Q. I am a 35 and have been experiencing shakiness in my hands, tingling in my left leg, minor vision disturbances, periodic minor dizziness, and I also seem to have a little trouble saying what I mean to say. This started a few months ago and none of the problems are major, but I am concerned that they may get worse. What could they indicate?

A. You have several neurologic symptoms. They are suggestive of a type of nervous system disorder or possibly a metabolism disorder. Disorders such as diabetes, thyroid disease or B-12 deficiency can cause these symptoms, as could multiple sclerosis. I think it is very important you see an internist for a thorough history, physical exam and lab studies. You may also need an MRI. If the internist cannot determine the cause, your next step should be seeing a neurologist. I also would suggest seeing an ophthalmologist for an eye exam. I hope this helps.

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