Dr. Aida Abaz Quka
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am 29 years old. What would be the specific symptoms of alcoholic neuropathy? I am having some nerve issues, they conducted two separate neurological exams (no conductivity testing just the general exam) but the neurologist did not find anything abnormal. I am a mild to moderate drinker and have been drinking for about six years. I do not binge drink or drink more than a glass or two of alcohol every other day or so. I eat very healthful and work out. I have had all sorts of bloodwork and nothing has come up (Ac1, B12, thyroid, etc.). My magnetic resonance imaging (MRI) is scheduled in five weeks to rule anything else out. Doctor says my symptoms are anxiety but want to make sure. Symptoms include some weakness in my hands when I wake up, tremors at night, feelings that have changed over time in my feet. No official pins or needles, just some general "strange" feelings in my feet that come and go and change from foot to foot. I only had a feeling of burning in my feet twice. Sometimes there is a region that feels like there is something in my shoe. This has all come up in the past two months. Would alcoholic neuropathy take longer? Will it have more consistent symptoms? Will it show up on a neuro exam? The neurologist insists that I do not need conductivity testing. I just want to rule out alcohol before I drink anything again. It seems like from the literature I have read that alcoholic neuropathy develops after a lot of drinking and poor nutrition. And it seems to be pain that is constant that develops first. Is it true? I am currently taking Spironolactone, Yaz, and Urex.
Hello,
Welcome to icliniq.com. I read carefully your question and would explain that your symptoms are not typical of alcoholic neuropathy. Anyway, tremor is very common after years of alcohol intake. I would first recommend checking vitamin B1 plasma levels and vitamin D plasma levels for possible deficiency. I agree with your neurologist, on the fact that when reflexes are present we can exclude peripheral neuropathy. But sometimes, single-fiber EMG (electromyography) would give more information on possible small fiber neuropathy. In the meantime, I would recommend taking magnesium supplements in order to help to improve your situation. You should discuss it with your doctor on the above tests.
Patient's Query
Thank you doctor,
My vitamin D levels were normal and I supplement with B vitamins (they did not test for B1 but I eat healthily and supplement so should be fine?). Yes, all my reflexes, etc., are normal. I think the magnetic resonance imaging (MRI) is just to rule out say something like MS. But I do not have any other symptoms of that. I did take Macrobid when this all started and Macrobid does have reports of neuropathy. But I took it for only three days and have taken many times before for urinary tract infection (UTIs) without a problem. I mentioned conductivity testing to my doctor but he said he did not agree with the need for it. I assume that is because he is very confident about my exam is normal. He has referred me to a psychologist for anxiety medication which is fine. I just do not want to drink and do any further damage, but it does seem alcohol would be unlikely unless I am very unlucky.
Hello,
Welcome back to icliniq.com. I think anxiety is playing an important role in this clinical situation. For this reason, anxiety medication will help improve your situation. A brain MRI (magnetic resonance imaging) would help exclude MS (multiple sclerosis) or brain atrophy. But I do not think that it is an urgent situation, as your symptoms are really not very concrete or suggestive of MS. I recommend trying magnesium supplements too. A healthy diet (rich in vitamins and proteins) and regular physical activity are helpful too.
Patient's Query
Hello doctor,
I want to go ahead and ask a couple more follow-up questions, if possible, as I appreciate your help so far. My follow-up questions are: 1. I understand that anxiety can play a role in my symptoms, especially the shaking in my sleep or being tense in my sleep, even some funny feelings that come and go in my extremities. In the last two months since this started, I have had times when my toes feel burning, or I have a "buzzing" in my foot that feels like a phone going on and off. Occasionally one part of my foot will feel weird. But all these things seem to come and go. For the last two days, for example, nonstop, I feel like I have something in my shoe right in the center of my arch, but nothing is there. It is really annoying. It is not where Morton's neuroma is usually located, but it does not feel like anything I have ever had. These do not seem like traditional anxiety symptoms. Maybe it is more that I am overly sensitized now and feeling strange things. 2. I do not think I have been exposed to anything that would cause these symptoms, and I mentioned that to my doctor. He seemed unconcerned. I assume this because toxic exposures must usually come with multiple symptoms or symptoms that are more consistent in the nervous system.
Hello,
Welcome back to icliniq.com. The discomfort in your feet during the night could be related to restless leg syndrome. For this reason, I recommend checking iron plasma levels for possible deficiency. Regarding the toxic substances you may have been exposed to, I would not exclude this possibility, but they usually lead to skin and lung disorders before leading to neurological problems. Symptoms of neuropathy are: 1. Loss of sensation in the form of socks on the legs and gloves on the hands. 2. Reflexes are diminished or absent. 3. There is persistent tingling, burning sensation, and numbness in the feet and hands.
Patient's Query
Hello doctor,
1. Regarding the chemicals, none of my coworkers have any symptoms, and we all work in the same environment, and with the same things, so I assume that is a good sign. Heavy metals and organic solvents are mainly the big offenders for neuro stuff. I do not really work with solvents or heavy metals; any exposure would have been minimal. We also have good ventilation in our storage room and labs, so even if a volatile compound were leaking, it would not linger long. 2. The rest of the neuropathy symptoms seem like things I do not have. According to the neurologist, I have had some weird sensations but no pins and needles, and all my neuro tests were fine. Could that feeling as well be from anxiety? I keep not trusting the "anxiety diagnosis" because my symptoms seem odd, but maybe that is because I am not familiar with what physical symptoms anxiety can cause.
Hello,
Welcome back to icliniq.com. Here are my answers to your questions: 1. As long as you have good ventilation and no one of your coworkers has any symptoms, I do not think you should worry about it, as it is less likely. 2. As your symptoms fluctuate, I think that anxiety plays a vital role in this clinical situation, and you should try to focus on it. Yoga and magnesium supplements can help in this regard. However, as your symptoms are not typical of neuropathy, you should try not to think about it. 3. Regarding neuropathy, it does not fluctuate, and it usually progresses very slowly ( months, years). As you are taking vitamin B supplements and have stopped alcohol, you should not worry about it. A rapid progression would be exceptional, and you would not be able to walk. So, I do not think that there is any progression. On the other hand, slightly damaged nerves can regenerate with time. So there is no reason to panic.
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