand Weakness and Tremor
- Essential Tremor: This is a common neurological disorder that can cause tremors, especially when using the affected hand. It can worsen over time.
- Carpal Tunnel Syndrome: This condition can cause weakness, tingling, and tremors in the hand due to compression of the median nerve.
- Multiple Sclerosis (MS): Given your concern and upcoming neurology appointment, MS could be a possibility. It can cause a variety of neurological symptoms, including weakness and tremors.
Fatigue, Headaches, and Eye Pressure
- Migraine: Your history of migraines could explain the headaches, eye pressure, and vision issues. Migraines can also cause fatigue.
- Heat Sensitivity: This could be related to your migraines or another underlying condition like MS, which can cause symptoms to worsen with heat.
Constipation
- Dietary Factors: Changes in diet or fluid intake can cause constipation.
- Medications: Some medications, including those for ADHD, can cause constipation as a side effect.
Irritability
- Anxiety and ADHD: Both conditions can contribute to irritability, especially if stress levels are high.
- Hormonal Changes: Fluctuations in hormones can also cause mood changes and irritability.
Tinnitus
- Hearing Loss: Tinnitus is often associated with some degree of hearing loss.
- Neurological Conditions: Conditions like MS can also cause tinnitus.
Knee Stiffness
- Osteoarthritis: This is a common cause of knee stiffness, especially if it has been ongoing for several years.
- Muscle Weakness: Weakness in the muscles around the knee can contribute to instability and stiffness.
What you can do
Right Hand Weakness and Tremor
- See a Neurologist: Your upcoming appointment is crucial. They may perform tests like an MRI or nerve conduction studies.
- Physical Therapy: This can help improve strength and coordination in your hand.
- Avoid Strain: Try to avoid activities that exacerbate the weakness and tremor.
Fatigue, Headaches, and Eye Pressure
- Stay Cool: Avoid heat and humidity as much as possible. Use fans or air conditioning to stay cool.
- Hydrate: Drink plenty of water, especially in hot weather.
- Migraine Management: Continue using Excedrin as needed and discuss other migraine management strategies with your doctor.
Constipation
- Increase Fiber: Eat more fruits, vegetables, and whole grains.
- Stay Hydrated: Drink plenty of water throughout the day.
- Exercise: Regular physical activity can help improve bowel movements.
Irritability
- Mindfulness and Relaxation: Practice mindfulness, meditation, or other relaxation techniques.
- Counseling: Consider talking to a mental health professional to help manage anxiety and ADHD symptoms.
Tinnitus
- White Noise: Use a white noise machine or fan to help mask the ringing.
- Hearing Check: Consider seeing an audiologist for a hearing test.
Knee Stiffness
- Strengthening Exercises: Focus on exercises that strengthen the muscles around your knee.
- Avoid Overuse: Try to avoid activities that put excessive strain on your knees.
What you should look out for
Given the complexity and severity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care more urgently include:
- Sudden Worsening of Symptoms: If any of your symptoms suddenly worsen, seek immediate medical attention.
- New Neurological Symptoms: If you experience new symptoms like vision changes, severe dizziness, or difficulty speaking, seek care immediately.
- Severe Pain: If your headaches or any other pain becomes unbearable, seek medical help.
Remember, while I can provide guidance, it's essential to consult with healthcare professionals for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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