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Undiagnosed Symptoms (Expert Forum)
Brain Lesions
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
Questions in the Undiagnosed Symptoms forum are answered by Dr. Kevin Pho. Topics covered include breathing difficulties, feeling cold, cough, diarrhea, dizziness, fainting, fever, indigestion, itching, nausea, numbness, pain (chronic), paralysis, rash, sweating, swelling, urination problems, and vomiting.
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Brain Lesions
by dittledittle, Mar 26, 2007 12:00AM
51 yr. old female. In 2000 I got iritis and during treatment started getting flu-like symptoms, low back pain/stiffness & severe diarrhea. Blood work for Lupus, Sarcoidosis, etc.-all negative. Had colonoscopy, found lesions and diagnosed with Ulcerative Colitis, started on Sulfasalazine. Tested for HLAB27 positive spondylitis and sent to Rheumatologist. Rheumatologist said my symptoms and blood tests do not correlate to any rheumatologic disease.In 2002 got daily headaches and sent to Neurologist who found brain lesions and incidental brain cyst in anterior right temporal lobe. Symptoms were balance problems,leg weakness,right arm weakness,low back pain & frequent urinating. Hypoactive reflexes/normal blood pressure range. Radiologist report said MS. Went to a MS Neurologist who started me on Solumedrol treatments & Betaseron, Neurotin, calcium. Told could be progressive MS due to my age. 2 yrs. ago got optic neuritis and started having muscle spasms, short term memory difficulties & arthritis. I have had numerous repeats of optic neuritis and Doctor found that none of the MS drugs work for me. Neuro doesn’t think I have MS, says brain lesions are not in typical areas. I’ve had blood tests for B12, Lupus, Sarcoidosis, Lyme, Wegners, Parkinson's,etc. & normal chest X-ray. Repeats tests, all negative. I have some neurofibromas just under the skin on my arms since 1980 and have started to get new ones. CNS slowed nerve conduction in right leg. My spinal fluid analysis was normal,no oligoclonal bands. There are multiple small foci of bright FLAIR signal in the subcortical white matter of both hemispheres in a relatively symmetric distribution. Posterior fossa is unremarkable, no abnormal enhancement is present post gadolinium. No mass effect or midline shift,no extra-axial mass or fluid collection demonstrated. Paranasal sinuses & the temporal bones appear normally aerated. Original brain lesions do not go away, getting more new ones, too many to say normal aging. What do you think diagnosis could be? Or testing for?
Doctor's Answer
by Kevin Pho, MD, Mar 26, 2007 12:00AM
, Mar 26, 2007 12:00AM
You have had a comprehensive evaluation for your symptoms. If MS is still a possibility, there are no further tests you can have other than the MRI and testing the CSF fluid as well as evoked potentials. Having another neurological opinion to evaluate the tests can be considered for another opinion.
Further evaluation with an ophthalmologist can be done to look at the optic neuritis.
Ulcerative colitis can itself be associated with various eye symptoms - such as scleritis and uveitis (approximately 3 to 5 percent of cases). Treatment normally is targeted at the inflammatory bowel disease.
I agree that the rheumatology route has been exhausted - I cannot think of further testing in this area that has not been considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Further evaluation with an ophthalmologist can be done to look at the optic neuritis.
Ulcerative colitis can itself be associated with various eye symptoms - such as scleritis and uveitis (approximately 3 to 5 percent of cases). Treatment normally is targeted at the inflammatory bowel disease.
I agree that the rheumatology route has been exhausted - I cannot think of further testing in this area that has not been considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
How is your fatigue level ? Are you sleeping well and do you have any muscle aches ?
You mentioned flu-like symptoms, short-term memory, weakness, pain, frequent urination, balance problems & arthritis. If you still have the flu-like symptoms and especially fatigue, I would consider speaking with a physician who is familiar with treating CFS patients'. Many CFS patients' often have lesions on their MRI (brain) and I posted a link below on this discussion. You can also google "CFS" + "lesions" + "MS" for additional links. Of course to be diagnosed with CFS, your physician will need to rule out many other possibilities... but it sounds like you've already been there and done that. I do hope they repeated the lyme disease test because often the result could be a false negative.
As far as the weakness in your arm... you stated that it is only in one arm, correct ? Do you have the weakness in both legs ? You may want to ask your physician to check your cortisol level.
The only other thing I can think of is to ask your physician if Celiac disease could be responsible for some of your symptoms. Best of luck to you and I hope you do not give up in your search for answers...
http://www.medhelp.org/forums/neuro/messages/34460