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Neurology (Expert Forum)
Fungal Sinusitis despite negative CT scan?
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Fungal Sinusitis despite negative CT scan?
by KimSb, May 06, 2007 12:00AM
My main symptom is a unrelenting tight forehead sensation that leaves me in a daze & hungover. It feels like I'm wearing a helmet that's way too tight & is just debilitating & miserable. It also causes neuro-cognitive deficits such as major brain fog. An ENT at an Academic hospital has diagnosed me with a Frontal Fungal Sinusitis infection, although I have a negative CT scan. He has tried immunotherapy, various antibiotics & antifungal nasal rinses to no avail. He said surgery is a possibility, but surgeon couldn't guarantee that sinus surgery would relief the constant tight forehead sensation.
My internist, ID MD, & Neurologist at the same hospital are stumped. Spinal tap, 3 brain MRIs, EEG, EMG, & a 2 full spinal MRI's all negative & yielded no answers. He tried Elavil, SSRIs, Imitrix, Topamax, & no relief. He's convinced it's not a migraine as it's perpetual, with no relief.
Is it possible to have Frontal Fungal Sinusitis infection with a negative CT scan? Can it be virulent & recalcitrant, if so, what is the best treatment? Should I be looking for other possibilities to diagnose this main problematic symptom?
Your suggestions would be most appreciated.
My internist, ID MD, & Neurologist at the same hospital are stumped. Spinal tap, 3 brain MRIs, EEG, EMG, & a 2 full spinal MRI's all negative & yielded no answers. He tried Elavil, SSRIs, Imitrix, Topamax, & no relief. He's convinced it's not a migraine as it's perpetual, with no relief.
Is it possible to have Frontal Fungal Sinusitis infection with a negative CT scan? Can it be virulent & recalcitrant, if so, what is the best treatment? Should I be looking for other possibilities to diagnose this main problematic symptom?
Your suggestions would be most appreciated.
Doctor's Answer
by CCF-Forum-M.D.-SH, Jul 14, 2007 12:00AM
Dear Kim Sb
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 constant frontal tightness/pressure and confusion (brain fog) are non-specific, but are commonly seen in many disorders. It seems that you have had quite an extensive work-up already given the tests that you have listed in your post including MRI, EEG, spinal tap and trials on several good headache preventative medications (elavil, topamax), which are all things that I would have suggested as well. Based on the symptoms that you have described, I would be most suspicious of the fungal sinusitis as the cause of your symptoms. I would also make sure that your spinal fluid was examined closely for the specific fungus that was isolated form your sinuses, because it can spread from the sinuses to the spinal fluid easily. Sometimes it takes a sample of spinal fluid removed directly form the brain or upper spinal region (require neurosurgery) to obtain diagnostic results. You can have a fungal sinusitis with a negative CT, and I would follow you ENTs advice about possible sinus surgery.
If you are still unable to get answers, you may consider going to a major academic medical center to be re-evaluated in detail with a fresh perspective.
I hope this has been helpful.
Dr. S.H.
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 constant frontal tightness/pressure and confusion (brain fog) are non-specific, but are commonly seen in many disorders. It seems that you have had quite an extensive work-up already given the tests that you have listed in your post including MRI, EEG, spinal tap and trials on several good headache preventative medications (elavil, topamax), which are all things that I would have suggested as well. Based on the symptoms that you have described, I would be most suspicious of the fungal sinusitis as the cause of your symptoms. I would also make sure that your spinal fluid was examined closely for the specific fungus that was isolated form your sinuses, because it can spread from the sinuses to the spinal fluid easily. Sometimes it takes a sample of spinal fluid removed directly form the brain or upper spinal region (require neurosurgery) to obtain diagnostic results. You can have a fungal sinusitis with a negative CT, and I would follow you ENTs advice about possible sinus surgery.
If you are still unable to get answers, you may consider going to a major academic medical center to be re-evaluated in detail with a fresh perspective.
I hope this has been helpful.
Dr. S.H.
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My symptoms are similar to yours, except add on a never ending headache to the forehead tightness. Beleive me, I know what the forehead tightness is like...people thought I was crazy or depressed for a long time. Does it kind of feel like it's hard to raise your eyebrows? I was diagnosed with a benign bone tumor behind my forehead after much persistance, which was never brought to my attention by the first 2 radiologists who read my MRI. Of course I'm not saying that's what you have, in fact, odds are against it, but you never know, and this is what I have to offer you...
Yes, exactly. Drives me nuts. ENT did point out a deviated septum & enlarged turbinates. He said I need surgery for that but surgeon said it would help my forehead symtoms. Wouldn't my multiple MRIs have shown a bone tumor or irregular mass behind the forehead? Should I have the MRIs read again by a different specialist who looks specifically for bone tumors of the forehead?
Thanks for the suggestions
would or wouldn't help your symptoms?
The thing is...different radiologists may or may not decide to report every little thing. I know again, it does sound strange, but the first radiologist completely ignored the tumor despite the fact that it is blatently obvious to see...I don't know the real reason for these things, but I suspect it may have to do with a balancing act they play--it's benign, there's no edema, it's not going to kill him, so let's spare him the concern and extra testing--that's the only thing I could think of, but I may never know. It was not until I went to a teaching hospital that it was pointed out to me and now I have MRI every 6 months to follow up until I decide it's time for surgery if I can't stand the symptoms anymore. Though, I might be trying the nasal surgery first in the remote chance it would help my forehead tightness and headache...I have a constantly blocked nose too, so even if it doesn't work, it should help me with that.
I will ask the MD to look for any "insignificant" lesions or masses around the frontal sinuses or supra-orbital regions.
Hope you get some answers soon.
I have to agree with what the other person posted about masses etc, I was CT scanned during two hospital admissions in Jan 06 and they did not report a tumor seen in my pineal gland. When my symptoms worsened I was MRI'ed without contrast by the neuro, they saw the tumor and reported it - the first time we were told about it. They repeated the MRI in december 06, this time with contrast and found not only the tumor (which had not grown thankfully) but also some significant twisting of my left carotid artery. So now I am told I need to be scanned at least annually to check for changes. Point being, the first radiologist did not report the finding and it was in fact part of what was going on for me, though not by any means everything. The hematologist/oncologist who I see, was the one who teased out the info and figured out why the tumor was new information to all of us, middle of 06.
Frustrating but you do have to advocate for your own health.
Fiona
would or wouldn't help your symptoms?
Robert, sorry, I missed this. See, I'm totally in a fog. He said it probably wouldn't help. My allergist thinks it may help as he said I have a "thickening" of the frontal sinus which he said is indicative of chronic infection.
Haing another CT scan soon.
Background: 44 year old male in decent health. Retired from the Army in 2006 and had a complete physical. Everything was fine except for lower back degenerative disk diease and mild hearing loss. Took a contractor job in Iraq. After 4-months, I was sick with extreme fatigue, head pressure, lightheaded and tinnitus. Finished my year there in early 2007 and took a 3-month vacation at home and now am working for the government in Germany.
After getting over whatever illness I had in Iraq (lasted 3-4 weeks), I was left with constant painless head pressure, lightheaded and tinnitus. Saw a couple of general doctors in Iraq and was given prescription pain medication (even though it mostly painless) and was told allergies or sinus or tension headache. Tried the meds with no change with the head pressure. Saw an ENT in Iraq who felt it just a left-over from a viral infection which could take months to heal.
When I came back from Iraq, I had a CT Scan, sinus x-rays and had a chiropractor work my back and neck for a month. The MDs ruled out a sinus infection or serious allergies. They gave me more pain medication (do not take), high BP med (do not have high BP) and a nasal spray thinking it was some type rhinitis or chronic headache. I took 3-months off at home to rest and relax in case it was burnout. Sometimes at night, I feel a painless throbbing in the back of my neck and lower head when it is on the pillow.
Questions: 1) Can a viral infection take months to completely get over and can the head pressure lightheaded feeling be attributed to a post viral infection? 2) Can you develop a chronic headache without any history of headache and have just pressure without pain? The prescription meds did nothing for head pressure.
I am pretty much at a total loss since having this stuff for a year now. Have lived in Iraq, KY and Germany with no change. Have seen 5-doctors who all had different opinions to include allergies, tension headache, sinus inflamation (inflammation) (not infection), rhinitis.
I have a constant tightness in my forehead, especially if I try to raise my eyebrows. I had an eye test and asked whether my eyesight would cause this but he said no. I have been to the doctors and they say they don't know.
The only relief I get is wearing glasses. It seems to relieve the symptoms but not totally. As soon as I remove my glasses, the tightness immediately starts again.
It doesn't feel like my vision is the cause but helping my vision relieves the tightness. My eyesight was brilliant before getting this pain in my neck and wonders if the pain in my neck would cause the tightness in my forehead.
It is also said it could be due to tension but I am a very relaxed person and don't have any problems except the problems stated here of course.