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Q. I started feeling tired and nauseous after Trigger point injections. Kindly help me.

Answered by
Dr. Hitesh Kumar
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Aug 17, 2021

Hi doctor,

I need an EEG Report explained. I have been feeling tired and nauseous when I exercise, not sleeping well. I was given trigger point injections three months ago. It made me feel worse. I was given a 72-hour ambulatory EEG. I have the report, and I do not know what the results mean because it is written using medical terms. I had several laboratory tests and an MRI of the spine done. Everything is normal. I have this for the past eight months. Kindly give your opinion.

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#

Hello,

Welcome to icliniq.com.

I would also like to know some more details about your symptoms:

1) Since when you started to have symptoms?

2) What were the exact symptoms (apart from feeling tired and not sleeping well)? Please describe in detail.

3) Had any loss of consciousness?

4) Any episodes of unawareness from surroundings?

5) Any seizures or fits or jerks in body parts?

6) What you mean by trigger points? Please describe.

7) Which injections you received?

8) Does some abnormal body activities happen during sleep?

9) Have you had any neck or back pain?

10) Any pain or tingling or numbness or weakness in arms or hands?

Other information:

1) How is your sleep routine? Do you get sleepy soon after lying in bed, or it takes a long time? Once got sleepy, do you have frequent awakenings during sleep? Do you feel fresh on awakening from sleep in the morning?

2) How is your usual mood in day-to-day activities? Happy or toward the sad side (thinking about past events) or toward the worried side (thinking about future things or irritable or something else)?

3) How is your appetite?

The EEG (electroencephalogram) finding description mentioned are of normal patterns in awake and sleep. No abnormal finding was mentioned in the description (attachments removed to protect the patient's identity).

But in EEG's final impression, they mentioned L (left) > R (right) temporal lobe epileptogenic activity. Such epileptogenic activity can be found in patients having seizures or fits, though occasional such activities can be found in normal individuals also. EEG alone is never diagnostic. It is a must to correlated with clinical symptoms and signs.

In NCV (nerve conduction velocity) and EMG (electromyography) conclusion, they mentioned the possibility of some nerve compression in the spine at the level of C4-C5, C5-C6, C6-C7 in the neck with mild affection in two nerves of arms (median nerve and ulnar nerves) and the possibility of some nerve compression in the spine at the level of L5-S1 in the lower back.

Same way, NCV findings also need to be correlated clinically. Alone, NCV does not make a final diagnosis.

Kindly answer the questions for further help and management.


Hi doctor,

Thank you.

My neurologist quit the medical facility. I have had EKG, MRI of brain and neck and back, numerous blood tests, CAT scans, chest X-rays, and all were normal other than very low Vitamin D level (27). Had heart doctor do a lot of tests, all normal I attached the neurologist assessment.

I do not know what to do to feel better. As a preface, when I was 3-year-old, I was diagnosed with dyspraxia. I have a stereotype of head swaying and was diagnosed with hypotonia. Over the years, I have grown out of these disorders, except occasionally, I may sway my head back and forth, but it would be for a very short period of time and may occur when I am bored not doing too much. I also had giardia at the same time and was not diagnosed until a year and a half later.

1) I started having symptoms 11 months ago, was very healthy, worked out every day with weights, and played basketball.

2) I had no seizures or fitted ever in my life. Exact symptoms began as extreme fatigue, trouble sleeping, lightheadedness and worse when I exercised, muscle pains, and some pains in the neck and chest.

3) I was given Trigger point injections by neurologist four months ago. Location was bilateral trapezius, bilateral cervical paraspinal muscles, and sternocleidomastoid.

4) Injections were three syringes, each one of Lidocaine 1% 4 ml, mixed with Kenalog 40 mg/ml, 1 ml were injected into each trigger point. After these injections, until today still, I am sweating almost every day and nauseated.

5) No abnormalities when sleeping other than I do not sleep well and keep waking up.

6) I have neck and back pain. It was bad at first, and physical therapy was helping.

7) I just have tightness in my biceps, that is it.

I usually fall asleep quickly because I work all day. After four or five hours, I wake up and cannot go back to sleep. I am usually happy but very annoyed because I do not have as much energy as I used to. I am 18-year-old. I eat a lot of food because I always feel hungry and lack energy, so I feel I need to eat.

Kindly help me.

#

Hello,

Welcome back to icliniq.com.

As per your description and with no significant abnormality in MRI (magnetic resonance imaging), cervical spine and LS spine (lumbar spine) and attached electrophysiological study (attachments removed to protect the patient's identity), there may be the possibility of:

1) Fibromyalgia.

2) Chronic fatigue syndrome.

3) Associated depression or other psychiatric ailments.

4) Connective tissue disorder.

Among these, we can try to get some blood investigations for the search of connective tissue disorder. But for the remaining possibilities, no specific blood or other tests available. That is judged by clinical means only.

The tests that can be done are ANA (anti-nuclear antibody) in IFA (indirect immunofluorescence) method, c-ANCA (antineutrophil cytoplasmic autoantibody, cytoplasmic), p-ANCA (peripheral antineutrophil cytoplasmic antibodies), ENA profile (extractable nuclear antigen antibodies), ESR (erythrocyte sedimentation rate), T3, T4, and TSH (thyroid-stimulating hormone).

For management, try physiotherapy or mediation and daily exercises (jogging 20 to 30 minutes in the morning). For medications, I would suggest you discuss neurologist physically.

I hope this was helpful.



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