Re: Follow up to Odd Neurological Symptoms

Posted By M. Hinn on September 19, 1997 at 13:20:16:

In Reply to: Re: Follow up to Odd Neurological Symptoms posted by CCF Neurology MD on September 19, 1997 at 02:22:54:







: : This is a follow up to what I posted a few days ago:

About four years ago, I started getting a "flash of light" in my right eye
that would gradually take over the majority of my field of vision in
my right eye. I would get these about 3-4 times a year. My eye doctor told
me that they were called "ocular migraines." About a year ago, these flashes
of light began increasing in frequency, occuring at least once a month.
Other, more alarming symtoms (symptoms) have been occuring with them including numbness
in the right side of my face and right arm, confusion, dizziness, weakness, slurred speec,
inability to say words in their correct order, etc. Sometimes the numbness
occurs without the flash of light in my eye. A headache never accompanies
these symptoms.

I had a full blood workup and a CT scan but nothing appeared to be abnormal.
Of course I am now extremely frustrated. What could be the cause of
these symptoms and what other diagnostics should be performed?

Thanks!




     =

Dear M. Hinn:

While the symptoms you describe are somewhat typical of migraine auras, you do not get headaches. The term "migraine equivalents" has been used to describe such episodes. Most patients with migraine equivalents are usually somewhat older individuals, often with a remote history of migraine attacks, or with a family history of migraines. Since the symptomatology could well result from serious underlying cerebrovascular disease (athersclerotic narrowing or otherwise), either in the neck, or intracranially, detailed vascular testing is mandatory in a fair number of cases. This is specially the case if the individual is older with vascular risk factors, if the history of migraine headaches is not strong, and if the character of the events is not entirely typical of migraine auras. Depending upon the judgement of your treating neurologist, tests like carotid ultrasound, MRA of the neck and intracranial vessels, transcranial doppler, and cerebral angiography may or may not be appropriate. There are also some blood tests that may be indicated.
If symptoms are geting worse, or are changing in character, or if you are sufficiently concerned, you should speak to your neurologist again about this matter. Else, you may consider seeking a second opinion. If you live in the Cleveland area, I suggest that you see one of the cerebrovascular specialists at the Cleveland Clinic. I strongly recommend Dr. Anthony Furlan, Dr. Cathy Sila, and Dr. Judith Hinchey, who are nationally renowned experts in this field.
You could call [phone] locally, or [phone] toll free for an appointment.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.





Thanks,

I am 27 and other than the "flashes of light" that began 4 years ago, I have had no history of migraine. I did find out that they only ran the CT scan without contrast and now they said that they should have run it with contrast. Expensive mistake! Thanks for your advise. As you can imagine, this is a frustrating and slow process of diagnosis!

M