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cerebral gas embolism??
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cerebral gas embolism??

Tam has suffered severe pain in her right temple area since a deep dive scuba incident over a year ago.  She is 39.  After ascending too fast, she had blood in her nose and mouth and unusual vaginal bleeding.  She did not lose consciousness and was not given oxygen.
24 hours later she was taken to the ER with head pain, back pain, dizziness, and was unable to stand.  The doctor inquired about hyperbaric decompression and was told it was too late.  She was treated for an ear infection and discharged.
Three months later she was diagnosed post menopausal. Her ovaries had atrophied.
She has seen neurologists, endocronologist, gynecologist, ent, neurosurgeon, dentist, opthamalogist, gen. practioner, and psychiatrist.  She had a biopsy for Temporal Arteritis which was negative.  Her head pain is constant and extreme made worse by motion.
She is being treated by a pain management specialist for infarctions in the brain the ent said was caused by cerebral gas embolism that exploded near her thalamus and pituitary damaging tissue and nerves.  The say the damage would not show up on MRI because of the deep location and "probable" small size of the infarcts.  They say the damage is permanent and inoperable and she will have to live with the pain for the rest of her life.  They say she has suffered a series of small strokes and "ischemic cascade effect".
She had taken Darvocet, Lortab, Celebrex, Nortriptyline, Methpredlisone, and is now on Estratest, Provera, Percocet, Neutrontin, and Clonazepam.  No relief and she sleeps very little.
She has lost her job (because of the pain) and her health insurance.  She has lost the quality of life she shared with her life partner.  She is slowly losing herself to the pain and medication.  I am concerned about her even though I know she wants to hang on for her young daughter's sake.
What do you make of the diagnosis and the treatment?  Is there any hope for her?  Are the doctors on the right track?  Thank you for your time and this wonderful forum.
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Avatar_n_tn
Dear Jan:

I would find it difficult to believe that your daughter? friend? ovaries atrophied in 3 months due to an air embolism with little other symptoms.  Besides that, I think your friend? daughter? could benefit from an MRI.  That would show where the damage occured in the brain.  That will help with her pain syndrome, because it will help define the brain lesion and if the pain might be related to the brain lesion.  Since she has been on most of the pain medications, I would suggest a pain managment consultation to see what her options might be.  First, try and define the lesion, then given that data, try and see what alternatives to medications already tried for her pain.  I am sorry I'm not much help, but doing medicine over the internet is not possible.

Sincerely,

CCF Neuro MD
7 Comments
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Avatar_n_tn
Sorry I didn't say.  Tam is my daughter.  Could you explain panhypopituitarism?  This was mentioned as a possiblity by one doctor.  Should I conclude that any damage would definitely be seen on an MRI?  In other words, no evidence, no damage?  Are there other areas to look at that might be causing this pain?  Could it possibly originate in the back or the neck?

I failed to mention she has had MRA, MRI (brain and jaw) CT scans with no results.  Sorry, there was so much information to try to put down. Are there nerve conduction tests to see if and where there might be nerve damage? Thank you.
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Avatar_n_tn
Dear Jan:

If your daughter really had panhypopituitary, she would be dead by now.  This is when the pituitary gland stops working.  She you not have any cortisol to protect here during times of stress, her electrolytes would be out of balance, she would have diabetes insipitis, and her endrocrine system and reproduction functioning would be gone.  But, certainly she would be dead.  Since the MRI did not show anything, I would imagine that she has no lesions in her brain that could cause her pain.  It would be highly unlikely that she had an embolism to the brain as this would show brain damage.  Her pain is not from her brain, but likely lies somewhere outside of the brain in the peripheral nervous system.  I think I would get a second opinion from a neurologist in a close by medical center or university.

Sincerely,

CCF Neuro MD
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Avatar_n_tn
Not to belabor this because she certainly is not dead but funny you should mention her reproductive function because it is gone.  Her ovaries are devoid of eggs and completely atrophied as are her other reproductive organs.  

She did spend three days at Shands in Gainesville, Fla where she was examined by a team of doctors who all differed in their opinions.  Some were all for the gas embolism.  She has been seen by a number of neurologists.  Don't you see what we are up against?  The only two definite diagnosis she has gotten in over a year were Temporal Arteritis (which was wrong and caused her more pain because of the biopsy) and the gas embolism.  She is suffering and I am becoming more and more discouraged by the medical profession in general, not to include you as I am sure you are trying to help but you can only do so much without seeing her.  She has tried to get into Mayo Clinic but they turned her down.
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Avatar_n_tn
Dear Jan:

I really do not believe that your ovary problem arose from her gas embolism.  An event to cause degeneration of her ovaries should have left tell-tail signs, such as hemorrhage, ischemic changes etc.  I am not sure what to tell you as when the brain is traumatized by ischemia, embolism there are tell tail signs on the MRI, MRI with diffusion early, etc.  Sorry that I am little help.

Sincerely,

CCF Neuro MD
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Avatar_n_tn
Thank you, doctor.  I appreciate your time and patience.
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Avatar_n_tn
you are welcome.

CCF Neuro MD
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