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Neurology (Expert Forum)
Fungal Sinus Infection with a normal CT Scan?
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Fungal Sinus Infection with a normal CT Scan?
by KimSb, Dec 22, 2006 12:00AM
I've been suffering from persistant pressure, tightness in my forehead for several years. This causes physiological & Neurocognitive symptoms that have effected my functioning. I'm in a fog & it effects my thinking. Nothing has helped & the symptoms are perpetual.
After a number of neg blood tests, normal brain/thoracic/cervical MRIs, EEG & spinal tap, my Neurologist at an academic hospital sent me to an ENT and an allergist.
The ENT said my sinus CT scan showed a mild thickening of the frontal & maxillary sinus. While he thought surgery would help my breathing, he didn't think it would help my chronic head or pressure symptoms. He put me on Zithromax, which didn't help.
The allergist said my IgE mold tests were elevated & he put me on mold immunotherapy injections & antifungal rinses. Sevral months later & neither treatment has alleviated the problem.
Is it possible to have a fungal sinus infection & yet have a normal CT scan? If so, what treatment(s) are recommended.
Thanks & happy Hollidays
After a number of neg blood tests, normal brain/thoracic/cervical MRIs, EEG & spinal tap, my Neurologist at an academic hospital sent me to an ENT and an allergist.
The ENT said my sinus CT scan showed a mild thickening of the frontal & maxillary sinus. While he thought surgery would help my breathing, he didn't think it would help my chronic head or pressure symptoms. He put me on Zithromax, which didn't help.
The allergist said my IgE mold tests were elevated & he put me on mold immunotherapy injections & antifungal rinses. Sevral months later & neither treatment has alleviated the problem.
Is it possible to have a fungal sinus infection & yet have a normal CT scan? If so, what treatment(s) are recommended.
Thanks & happy Hollidays
Doctor's Answer
by CCF-Neuro-M.D.-SH, Jan 22, 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 that you describe of forehead pressure and brain fog are often difficult to diagnose, mostly due to their vague nature. The 2 most common senarios I have found with this constellation of symptoms is, migraine headaches and/or depression. Migraine headaches often have a "sense of being off" type feeling associated with them. These are sometimes called confusional migraines. The often misunderstood fact about migraines is that you can suffer with the associated features of migraines (such as the confusion) with out the more typical pounding headache, sensitivity to light, nausea, etc. For this I would recommend a trial on a migraine prophylaxis agent such as elavil, topamax, or nadolol. The confusion in migraines tends to be more episodic than you describe, but it sounds like you have been through a lot already, and it would be worth a trial (may take 3-4 weeks to take effect). The much more common explanation of "brain fog" is depression. This is a very common feature and is assoicated with not feeling sharp, short term memory loss and increased errors due to inattention. Many patients relate that they dont feel sad or 'depressed' and discount this possibility. I would encourge you to suggest a trial on a antidepressant such as wellbutrin, effexor, lexapro, etc to evaluate for this possibility (will also take 3-4 weeks to respond). There has been numerous reports of 'neuro-cognitive' problems with "toxic mold syndrome" in the popular press. However, there is very little science to support this as an actual disease and most experts think the 'neuro-cognitive' changes are unlikely to be caused by the mold (but the jury is still out). There is no known treatment for 'toxic mold' except for avoiding exposure. There are people who can evaluate your home or buisness for mold and if it is found in significant quantity than you may try moving locations (sometime also called 'sick building syndrome').
I hope this has been helpful.
The symptoms that you describe of forehead pressure and brain fog are often difficult to diagnose, mostly due to their vague nature. The 2 most common senarios I have found with this constellation of symptoms is, migraine headaches and/or depression. Migraine headaches often have a "sense of being off" type feeling associated with them. These are sometimes called confusional migraines. The often misunderstood fact about migraines is that you can suffer with the associated features of migraines (such as the confusion) with out the more typical pounding headache, sensitivity to light, nausea, etc. For this I would recommend a trial on a migraine prophylaxis agent such as elavil, topamax, or nadolol. The confusion in migraines tends to be more episodic than you describe, but it sounds like you have been through a lot already, and it would be worth a trial (may take 3-4 weeks to take effect). The much more common explanation of "brain fog" is depression. This is a very common feature and is assoicated with not feeling sharp, short term memory loss and increased errors due to inattention. Many patients relate that they dont feel sad or 'depressed' and discount this possibility. I would encourge you to suggest a trial on a antidepressant such as wellbutrin, effexor, lexapro, etc to evaluate for this possibility (will also take 3-4 weeks to respond). There has been numerous reports of 'neuro-cognitive' problems with "toxic mold syndrome" in the popular press. However, there is very little science to support this as an actual disease and most experts think the 'neuro-cognitive' changes are unlikely to be caused by the mold (but the jury is still out). There is no known treatment for 'toxic mold' except for avoiding exposure. There are people who can evaluate your home or buisness for mold and if it is found in significant quantity than you may try moving locations (sometime also called 'sick building syndrome').
I hope this has been helpful.
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Hope you find some answers soon.
Fiona
If you get a different diagnosis, I would like to hear about it.
I made lots of progress with most of my symptoms but my head symptoms didn't budge. Nothing seems to help & it's greatly effecting my ability to function.
I don't get migraines per se, but a fuzzy, foggy tightening & pressure sensation in my head. It feels like I'm wearing a helmet that's too tight or as if I have a vise around the side of my forehead. Blury vision at times, too. PET scan was also normal.
I realize the MD is busy, but he totally ignored the follow up posts stating that Migraines had been ruled out & the meds he metioned had been tried to no avail.