A 40-Year-Old Man With Dizziness, Confusion, and Neuropathy

A 40-Year-Old Man With Dizziness, Confusion, and Neuropathy

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Amanda Kennedy, MD, MPH; Jeffrey Kaplan, MD; Dianna Quan, MD

January 21, 2020

Editor’s Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 40-year-old man is referred for neurologic evaluation after presenting with peripheral neuropathy. Three years ago, he noted numbness, burning pain, and reduced temperature sensation in his feet. For the past 2 years, he has had dry eyes and dry mouth; urinary retention that requires self-catheterization; gastrointestinal symptoms, including alternating diarrhea and constipation; and nausea. His weight has decreased by 40 lb (18.1 kg) over 12 months. He has noticed decreased sweating.

For several months, he has had frequent syncopal episodes triggered by positional change. In hindsight, he reports intermittent dizziness associated with a “daydreaming” feeling that began 8 years ago; however, these spells were not associated with loss of consciousness. He was also recently diagnosed with Sjögren syndrome.

He reports no chest pain, palpitations, shortness of breath, or edema. A review of systems is otherwise unremarkable. His past medical history is notable for hypothyroidism. His family history is notable for a grandfather who had gastrointestinal problems and a sister who has palpitations. His parents are alive and have no neurologic symptoms. He takes no medications or supplements.

Medscape © 2020 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Amanda Kennedy, Jeffrey Kaplan, Dianna Quan. A 40-Year-Old Man With Dizziness, Confusion, and Neuropathy – Medscape – Jan 21, 2020.

Adult Neurology Resident, University of Colorado School of Medicine, Boulder, Colorado

Disclosure: Amanda Kennedy, MD, MPH, has disclosed no relevant financial relationships.

Associate Professor of Pathology, University of Colorado School of Medicine, Boulder, Colorado

Disclosure: Jeffrey Kaplan, MD, has disclosed no relevant financial relationships.

Professor of Neurology, University of Colorado School of Medicine, Boulder, Colorado

Disclosure: Dianna Quan, MD, has disclosed no relevant financial relationships.

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A 40-Year-Old Man With Dizziness, Confusion, and Neuropathy

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Nerve Pain Explained

Nerve Pain Explained

People with nerve pain feel it in different ways. For some, it’s a stabbing pain in the middle of the night. For others, symptoms can include a chronic prickling, tingling, or burning they feel all day.

Uncontrolled nerve pain can be hard to bear. But with treatment, it can often be adequately controlled.

 

Pain is supposed to be a warning. When your hand gets too close to a stove, the nerves send a pain signal to the brain — and you pull back before you burn yourself. But if you have nerve damage, that system isn’t working. Damaged nerves may send false signals — and you feel real pain, often without a cause. Damaged nerves may also result in you not feeling pain when you have an injury.

Some find that certain body positions or activities — like standing in line or walking — become painful. Nerve damage may also make your body overly sensitive. Some people may experience pain from bed sheets draped lightly over the body.

Nerve damage may cause loss of sensation or numbness in the fingertips, making it harder to do things with your hands. Knitting, typing, and tying your shoes may become difficult. Many people with nerve damage say that their sense of touch feels dulled, as if they are always wearing gloves.

Nerve pain is often worse at night. The touch of sheets or the pressure of lying down may be terribly uncomfortable. If you can’t sleep because of your nerve pain, make sure to mention it to your doctor. Modifying lifestyle habits or taking medicine could help.

In addition to dulling your sense of touch, nerve damage can result in muscle weakness or affect your sense of balance. Either of these could lead to falls.  Assistive devices — like braces, canes or walkers — may help. Physical and occupational therapy may also help.

Nerve damage doesn’t just cause pain. It may also cause numbness that may prevent you from feeling pain when it matters. People with nerve damage sometimes injure themselves without realizing it. Your doctor may recommend that you check yourself for injuries regularly — especially your feet.

Left untreated, nerve damage may worsen over time. It usually starts in the nerves farthest from the brain and spinal cord — like those in the feet and hands. Then it may move up into the legs and arms.

However, if you get treatment for the medical condition causing the nerve damage, you may be able to stop the damage — and even reverse it.

In many cases, nerve pain may be controlled. Start by getting an assessment at the doctor’s office. Be ready to answer questions. How long have you had pain? What does it feel like? How does it affect you? The answers will help your doctor figure out what’s causing your pain and how to treat it.

Many conditions — such as diabetes, shingles, and cancer — may cause injury and nerve pain. Some people develop nerve pain for no known reason.

It is important to try to find the underlying cause of your nerve pain, such as uncontrolled diabetes, and seek appropriate treatment for it. It may help ease your pain and stop the progression of damage. But be sure you seek treatment for your pain too.

Over-the-counter painkillers may be the first treatment your doctor recommends. These may include nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen — or other analgesics, such as acetaminophen or prescription medicines. Other options include painkilling creams, ointments, oils, gels, or sprays that are used on the skin.

There are many prescription medicines that may help with nerve pain. Some are powerful painkillers. Other drug types might help too. Medicines originally used for depression and epilepsy are often prescribed to relieve nerve pain.

Complementary or alternative treatments may help. For instance, studies have found that acupuncture may ease nerve pain. In some cases, nerve pain is caused or aggravated by a deficiency of vitamin B-12. Taking supplements — under your doctor’s care — could help.

In addition to working with your doctor to find treatment that works, you can take other steps to fight chronic pain. Getting regular exercise, keeping a healthy weight, and improving your diet may help.

Sources
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Medically Reviewed on 12/6/2016

Reviewed by Carol

DerSarkissian on December 06, 2016

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SOURCES:

American Academy of Family Physicians: “Diabetic Neuropathy.”
National Institute of Neurologic Disorders and Stroke: “Peripheral Neuropathy Fact Sheet.”
National Pain Foundation: “Using Complementary Therapy.”
Medscape Reference: “Nutritional Neuropathy.”
PDR Health: “Peripheral Neuropathy Treatment.”

Reviewed by Carol

DerSarkissian on December 06, 2016

This tool does not provide medical advice. See additional information.

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Nerve Pain Explained

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