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Neurology (Expert Forum)
Having neurological symptoms and unsure what to do
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Having neurological symptoms and unsure what to do
by fearfactor, Jan 22, 2007 12:00AM
I am a 34 year old female and have a long history of anxiety disorder, including OCD and health anxiety (just to get that out of the way). Since about a year ago, I have been having symptoms such as heart palpitations, feelings of vertigo, "brain fog," headaches. Sometimes the vertigo gets really bad and I feel like I will lose my balance though it's not accompanied by a fainting feeling. I had an MRI in 2000 due to a severe episode of headaches and vertigo and was told it was just sinus problems. I also experience fasciculations (especially in the hands and thumb and also in the face) and numb feelings in my hands. I have optic disc drusen and went to a specialist in opthalmology to be checked for optic neuritis, which I don't have. I do occasionally have blue flashes before my eyes and sometimes when I am startled or turn my head fast I get flashes. I do have fairly severe migraine headaches and take beta blockers for them. I have been prescribed Topamax but don't take it yet because I'm scared of side effects. I have suspected temporal lobe epilepsy. I am VERY concerned that I have MS. I am wondering if I should pursue testing because I realize this could very well be anxiety and/or some nonspecific neurological problem that isn't serious. The twitching and numbness plus the vertigo are what make me think MS is a possibility. I had the MRI back in 2000 - if I have MS would it have shown up back then? I don't want to spend lots of money on tests if it's probably just anxiety. I am also concerned about the eye issues. What do you think I should do? Thanks!
Doctor's Answer
by CCF-Neuro-M.D.-SH, Feb 12, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and story that you describe are most consistent with migraine headaches and/or depression. Twitching is not a typical symptom of multiple sclerosis, although it can present with vertigo and numbness (but the numbness is usually more focal [not both hands at once]). Given your symptoms of vertigo an ENG (electro-nystagmogram) might help determine the etiology (central [brain] vs peripheral [ear]). I would suggest that you have a repeat MRI of the brain and cervical spine with GAD contrast. I suspect that your visual symptoms are an aura to your migraine headache (do not have to be followed by a headache to be an aura). The exam by a ophtamologist was a good idea to evaluate for active optic neuritis. The most sensitive way to examine for past optic neuritis is a visual evoked potential VEP. Given your history of 'suspected temporal lobe epilepsy' then another medication (besides a beta blocker that may cause fatigue-and make depression worse) that works both for epilepsy and migraine prevention such as topamax, lyrica, neurontin, etc. The side effects of topamax can largely be avoided by increasing the dose slowly over several weeks. Depression can also cause the feelings of brain fog and can make headache worse. Paxil is a popular SSRI that can benefit OCD type traits.
I hope this has been helpful.
The symptoms and story that you describe are most consistent with migraine headaches and/or depression. Twitching is not a typical symptom of multiple sclerosis, although it can present with vertigo and numbness (but the numbness is usually more focal [not both hands at once]). Given your symptoms of vertigo an ENG (electro-nystagmogram) might help determine the etiology (central [brain] vs peripheral [ear]). I would suggest that you have a repeat MRI of the brain and cervical spine with GAD contrast. I suspect that your visual symptoms are an aura to your migraine headache (do not have to be followed by a headache to be an aura). The exam by a ophtamologist was a good idea to evaluate for active optic neuritis. The most sensitive way to examine for past optic neuritis is a visual evoked potential VEP. Given your history of 'suspected temporal lobe epilepsy' then another medication (besides a beta blocker that may cause fatigue-and make depression worse) that works both for epilepsy and migraine prevention such as topamax, lyrica, neurontin, etc. The side effects of topamax can largely be avoided by increasing the dose slowly over several weeks. Depression can also cause the feelings of brain fog and can make headache worse. Paxil is a popular SSRI that can benefit OCD type traits.
I hope this has been helpful.
Right now, I take propranolol, too - I take 10 mg in the morning and 10 mg at night. It does help with my palpitations and anxiety as well as my headaches but I can't take a lot because it tends to make my heart rate go way too low. I am hopeful the Topamax will help me, but I'm scared of all the side effects like memory problems and even electrolyte imbalances. I plan to start Topamax after I take the bar exam next month - don't want to have a bad memory while studying!