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Urology (Expert Forum)
follow-up to 'microscopic haematuria significant?' post
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
follow-up to 'microscopic haematuria significant?' post
by aliaat, Jun 19, 2004 12:00AM
Dear Dr.,
I have a follow-up query from my recent posting (“Haematuria significant?”) of June 11. Since then, it seems I developed a bout of neuro symptoms: numbness of left side of face, including L. temple area, around L. eye, L. gums, L. lower lip, and L. side of tongue. Basically feels like it’s swollen and something is pulling the whole side down, but no (discernible) drooping of lip or eye. I understand this is possibly an inflammation in a cranial nerve, with difficulty “spitting”, chewing, and to a lesser extent, swallowing. I think the latter is more from the inability to sense on the entire left side of tongue though, although uvula seems to deviate to the right. Neuro isn’t concerned (I guess they expected it so they will probably upgrade from “probably MS” to “definite” MS when I see them next), and I haven’t had a neuro exam.
However, while I was sticking tongue out to see if any deviations, etc., I noticed that it had turned quite a bit lighter; a bit of a shade of yellow. Along the length (bilateral) there is yellowish and whitish discolouration. This does not go away or decrease with brushing, etc. Now I am quite meticulous in hygiene, and brush at least 3 times daily, Listerine, etc., so I don’t see how this could be some sort of plaque/infection. From the time of my last posting, where I raised the concern of microscopic haematuria, still no word from the hosp. re. abdominal ultrasound appointment. I am concerned that the haematuria/urinary symptoms and this new batch of neuro symptoms may be related (autoimmune?). Just for a recap, in Nov. ’03 CSF test showed + ANA, 1:160 along with all the CNS demyelination. I would appreciate any thoughts on all this, especially:
1) Any significance to the yellow tongue? If it helps, the muscle itself turns an obvious light/yellow colour when “compressed” against lower mouth. Skin and eyes are not yellow as far as I can tell
2) What can the tongue discolouration stem from? Kidney, liver, gall bladder, etc.? Should I even bring it up to the doc.?
3) Do you think it’s possible that the two issues (haematuria and facial symptoms) are related, or would this more likely be a coincidence? I.e. what is the likelihood that this is an autoimmune problem not confined to the CNS?
4) What would be the investigations you would recommend if someone presented to you with such a case? I.e. would you treat the symptoms as combined/separate, or have a specific concern?
Many apologies for the extended post. I understand you can only speculate, not diagnose. I just want to make sure that, when I do see the specialists (which are at 2 separate hospitals), I am comfortable that all possibilities are being explored. A bit of info-ammo so to speak. All of this coming on within such a short time, and having to wait so much to get answers, is a little bit unsettling, especially when one is in the last stages of completing an M.Sc.!
Again, many thanks!
I have a follow-up query from my recent posting (“Haematuria significant?”) of June 11. Since then, it seems I developed a bout of neuro symptoms: numbness of left side of face, including L. temple area, around L. eye, L. gums, L. lower lip, and L. side of tongue. Basically feels like it’s swollen and something is pulling the whole side down, but no (discernible) drooping of lip or eye. I understand this is possibly an inflammation in a cranial nerve, with difficulty “spitting”, chewing, and to a lesser extent, swallowing. I think the latter is more from the inability to sense on the entire left side of tongue though, although uvula seems to deviate to the right. Neuro isn’t concerned (I guess they expected it so they will probably upgrade from “probably MS” to “definite” MS when I see them next), and I haven’t had a neuro exam.
However, while I was sticking tongue out to see if any deviations, etc., I noticed that it had turned quite a bit lighter; a bit of a shade of yellow. Along the length (bilateral) there is yellowish and whitish discolouration. This does not go away or decrease with brushing, etc. Now I am quite meticulous in hygiene, and brush at least 3 times daily, Listerine, etc., so I don’t see how this could be some sort of plaque/infection. From the time of my last posting, where I raised the concern of microscopic haematuria, still no word from the hosp. re. abdominal ultrasound appointment. I am concerned that the haematuria/urinary symptoms and this new batch of neuro symptoms may be related (autoimmune?). Just for a recap, in Nov. ’03 CSF test showed + ANA, 1:160 along with all the CNS demyelination. I would appreciate any thoughts on all this, especially:
1) Any significance to the yellow tongue? If it helps, the muscle itself turns an obvious light/yellow colour when “compressed” against lower mouth. Skin and eyes are not yellow as far as I can tell
2) What can the tongue discolouration stem from? Kidney, liver, gall bladder, etc.? Should I even bring it up to the doc.?
3) Do you think it’s possible that the two issues (haematuria and facial symptoms) are related, or would this more likely be a coincidence? I.e. what is the likelihood that this is an autoimmune problem not confined to the CNS?
4) What would be the investigations you would recommend if someone presented to you with such a case? I.e. would you treat the symptoms as combined/separate, or have a specific concern?
Many apologies for the extended post. I understand you can only speculate, not diagnose. I just want to make sure that, when I do see the specialists (which are at 2 separate hospitals), I am comfortable that all possibilities are being explored. A bit of info-ammo so to speak. All of this coming on within such a short time, and having to wait so much to get answers, is a little bit unsettling, especially when one is in the last stages of completing an M.Sc.!
Again, many thanks!
Doctor's Answer
by Kevin Pho, MD, Jun 21, 2004 12:00AM
, Jun 21, 2004 12:00AM
To answer your questions:
1/2) Jaundice can sometimes cause a yellow tounge. If this is suspected, I would test the liver function - an elevated bilirubin level is suggestive of this. If there are significant findings, the next step should be a liver/gallbladder ultrasound.
3) It may be possible that the symptoms are related. Difficult to say without being familiar with your case. Any number of autoimmune diseases would not be confined to the CNS - lupus, rheumatoid arthritis etc.
4) If there are neurologic symptoms, an MRI of the brain and MRA of the neck vessels would be the most comprehensive first test to consider. This can be discussed with your personal neurologist.
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.
Medical Weblog:
kevinmd_b
1/2) Jaundice can sometimes cause a yellow tounge. If this is suspected, I would test the liver function - an elevated bilirubin level is suggestive of this. If there are significant findings, the next step should be a liver/gallbladder ultrasound.
3) It may be possible that the symptoms are related. Difficult to say without being familiar with your case. Any number of autoimmune diseases would not be confined to the CNS - lupus, rheumatoid arthritis etc.
4) If there are neurologic symptoms, an MRI of the brain and MRA of the neck vessels would be the most comprehensive first test to consider. This can be discussed with your personal neurologist.
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.
Medical Weblog:
kevinmd_b
