Question: metabolic brain trauma??

[Rob-Muler]

  Dear Doctor:
  Please allow me to describe what I perceive as a progressive metabolic
  trauma to my CNS.
  I will follow with a brief history, symptoms, current medications and
  effects, and results of basic testing.
  I am at a total loss as I am told that this is a general anxiety
  disorder, have been hospitalized for treatment with benzodiazapines of
  various types. Fail to believe this Is simply a GAD, as the symptoms are
  progressing over a lengthy period of time and they also include weight
  loss, fatigue, visual disturbances Darkening of vision, possible
  vestibular type issues vertigo, dizziness, loss of strength, extreme
  depersonalization sensation, decreasing awareness of the surrounding
  environment although difficult to describe, continued loss of memory and
  a very high correlation with caloric intake.
  Should be noted that I have had two physicians after doing some blood
  work tell me nothing more I can do for you with no explanation. This was
  very upsetting as I am told this is purely an anxiety disorder. No one
  seems to want to deal with this for some reason except the hospital
  psychologist that is prescribing the medications.
  History:
  Male, Caucasian
  Age: 41
  Occupation: ME
  Non drinker
  Non smoker
  Length of time condition is progressing at least very noticeably enough
  for hospital admission.: 3 years.
  Symptoms: .
  General,
  As described previously.
  Sleep disturbance.
  Constant RUQ discomfort.
  Sinus tach after any calorie load, 100-160BPM, no heart disease found on
  std. stress test and stress echo.
  Chronic fatigue.
  Tinnitus.
  Acute symptoms:
  Complete loss of recall of previous events.
  Extreme decrease in strength.
  Gait abnormal.
  Coordination abnormal.
  Extreme darkening of vision ,like near syncope.
  Tremor.
  Sensation that the organ, the brain is either lacking perfusion, lacking
  proper metabolites or receiving improper metabolites,
  lacking glucose or not receiving glucose in form of usable energy.
  Morning vomiting.
  In ability to perform simple tasks ,such as play bingo.
  Sensation that the information from all of the senses is clouded to the
  point of not being able to function normally.
  Any caloric intake at this time greatly exacerbates the condition.
  Fever>100 degrees F.
  Acute diarrhea.
  Simple tests ,counting backwards are challenging, a great surprise to me
  being an ME.
  Loss of feeling now in left pinkie finger, insensitive to needle *****.
  Unusual pink raised lesion, about .8 CM on right-hand, started 2 months
  ago, to be seen by dermatologist soon.
  Medications:
  Initial: Ativan, quelled the symptoms for almost a year, then
  effectiveness lessened and started worsening of the symptoms.
  Discontinued.
  Propranalol: slowed the sinus tach but eventually started causing the
  near syncope visual darkening. Was told to stop taking by one physician
  and never explained why although I pressed the issue.
  Xannax, again quelled the symptoms but was very short acting and
  symptoms would return.
  Clonazepam: Greatly quelled symptoms for the past 8 months and now
  starting to loose effectiveness.
  Tylenol for RUQ and LLQ pain and discomfort.
  Strange coincidence: A diet soft drink such as diet Coke or Pepsi seems
  to slightly quell the symptoms.
  General hematology:
  Bilirubin: mildly elevated
  GGT: mildly elevated, randomly,
  Glucose: normal
  Alk Phos: normal
  Ammonia: slight to moderate elevations, increasing.
  CK elevated during acute attack. CK-MB elevated during acute attack.
  LDH:elevated during acute attack.
  Troponin: normal during acute attack.
  CBC W/Diffs.: slightly elevated with acute attack, normal cell
  morphology.
  Glucose Tol Test: normal.
  Basic Urinalysis: Although the color and smell have changed, the smell
  is quite potent.
  CT: Brain with in normal limits.
  CT liver: with in normal limits.
  Resting EKG: abnormal serial change, T-waves have all inverted in all
  precordial leads as well as lead II and III.
  Cardiac stress test :equivocal, ST-segment depression of 2mm in
  precordial leads.
  Cardiac stress echo: normal wall motion.
  Cardiac event recording: Sinus tach, after eating and slight work load,
  random PVC's. Otherwise normal.
  My Conerns/belief/hypothisis:
  I have a progressive disorder that is slowly destroying the CNS, that
  either no doctor wants to tell me because of the magnitude of what it is
  or does not know what is truly going on.
  As an engineer I have recorded the various trends in symptoms,
  effectiveness of medication and what I will call a degeneration of
  mental capacity.
  I realize this may sound odd but if my predictions are based on the
  extrapolation of my collected data I could be in
  a state of complete mental dysfunction with in a 2-6 month period. I
  layman's terms. this feel like the brain cells, neurons, synapse
  or other organelle are deteriorating and it is due to a metabolic
  dysfunction in the GI system of organs due to the very high correlation
  with calorie load.
  I am also very surprised that the time frame from intake of the calorie
  load to the onset of the symptoms always ranges from
  about 30-60 minutes. A single dose of clonazepam, 1 mg will greatly
  reduce the visual, motor and other sensory issues as well as the effect
  on memory and depersonalization.
  My long term fear is complete loss of mental function with such a
  terrible sense of depersonalization that I will be suffering from this
  hypothetical disorder, if you will for a very long time with extreme
  mental pain and physical disability.
  MY QUESTION: Do you know of any disease process that may even sound like
  what I have described?
  Even any differential DX?
  I am functioning to about 85%-90% capacity in my normal life and career
  at this time under the control of Clonazepam.
  Again I say I am at wits end, if you will, please respond with some
  suggestions as to how to approach this.
  Thanks. Please forgive the lengthy e-mail.
  Best Regards:
  Robert A. Muller, ME

[HFHS MD-JM]

_
Mr. Muller,
It appears from your description that you are suffering from several
physical symptoms in addition to a high level of anxiety.  You report
being diagnosed with generalized anxiety disorder but doubt its accuracy.
Your question is "Do I have any answers based on your history what this
condition might be?"
It is possible that you suffer from an anxiety disorder which can manifest
itself in this very way.  You have had several studies and exams which are
essentially unremarkable.  This is very important because several medical
conditions can mimic anxiety disorders but, fortunately these are readily
discovered upon evaluation(ie cardic conditions, hypoglycemia, hyperthyroidism
etc.)  You may also have a somatoform disorder which is a group of psychiatric
disorders that have physical symptoms as their hallmark.  Patients with
hypochondriasis, for example, are convinced that they have a disease in
the absence of supporting findings and tend not ot heed their physician's
reassurance.  
You also alluded to Klonopin being helpful in maintainig your functioning
at 85-90% level, which is not ideal but still very good.  As for your mental
functioning, it also appears to be grossly intact, as you have summarized
your situation in a well thought out manner.
I recommend that you continue with your current medications which hopefully
is being monitored by a psychiatrist and consider therapy.  I would select
a physician whom you feel comfortable working with as this seems to be a
key issue for you.  Best of luck.
Sincerely,
HFHS MD-JM
Keywords:  Somatoform disorders, Hypochondriasis, anxiety