Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Subject: Re: Mystery illness; where next?
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF Neuro MD *!* on January 05, 1998 at 21:15:33:
In Reply to: Mystery illness; where next? posted by Lauren on January 04, 1998 at 21:45:47:


: Hi. I am a 36 year old woman who has been searching, unsuccessfully, for a diagnosis (and treatment!) of my vast array of neurological and other symptoms that have
debilitated me for the last 3-1/2 years. My primary symptoms include daily near-fainting and light-headedness episodes (subsesquently diagnosed as neurally mediated hypotension),
severely impaired gastrointestinal motility (I have had Crohn's disease isolated to my colon for 18 years, and tests showed that my motility problems are not Crohn's related),
intermittent "mind fog," memory problems and difficulty concentrating (these have actually improved over the last year), muscle weakness, joint pain, difficulty focusing my eye muscles,
and some fatigue (this was initially my worst problem, but has improved since the onset of this illness). On particularly bad days, I have episodes after eating which consist of burberigmi noises from my stomach, shaking, sweating, and feeling like I'm going to faint. Extreme food intolerance (not Crohn's related, as per my gastroenterologist), heart palpitations (non-sustained ventricular tachycardia and MVP) also are a problem for me.
I recently began experiencing joint pain, but all tests showed nothing. I cannot exercise due to muscle weakness and inability to store glucose for energy use. I lose my hair and eyebrows regularly (although it usually grows back in pretty quickly),
and have seen major changes in the texture and dryness of my hair and skin.

I have been sent from one specialist to another, and have received partial diagnoses (i.e., neurally mediated hypotension, gastroesophageal reflux, slow motility, estrogen deficiencies, test positive for Hashimoto's antibodies), but still do not have a clear answer for my overall condition.
At this point, I feel there is either a single factor affecting multiple systems (i.e., endocrine, neurologial and gastrointestinal systems). However, I have not been able to find a doctor--or team of doctors--who can view my situation in its entirety. Going from specialist to
specialist only provides me with partial diagnoses that provide no clues for treatment. I have been referred to a neurologist who specializes in disorders of the autonomic nervous system, but I am not sure whether this is the most helpful next step. I would appreciate it if you
could please advise what might be a reasonable approach---Thank you.

--Lauren


=
It seems unlikely to me that you will find a single doctor who will have expertise in such a wide range of anatomical systems, given the wide range of symptoms it is equally unlikely that a multidisciplinary team exists who
deal in these problems.
It is of course possible that you have two separate problems in which case two distinct diagnoses are appropriate.
The best chance for a diagnosis which ties most if not all, of your symptoms together is one based on dysfunction of the autonomic nervous system, this branch of the nervous system controls blood pressure and problems in blood pressure can lead to fainting, it also controls motility in the bowel , eye focusing and the heart rate which are all problems you also mention. Fatigue and subjective muscle weakness might be attributable to this cause also.
I find it difficult to tie in the skin and hair changes to the entire picture , they suggest an endocrinological or autoimmune disorder might be also present.
As regards your next step I think a neurologist who specializes in autonomic disorders is a very good next step, I am not confident that he will be able to put all of your symptoms in one neat diagnostic package , however I think it is a good choice.
You should remain open to the possibility that there are two different processes going on however.
This information is provided for general medical education purposes only.
Please consult your physician for diagnostic and treatment options of your specific medical condition.


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