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Q: Possible Neurological problem ( Answered 5 out of 5 stars,   1 Comment )
Subject: Possible Neurological problem
Category: Health > Conditions and Diseases
Asked by: chewy2000-ga
List Price: $25.00
Posted: 19 Feb 2003 19:54 PST
Expires: 21 Mar 2003 19:54 PST
Question ID: 163734
Here's a list of symptoms I'm noticing, I'm also giving the time when
I first began to notice them.  

1 1/2 years ago:
   -began noticing slurred speech, mild stuttering, difficulty
    sentances when speaking, mixing up words when I speak them.
       (examples:  The word on the left is the one I was trying to
say, on the
         right is what came out:  test->taste, grain->bread,
   -I also confuse words in my head, happens many times a day.
       (examples: nothing->nething, white lettering->write lettering,
         seedless grapes->grapeless seeds, 
         Francis-Ford Coppola->Francis Cord Fopola)
   -poor short-term memory
   -I generally feel slower mentally

6 to 8 months ago: 
   -I make many, many more typos when typing on the keyboard.
       (reading->ready, beard->bears, hour->house, fun->fine)
   -when I write my signature, it looks more like a scribble
   -my sense of balance isn't as good as it used to be
   -I've noticed that I dribble extra urine after urinating 
      (will be visiting a urologist on this soon...)

-I am male, in my mid twenties
-got a basic blood test from my family doctor, no problems found.
-A thyroid (TSH) test was done, it's normal.
-A neurologist did some motor-control tests on me, didn't notice
  wrong, except for the balance issue. (which he didn't feel was very
-Got a cat scan of my brain, no problems found.
-Went to a speech therapist, she did notice problems with my speech,
  when I explained my other symptoms, I'm now being refered from one
  speech therapist to another
-I am not depressed or under a great deal of stress.

I'd like to find out what conditions this might be, to help point the
endless doctor referals in the right direction.  The only ones I've
using Google would be maybe Huntingtons Disease (impossible, my
parents don't have it), or late-onset MLD (should have shown something
on the cat scan)

Any help would be greatly appreciated.

Subject: Re: Possible Neurological problem
Answered By: kevinmd-ga on 20 Feb 2003 11:14 PST
Rated:5 out of 5 stars
Hello - thanks for asking your question.

Although I am an internal medicine physician, please see your primary
physician for specific questions regarding any individual cases –
please do not use Google Answers as a substitute for medical advice. 
I will be happy to answer factual medical questions.

Without meeting you or examining you, it is impossible to come up with
a diagnosis.  This information is for education only - you can discuss
this with your personal physician.

When someone as young as you describes neurological symptoms such as
dysarthria or movement disorders, there are a few conditions that come
to mind.  I will briefly discuss them here.

1) Juvenile Parkinson's Disease
PD typically presents in middle and late life. However, early-onset
disease can occur before age 40 years, and a juvenile form presents
before age 20. Most affected children have a rigid, akinetic disorder,
although many have a typical resting tremor.  The diagnosis of
juvenile parkinsonism is based on clinical signs. Patients have
gradual onset of slowness of movement, tremors in the hands or legs
(but not the head), rigidity of muscles, shuffling gait, and postural
instability. Other signs include lack of facial expression
(hypomimia), drooling, dysarthria, and dystonia (involuntary spasms
and abnormal postures of hands and feet).

2) Wilson's Disease
Wilson disease (WD, hepatolenticular degeneration) is a treatable
cause of juvenile parkinsonism, dystonia, and other movement disorders
(1). This rare disorder has an estimated prevalence of 30 per million.

Clinical manifestations of WD are rare before age 6 and almost always
present before the age of 30. Adolescents tend to present with liver
disease, whereas young adults are more likely to present with
neuropsychiatric disease (2). All patients with neuropsychiatric
disease have compensated cirrhosis that often is not detected until
Wilson disease is diagnosed.

From UptoDate:
"Neurologic manifestations are apparent at presentation in 35 to 70
percent of patients (3). In one series, psychiatric symptoms
(including depression, emotional lability, personality change, and
slow mentation) and neurologic symptoms each occurred in approximately
one-third of the patients. The most common neurologic findings at
first evaluation were dysarthria (97 percent), dystonia (65 percent),
dysdiadochokinesia (58 percent), rigidity (52 percent), gait and
postural abnormalities (42 percent), tremor (32 percent), abnormal eye
movements (32 percent), hyperreflexia (29 percent), drooling (23
percent), and bradykinesia (19 percent)." (4)

3) Huntington's Disease
Huntington disease (HD) typically presents during the fourth and fifth
decades of life; however, onset occurs during childhood or adolescence
in approximately 10 percent of affected patients.

Patients with juvenile-onset HD develop dystonia, ataxia, and
seizures. Most of them have the akinetic-rigid syndrome termed the
Westphal variant. Approximately one-fourth have the classic feature of
chorea seen in adults. Children also have more rapidly progressive
disease than adults.

4) Hallervorden-Spatz disease (HSD)
Hallervorden-Spatz disease (HSD), also known as neurodegeneration with
brain iron accumulation type 1, is a rare progressive
neurodegenerative disorder that causes parkinsonism and dystonia in
children. The onset of HSD typically is between 4 and 12 years,
although it may present as parkinsonian dementia in adults.

Children with HSD have posture and gait abnormalities, bradykinesia,
rigidity, and other parkinsonian features, including tremor. Affected
patients also may have hyperkinetic movement disorders, such as
dystonia and choreoathetosis, as well as progressive dysarthria,
dementia, ataxia, spasticity, seizure disorder, optic atrophy, and
retinitis pigmentosa. (4)

5) Multiple Sclerosis
Diseases that affect central nervous system myelin can be categorized
as demyelinating (acquired, inflammatory) and dysmyelinating (abnormal
formation of myelin, usually genetic basis). The most common
autoimmune inflammatory demyelinating disease of the central nervous
system (CNS) is multiple sclerosis (MS).

The clinical features of MS are quite broad.  From UptoDate:
"Gait imbalance, difficulty in performing coordinated actions with the
arms, and slurred speech may occur as a result of impairment of
cerebellar pathways. Physical examination typically reveals dysmetria,
decomposition of complex movements, and hypotonia, most often observed
in the upper extremities . . . Bowel, bladder, and sexual dysfunction
are common in MS. The extent of sphincter and sexual dysfunction often
parallels the degree of motor impairment in the lower extremities. The
most common urinary complaint is urgency, which is usually the result
of uninhibited detrusor contraction due to a suprasegmental lesion.
Urinary incontinence becomes more common as the disease progresses;
with involvement of sacral segments of the spinal cord, symptoms of
bladder hypoactivity may evolve such as decreased urinary flow,
interrupted micturition, and incomplete bladder emptying. An atonic
dilated bladder that empties by overflow results from loss of
perception of bladder fullness and is usually associated with
urethral, anal, and genital hypoesthesia, and sensory deficits in the
sacral dermatomes . . . The most frequent abnormalities are with
abstract conceptualization, recent memory, attention, and speed of
information processing. The degree of cognitive decline correlates
with the severity of cerebral pathology on MRI." (5)

I hope that this helps.  Again, this information is for patient
education only.  I strongly suggest followup with your personal
physician or neurologist.

I can answer the diagnosis and treatments for each of these conditions
in seperate questions.

I stress that this answer is not intended as and does not substitute
for medical advice - please see your personal physician for further
evaluation of your individual case.
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.   
Kevin, M.D. 

Search strategy:  
No internet search engine was used in this answer.  All sources are 
from physician-written and peer-reviewed sources. 
1) Fink, JK, Hedera, P, Brewer, GJ. Hepatolenticular degeneration
(Wilson's disease). Neurologist 1999; 5:171.
2) Saito, T. Presenting symptoms and natural history of Wilson
disease. Eur J Pediatr 1987; 146:261.
3) Steindl, P, Ferenci, P, Dienes, HP, et al. Wilson's disease in
patients presenting with liver disease a diagnostic challenge.
Gastroenterology 1997; 113:212.
4) Jancovic.  Bradykinetic movement disorders.  UptoDate, 2002.
5) Olek.  Epidemiology, risk factors, and clinical features of
multiple sclerosis.  UptoDate, 2002.

Mayo Clinic - Dysarthria

Medline Plus - Speech and Communication Disorders

Medline Plus - Multiple Sclerosis

Request for Answer Clarification by chewy2000-ga on 20 Feb 2003 19:52 PST

Could a very mild stroke be the cause of this?  I haven't found any
information on mini-strokes causing this, and I never remember feeling
the symptoms of a stoke a year ago... A speech therapist speculated on

Clarification of Answer by kevinmd-ga on 20 Feb 2003 20:22 PST
A stroke can certainly give you neurologic deficits, depending on what
areas of the brain it affects.  From UptoDate:
"Vertigo, staggering, diplopia, deafness, crossed symptoms (one side
of the face and other side of the body), bilateral motor and/or
sensory signs, and hemianopsia suggest involvement of the posterior

Abnormalities of language suggest anterior circulation disease, as
does the presence of motor and sensory signs on the same side of the
body." (1)

Embolic or thrombotic strokes are rare for people under age 40.  If a
stroke were to occur in someone in their twenties, it would be likely
secondary to a bleed.

To rule this out, an MRI of the brain and MRA of the neck vessels
would have to be performed.

1) Caplan.  Clinical subtypes of stroke.  UptoDate, 2002.
chewy2000-ga rated this answer:5 out of 5 stars

Subject: Re: Possible Neurological problem
From: dnkgr-ga on 17 Aug 2003 13:20 PDT
You left out the possibility that these symptoms could be related to
Antiphospholipid Syndrome (APS), aka Hughes' Syndrome.  It is a blood
clotting disorder that can cause clots anywhere in the body in the
veins or arteries.  Because he is a young man who may have had a
stroke, he should be tested for the antibodies.  It is a simple and
relatively inexpensive blood test.

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