[48F] Experiencing falls, urinary incontinence, and leg weakness

Patient Description

A 48-year-old female reports a year-long history of dry eyes and blurry vision, described as cloudy with occasional double vision and peripheral flutters, despite using Restasis. She has been experiencing falls for over a year, more frequently in the afternoon or evening, both indoors and outdoors. Urinary incontinence presents as sudden urges or leakage, particularly when driving home or after walking her dog, for which she is on Oxybutinin. She also describes leg weakness, rating it 4 or 5 out of 10, with her thighs shaking after minimal activity, and numbness when squatting. She experienced numbness in her arms and around her mouth, which has improved over the last six months. Her medical history includes Bipolar 1, treated with Lithium, Fluoxetine, Lamictal, Protonix, and Oxybutinin, as well as Black Cohosh and hormone replacement cream for menopause, and multivitamins. She has had an adverse reaction to Wellbutrin and Abilify in the past.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Multiple Sclerosis (MS): A chronic disease that affects the central nervous system, particularly the brain and spinal cord. It can cause a wide range of symptoms, including numbness or weakness in one or more limbs, partial or complete loss of vision, usually in one eye at a time, often with pain during eye movement, double vision or blurring of vision, tingling or pain in parts of your body, electric-shock sensations that occur with certain neck movements, especially bending the neck forward, coordination problems, unsteady gait and falls, and problems with bowel and bladder function.

    • Diagnosis of MS typically involves a neurological examination, MRI, and sometimes a spinal fluid analysis.
    • Treatment of MS typically involves managing symptoms, speeding recovery from attacks, and slowing the progression of the disease.
  • Myasthenia Gravis: A chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs. The name myasthenia gravis, which is Latin and Greek in origin, means "grave, or serious, muscle weakness."

    • Diagnosis of Myasthenia Gravis typically involves a neurological examination, blood tests, and sometimes a single-fiber electromyography (EMG).
    • Treatment of Myasthenia Gravis typically involves medication to help improve neuromuscular transmission and increase muscle strength, and immunosuppressive drugs to control the production of abnormal antibodies.

Please remember that these are just possibilities and not a definitive diagnosis. It's important to consult with a healthcare provider for an accurate diagnosis.

What you can do

  1. Schedule an appointment with your healthcare provider to discuss your symptoms. They may refer you to a neurologist for further evaluation.
  2. Keep a symptom diary. This can help your healthcare provider understand your symptoms and their patterns.
  3. Stay hydrated and maintain a balanced diet. This can help manage your symptoms and improve your overall health.
  4. Try to avoid activities that may exacerbate your symptoms or increase your risk of falling.

What you should look out for

Seek immediate medical attention if you experience:

  • Sudden worsening of your symptoms
  • Difficulty breathing or swallowing
  • Severe weakness that prevents you from performing daily activities
  • New symptoms that concern you

Remember, this advice is intended to be general in nature, and specific causes may need different approaches. Always consult with a healthcare provider for appropriate treatment.

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1 yr ago

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People Also Ask


What are the common symptoms of Multiple Sclerosis (MS)?

Common symptoms of Multiple Sclerosis (MS) include numbness or weakness in limbs, vision problems such as double vision or blurring, tingling or pain in parts of the body, coordination problems, unsteady gait, and issues with bowel and bladder function.


How is Myasthenia Gravis diagnosed?

Myasthenia Gravis is typically diagnosed through a neurological examination, blood tests to detect antibodies, and sometimes a single-fiber electromyography (EMG) to assess the electrical activity between the brain and muscles.


What lifestyle changes can help manage symptoms of neurological disorders?

Lifestyle changes that can help manage symptoms of neurological disorders include maintaining a balanced diet, staying hydrated, keeping a symptom diary, avoiding activities that exacerbate symptoms, and ensuring a safe environment to reduce the risk of falls.


What should I do if I experience sudden worsening of symptoms like difficulty breathing or severe weakness?

If you experience sudden worsening of symptoms such as difficulty breathing, swallowing, or severe weakness, it is important to seek immediate medical attention to address these potentially serious issues.


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