Re: Elevated venous ammonia & CNS symptoms

Posted By peds neuro md bm on April 13, 1998 at 17:00:36:

In Reply to: Elevated venous ammonia & CNS symptoms posted by Robert A. Muller on April 03, 1998 at 11:19:53:






Dear Doctor;
I am a 40 year old male plagued with LLQ pain and discomfort and RUQ pressure and random pain for over a year.
Have had random elevations of Bilirubin, GGT, LDH, and ammonia and CNS troubles.
Bilirubin total:1.9 mg/DL max.
GGT: 73 U/L max.
LDH: 220 IU/L max.
Venous ammonia: 108 uMoL/L
Bun 3mg/DL min value.
GI Studies:
Liver ultrasound: 1cm hemangioma near portal vein. Suboptimal scan of entire liver due to bowel gas.
CT abdoman & pelvis: negative except for scattered diverticuli on sigmoid colon and a few hernias.
Sigmoidoscopies: negative with scattered diverticuli.
I suggest you see a neurologist for an evaluation to see if indeed you
have a neurologic problem or whether your problems are secondary to a
primary disorder elsewhere other than the nervous system.
Neuro and other studies:
EEG normal except for prominent frontocentrally predominant beta range fast activity.
Echocardiogram: Looking for mitral valve prolapse. Normal except for slight regurgitation of the tricspid & pulmonary valve. Minimal hemodynamic significance. I did not expect any MVP as I have no murmur, still do not know why they did this test.
24 hour urine: Negative for pheochromocytoma. Would of thought they would have tested for 5HIAA instead due to all my abdominal issues, variable BP and random flushing.
Sounds like almost the correct tests for carcinoid tumor and its systemic effects done for the wrong reasons.
My Concern: I was hospitalized for anxiety/depression a while ago and was put on Ativan and Zoloft, the symptoms at the time I felt, to me, were more metabolic, felt like a toxin in my brain or poor perfusion, I could no longer do my engineering calculations and sketches, Up all night, passing out/sleeping during day, darkening of the vision, loss of apetite, very bad tremor, tachycardia, LLQ and RUQ pain, difficult time recognizing familiar things, even tried the Reitan trail-making test and was significantly slower then than now.  What if any is the significance of the ammonia now? I am concerned that it may be having
CNS effects as I still have tremor, memory issues, problems sleeping. All started with the beginning of these GI issues.
Any Suggestions or comments? I hate to think my brain is slowly deteriorating.
Thanks in advance.
Robert A. Muller