IUBio

Sudden Onset of Cogwheel shakiness - Viral???

F. Frank LeFever flefever at ix.netcom.com
Tue Jan 5 23:07:35 EST 1999


Caught me with my references misplaced, and it's too late and I'm too
tired to figure out where they are  (had brought home a file of some of
my papers overy the past several years, for just such emergencies!)

HOWEVER (pending my posting exact citations): my paper at the Society
for Neuroscience (November. in LA) cited and used as a model a paradigm
using an animal model of Parkinsonism--6-OH-dopamine lesions
compensated for until basal ganglia compensation overcome by huge
demand due to stress (several kinds of stress used), wheupon motoric
deficits emerged.  Abigail Snyder and--??, in Neurology, c. 1986.

Update: Zalcman et al. (n.b. long ago, he participated  in this
newsgroup, gave up in disgust, I guess) showed that IL-1 acted like a
stressor in prefrontal-accumbens-caudate region, even at levels not
sufficient to engage HPA axis and elevate plasma cortisol.

Conceivably, with a pre-existing vulnerability, infection (causing
increased production of IL-1) could elicit latent basal ganglia
disorders.

SUBSEQUENTLY, I had the good experience to hear (Susan?) Swedo at the
Assoc for Res in Nerv & Ment Dis annual meeting (NYC, December): after
original illness, recurring challenges (strep throat?) caused
exacerbation of OCD and/or Tourette's thype symptoms.

Sorry for vagueness.  Will try to get exact citations later.

(If you FAX request to me at work, might help: 914-786-4978)

F. Frank LeFever, Ph.D.
New York Neuropsychology Group






In <76ppvh$9g6$1 at camel0.mindspring.com> "Gavin Roberts"
<mgroberts at mindspring.com> writes: 
>
>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
“wired”
>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!
>
>
>
>




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