Over the past few months I have been experiencing some mild cognitive deficits, mostly related to concentration & working memory, with some sleep issues (non-24 hour sleep/wake cycles, sleeping 12-14 hours at a time). A nurse practioner diagnosed me with ADD, which sort of makes sense, except I never had any learning difficulty as a child, or if I did - it was never like this. I am a 21 year old female, majoring in astrophysics, though these problems have rendered me virtually incompetent for the last few months.
I've had bloodwork done, including TSH and T4 levels, all normal. I had an MRI done (see link in the post script), which was normal(according to the report), but... Since I never actually talked to the radiologist, I was wondering if you could help me fill in some gaps. There's no increased signal anywhere, the ventricles look symmetrical, et cetera. But from my humble perspective, the meninges look kind of thick (and illuminated, in the T1 weighted images) in the front, particularly on my left side. I know every brain has its peculiarities, but I just thought it seemed like a coincidence. It may be completely irrelevant, but my left pupil is somewhat larger than my right when dilated - I just read somewhere that larger pupils could be a sign of increased intracranial pressure, but it may be that it has nothing to do with what side of the brain something is on.
I'm really clueless. The the MRI was probably normal, but is it possible that something could look subtle but still cause symptoms? It seems possible to me.
Stimulants have yet to help me. Would you recommend trying to see a neurologist, or should I just stick with psychoaffective drugs and therapy and hope I get better? I feel willing to try anything at this point - it seems as though my ability to consciously understand the world is slipping away.
P.S. I think you can look at the image here, I have it posted on my blog: http://truehayley.files.wordpress.com/2007/05/sagittalt1b.jpg
I suppose I should describe/give some examples of the specific problems I have. Like I said, it is mostly attention related - typically (several times a day) I will enter a room do something (get my keys, wallet, go to look for something on the internet, or check my e-mail) and before I can do it, I will forget what I'm doing. I can't remember why I went to a specific room, or sat down at the computer, et cetera. Usually I have to think very hard (for maybe 20-30 seconds), walking myself backwards through my train of thought, to recall again what it was that I meant to do. I completely forget about appointments, sometimes even classes I have every week, I just forget to go to.
Once I was with a friend and we were going to dinner after class, and she asked where I was going - it turns out I walking the opposite direction of where we were heading, even though by now I know the campus like the back of my hand.
Another time I had a doctor's appointment at 10:30 - I looked at the clock, which read 10:30, but I thought it said 10:15. Later when I came to the appointment I couldn't believe I was late, until the image of the clock came back to me later in my head - remembering it, I could clearly tell that the clock said 10:30 - but at the time, I whole heartedly thought it said 10:15.
I frequently make spelling errors now that I never have in the past. I call them spelling errors, but much of the time I just use the wrong word - "and" instead of "an", "two" instead of "to", "down" instead of "doubt." Like when I reach for the word in my head, I accidentally use a word that is stored close to the one I actually want to use. Ones that sound similar, or the wrong form of the right word, i.e. "went" instead of "came." I blog frequently, so rereading my entries I have been able to notice an explosion of these errors in recent months. About half of them I catch immediately, but many I can look at over and over again and not notice - it looks right at the time.
Any ideas? Does it sound like a bloodflow problem, a neuroendocrine issue, a dopamine deficiency? I'm a lowly physicist, I have no idea.
Oh, lowly physicist....Don't ever doubt your own observations. You describe real cognitive deficits, and I wouldn't blow them off. I would probably have you start with a good and thorough neuro exam, but you likely need a good neuropsych eval. These are the ones who can pick up the subtle cognition problems that the standard neuro exam won't. Most often they are PhD's rather than MD's. Sometimes referred to as psychometric testing. It's really not as much psychological testing as it is an exam of the finer points of cognitive function.
I wouldn't trust your own reading of MRI's unless you've had lots of experience. The body, alas, is rarely perfectly symmetrical. Even so, meningeal thickening would likely not be the cause of cognitive difficulties. The causes could range from sleep deprivation (eg. sleep disorder), to metabolic (hypoglycemia) to primary neurological, to endocrinological..... I could probably go on for pages. BTW, I often have many of those same problems. Mine is neurological. It really is hard when you remember having a sharp mind, but can't always summon it.
Bottom line, never be your own doctor for fear of having an idiot for a patient. See someone.
We can't afford to lose great minds...or as the brilliant Dan Quayle said, when speaking before the United Negro College Fund, "It's terrible thing to lose your mind." (sorry about the political humor)
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