I am a 30 year old male in relatively good physical shape. I have had no
previous health problems to speak of except some minor sinusitis. This
March 1998 I contracted Hepatitis A from a workplace cafeteria and did not
recover until the Middle of April. This was the first major ailment
(barring childhood Mono, Chicken Pox, flu, etc.) that I had contracted
during my life. Upon recovery I felt almost completely normal, returning to
my normal eating and work-out routines. I gained back the weight I had lost
(to 165 lbs) and quit drinking Alcohol altogether. I have never smoked.
On December 3, 1998 I noticed some difficulty typing on my PC. My thumbs
were shaking slightly and my hands were stiff and sore. At first I thought
it was probably just due to the large amount of work I had been doing
lately, but then I noticed some shakiness in my shoulders, arms, and legs
when I moved or lifted anything. I also noticed a slight resting tremor in
both thumbs and later in other fingers on both hands. The Cogwheel
shakiness was most noticeable in my shoulders when I moved or shrugged them
and in certain neck movements. Lifting my legs also precipitated some
shakiness and non-smooth muscle contractions.
On December 5 I went to the gym and noticed slight shakiness, but overall
had normal stamina and strength. I had no signs of an infection of any kind
before these symptoms presented themselves. The only possible sign of an
infection was a slight sore throat the weekend before.
The following are the symptoms that were first observed (starting Dec. 3)
ï‚· Tension in neck, shoulders and legs, accompanied by shaky, cogwheel muscle
movement. The shakiness and tension reminded me of what happens after
drinking lots of coffee and feeling tense and shaky. This tension “wiredâ€
me and I felt on edge and restless.
ï‚· Fatigue and stiffness in hands. Typing became difficult and hand strength
seemed diminished. Hands become swollen after too much activity.
ï‚· Slight twitching in lips
 “Shivering†spells where my body would shiver with much more vigorous
muscle contractions than normal (mostly in legs, torso and arms). These
episodes were usually triggered by a small chill, but some were spontaneous
(e.g. in bed while sleeping, nerves would come alive and muscles would start
to shiver). I was able to calm these episodes by warming up and taking
deep breaths to calm down.
ï‚· Sporadic muscle spasms
ï‚· Slight dizziness
ï‚· Facial tension
ï‚· Tingling in hands and feet, especially after working with my hands, or
after sleeping
ï‚· Overall anxiety due to mysterious symptoms
I scheduled an appointment with my Primary Care Doctor 7 days later (Dec 11)
and he performed a standard reflex/neurological exam on me accompanied by
CBC, ANA, CPK and SED rate blood screens. All turned out normal except the
CPK test which was elevated to 411 (normal range is 38 – 174). My weight
had also dropped about 10 lbs below my normal (from 165 to ~155 lbs).
On Dec 21 I was refered to a neurologist who performed another neurological
exam on me with no alarming reflex/neurologic findings. I demonstrated the
cogwheel shakiness in my hands arms and shoulders and mentioned my tense,
‘wired’ symptoms. He ordered tests for Thyroid, Parathyroid and
Hypocalcemia conditions, but all of these conditions were ruled out after
thyroid hormone, parathyroid hormone, magnesium, phosphorus and calcium
levels were all confirmed normal. My CPK was also re-drawn and determined
to be 214 – lower than the previous 411, but still slightly elevated. My
weight dropped to 150; 15 lbs below my normal weight of 165. He also
performed a nerve conduction study to see if my hand fatigue was related to
carpel tunnel. These studies showed very good nerve conduction.
On Dec 23, I worked out again (per OK from neurologist), hoping to increase
muscle mass and regain some weight. During this workout I noticed a
significant reduction in strength with much more shakiness and the need to
take more rests throughout. Immediately afterwards, I noticed that my thumb
and index fingers were twitching quite vigorously. I bought some weight
gain powder to try and augment my diet with additional calories and Protein.
The day after my workout (Christmas Eve), I was completely exhausted and
weak. I found it uncomfortable to stay standing for any length of time and
had to lay down often to regain energy. This weakness was primarily felt in
the legs, but was also felt greatly in my hands and arms as well. The
weakness continued for about 5 days with little improvement. It seemed that
every muscle group that I had worked on December 24, was greatly weakened
with no evidence of muscle re-building. I also started experiencing more
light headedness and what felt like slight pressure or tension on my
forehead, temples, behind the ears and the back of my head and neck. I also
had some slight nausea. With these symptoms, an MRI was ordered (Head,
Neck and Cervical Spine), but the results showed no abnormal tumors, lesions
or Myelin breakdown evidence. A Third CPK blood screen was also performed
(Dec. 29) and was recorded at 107, which was within normal limits. A lyme
disease test also came back negative.
In addition to the weakness, It was also more difficult to chew food (jaw
seemed to tire easily), and I had some facial fatigue that felt like I had
been smiling for hours. The wired, tense feeling and shivering episodes
seemed to subside with the onset of the weakness, however the cogwheel
shakiness of all limbs continued just as it had done for the 3 weeks before.
I concentrated on maintaining my weight and have so far been successful at
maintaining my weight at 150 lbs for the last week.
As of today (January 2, 1999) I have regained a small amount of strength,
but my legs are still very weak. I am afraid to work any part of my body
for fear of weakening myself any further. I am even refraining from doing
any hand strengthening exercises for fear of further damaging my hands.
Head and facial tension/fatigue seems to have subsided, but the cogwheel
shakiness seems more prevalent than ever. Overall neck and leg tension (and
semi-wired feeling) seems to be slowly coming back. My hands continue to be
very weak and fatigued. My primary care doctor and neurologist are both
stumped and the next step is a CT Scan of my abdomen to make sure that I don
’t have any Adrenal Gland abnormalities or any other surprises. The
following diseases have evidently been ruled out.
 Meningitis – Per neurological exam - No Brudzinki’s sign or Kernig’s sign
 Myelitis – Per neurological exam
 Encephalitis – No fever or brain inflammation
 Brain Tumor/Spinal Cord Neoplasm – Per MRI results
 MS – Per MRI results
 Peripheral Neuritis – Deep tendon reflexes in tact
 ALS (Lou Gehrig’s disease) – Per neurological exam and lack of
fasciculations
 Guillain-Barre’ – Per neurological exam – reflexes in tact
 Myasthenia Gravis – Per neurological exam (? Not sure)
 Wilson’s disease – no Kayser-Fleischer ring
My question is whether there is any explicable answer to these conditions
and what the probability that these symptoms are from a viral infection
which would not present itself in any standard way (e.g. fever, respiratory
infection, etc.)? Could this be a non-neurological condition possibly from
another chemical or hormonal imbalance? Due to the rapid onset of symptoms
I have also considered Heavy Metal Poisoning and or other poisoning as a
possibility, but have no idea where I might have been exposed to high levels
of such toxins. I am also wondering if these symptoms might represent the
onset of a rare variant of Parkinson’s disease which may strike younger
adults (note that Wilson’s disease is probably not it).
Any help with this or relation to any similar symptoms would be greatly
appreciated!
