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Epilepsy or MS or Neuro?
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Epilepsy or MS or Neuro?

4 yrs ago began have transient binocular vision loss 12-15 x's a day lasting seconds.  6 mos ago, transient peripheral vision loss accompanied by headache pressure at base of skull (which has been constant 24/7 since) along with nausea, tingling/numbness on right side of body, burning pains in head and right side of face, transient vision episodes, focal gaze staring episodes, twitching, orthostatic hypotension, positive Babinski response (by neuro), fatigue. Never actually loses consciousness, just gets very close to it.

She had one episode lasting 30-45 secs when could not spell her name and another episode where words came out jumbled lasting 30-45 secs.  Another occasion, school nurse noted dilated pupils that would not constrict to light with blood pressure of 88/40, pulse 70, and a headache worse than normal.  During focal gaze episodes, she said tried to talk but couldn’t and that she could hear me but my words were in slow motion, lasted maybe 2 mins.

However all test fine: MRI & MRA of brain & cervical clean, chest x-ray, neurological exam (except for Babinski) fine, Opthamologist said eyes fine, echocardiogram, EKG, EEG, Spinal tap, Western Blot Lyme Test, Heavy metal blood test, CBC, Hormone blood test, Tilt Table test showed orthostatic hypotension, peripheral vision test fine.

She does have normal low blood pressure (90/52), she has fibroadenomas in right breast (biopsy showed no malignancy), she has large globular pituitary (endo said normal for teen), Tilt test showed Orthostatic Hypotension (several times 80/28 during test but did not faint), she has mild spina biffida occulta, and Babinski response (neuro said not an issue if all other tests are fine).

I am at a loss as to what to do next.  She did have a new EEG yesterday, but we do not have results yet.  They are ready to write her off to psychological.

Question 1:  Can she have MS with clean MRI and clean Spinal fluid?
Question 2:  Is Babinski response significant if no other test findings showing abnormality?
Question 3: Could the focal gaze episode, speech episodes, etc. be seizures?
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368886_tn?1278962315
Hello.

To answer the third question, I would like to mention that I suspect absence seizures. Absence seizures (also called "Petit mal seizures") are seizures with momentary stare and unresponsiveness. The person does not usually recall all things clearly after the seizures. There may be some movements of the lips during the absence seizure, but it is not necessary.

EEG may come back normal in between episodes of absence seizures.

The large globular pituitary could in fat be the culprit for her vision problems. Further probe into the pituitary is needed.

I don't see the Babinski's response as insignificant. There is a definite upper motor neuron lesion.

Regards
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