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Neurology (Expert Forum)
Hard Palate Mouth Sores
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Hard Palate Mouth Sores
by Keek, Dec 26, 1999 12:00AM
Thank you for your time.
About a year ago I started developing these exquisitely painful deep ulcers in my hard palate and sometimes down my throat. In addition to the sores, I suffer from cognitive decline (this according to my husband :) and my speech pattern changes, I stutter and slur my words sometimes to where he says he cant understand me. Last week (with no ulcers) I developed complete vision loss in my right eye and my left arm felt very weak. I thought maybe it was from the flu since I vomited during this episode. It only lasted a few minutes and then I was left with just extreme tiredness. The next day I had mouth sores once again. Last year, at the beginning of these sores my doctor had a biopsy done on one of them which came back positive for "lupus cerebritis" so I was started on a large dose of prednisone which in fact helped so quickly I was wanting to never be without this miracle drug. However, now I know how dangerous this drug can be and dont want to spend the rest of my life off and on it. My blood test has come back ana neg. on occasion so Im not sure where we stand on the lupus. Can you possibly point me in another direction for help in what might be causing these symptoms? I wake up with dread sometimes when I feel these sores starting again, as they can completely overpower your life until they have healed (which is usually a couple of weeks.) I thank you for your time, especially during the holidays.
Many thanks,
Gail
About a year ago I started developing these exquisitely painful deep ulcers in my hard palate and sometimes down my throat. In addition to the sores, I suffer from cognitive decline (this according to my husband :) and my speech pattern changes, I stutter and slur my words sometimes to where he says he cant understand me. Last week (with no ulcers) I developed complete vision loss in my right eye and my left arm felt very weak. I thought maybe it was from the flu since I vomited during this episode. It only lasted a few minutes and then I was left with just extreme tiredness. The next day I had mouth sores once again. Last year, at the beginning of these sores my doctor had a biopsy done on one of them which came back positive for "lupus cerebritis" so I was started on a large dose of prednisone which in fact helped so quickly I was wanting to never be without this miracle drug. However, now I know how dangerous this drug can be and dont want to spend the rest of my life off and on it. My blood test has come back ana neg. on occasion so Im not sure where we stand on the lupus. Can you possibly point me in another direction for help in what might be causing these symptoms? I wake up with dread sometimes when I feel these sores starting again, as they can completely overpower your life until they have healed (which is usually a couple of weeks.) I thank you for your time, especially during the holidays.
Many thanks,
Gail
Doctor's Answer
by CCF Neuro[P] MD, RPS, Dec 26, 1999 12:00AM
Dear Gail:
The usual gold standard for CNS lupus is angiography. Although, a biopsy proven lupus is pretty diagnostic. The response to steriods is also indicative of CNS lupus. What was the sedimentation rate during the attack? I would think that you need to fully resolve the issue of whether you have SLE. The angiography would be important, but maybe I would start with a MRI and MRA of the brain to see what changes have occurred. If there is some indication of CNS SLE then I would do the angiography. If that proves negative then maybe you have Herpes Simplex and are suffering from Mollart's syndrome (reoccurring sterile encephalitis). But, first rule out the CNS lupus issue.
Sincerely,
CCF Neuro MD
The usual gold standard for CNS lupus is angiography. Although, a biopsy proven lupus is pretty diagnostic. The response to steriods is also indicative of CNS lupus. What was the sedimentation rate during the attack? I would think that you need to fully resolve the issue of whether you have SLE. The angiography would be important, but maybe I would start with a MRI and MRA of the brain to see what changes have occurred. If there is some indication of CNS SLE then I would do the angiography. If that proves negative then maybe you have Herpes Simplex and are suffering from Mollart's syndrome (reoccurring sterile encephalitis). But, first rule out the CNS lupus issue.
Sincerely,
CCF Neuro MD
Thank you.
I would see a neurologist. There are many things that can give symptoms that you describe and a good neurological examination, and workup can begin the diagnosis of your problems.
You do not tell me the symptoms that would accompany Mollaret's syndrome of headache, stiff neck, normal CSF analysis.
Sincerely,
CCF Neuro MD
I thank you once again for the opportunity to at least direct these questions to someone that could possibly help me and my doctor on the road to a diagnoses.
The posting indicating that if steriods helped then an autoimmune disorder might be indicated. However, it is far from diagnostic. So I would go ahead and have the tests done that I indicated. Bachet's would have been indicated if the ACE level in your CSF had been elevated and if you had mucosal ulcers on your rectum area or vagina. As previously stated, the gold standard for CNS lupus is angiography.
CCF Neuro MD
Thank you once again,
Gail
CCF Neuro MD