[40F] With neurological and musculoskeletal symptoms

Patient Description

A 40-year-old female has been experiencing a range of symptoms for approximately one year. The symptoms include a feeling of heaviness in the eyes, episodes of paralysis triggered by strong emotions, and a tingling sensation that feels different from typical pins and needles. The patient reports shoulder pain that began under the scapula, worsening with deep breaths, and has been persistent. Two months ago, the patient experienced excruciating pain in the left shoulder, followed by different pain in the right arm. Three weeks ago, the patient had a seizure-like episode, resulting in extreme lethargy and loss of strength in the left arm. Additionally, there is numbness in the right shoulder, affecting the ability to lift with the left arm and reach with the right arm. The patient has chronic high blood pressure but no known history of neurological conditions, substance use, or recent travel. The patient is currently taking Suboxone and reports no other medications or allergies.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations for what you might be experiencing. It's important to consult with a healthcare professional for a formal diagnosis, but here are some possibilities:

  1. Neurological Conditions: The combination of paralysis, tingling, and seizure-like episodes could suggest a neurological condition such as multiple sclerosis or another disorder affecting the nervous system. These conditions can cause a wide range of symptoms, including muscle weakness, numbness, and changes in sensation.

  2. Musculoskeletal Issues: The shoulder pain and numbness, along with the inability to lift or reach with your arms, might be related to musculoskeletal issues such as a rotator cuff injury or nerve impingement. These conditions can cause pain, weakness, and limited range of motion.

  3. Psychosomatic Factors: Sometimes, physical symptoms can be influenced by emotional or psychological factors. The paralysis occurring with strong emotions might suggest a psychosomatic component, where stress or anxiety manifests as physical symptoms.

What you can do

Neurological Concerns:

  • It's crucial to see a neurologist or your primary care doctor for a thorough evaluation. They may recommend imaging tests like an MRI or CT scan, as well as blood tests or a neurological exam to assess your symptoms.

Musculoskeletal Issues:

  • Consider seeing an orthopedic specialist or a physical therapist for an assessment of your shoulder and arm pain. They can provide exercises or treatments to help improve your range of motion and reduce pain.
  • At home, you can try gentle stretching exercises and apply ice or heat to the affected areas to alleviate discomfort.

General Health:

  • Keep a journal of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be valuable for your healthcare provider.
  • Use MDandMe to track your symptoms, get insights, and share your medical notes with your provider.

What you should look out for

While your symptoms are concerning, it's important to seek medical attention if you experience any of the following:

  • Sudden or severe worsening of symptoms
  • New or worsening paralysis or weakness
  • Difficulty speaking, swallowing, or breathing
  • Loss of consciousness or severe confusion

Remember, this information is not a substitute for professional medical advice. Please consult with a healthcare provider for a comprehensive evaluation and appropriate treatment.

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1 mo ago

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People Also Ask

What could cause episodes of paralysis triggered by strong emotions?

Episodes of paralysis triggered by strong emotions could be related to a condition known as cataplexy, which is often associated with narcolepsy. It can also be a psychosomatic response where emotional stress manifests physically. Consulting a neurologist is important for proper diagnosis.

How can shoulder pain that worsens with deep breaths be managed?

Shoulder pain that worsens with deep breaths could be due to musculoskeletal issues such as a rotator cuff injury or nerve impingement. Management may include physical therapy, pain relief medications, and exercises to improve range of motion. Consulting an orthopedic specialist is recommended.

What are potential causes of seizure-like episodes in someone with no known neurological history?

Seizure-like episodes in someone with no known neurological history could be due to various factors, including stress, metabolic imbalances, or an undiagnosed neurological condition. A thorough evaluation by a neurologist, including imaging and blood tests, is necessary to determine the cause.

How can chronic high blood pressure affect neurological symptoms?

Chronic high blood pressure can lead to complications such as stroke or transient ischemic attacks, which may present with neurological symptoms like weakness or numbness. Managing blood pressure through lifestyle changes and medication is crucial to reduce the risk of such events.

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