Aa
Enlarged cervical and submandibular lymph nodes on neck MRI--worrisome?
I've had a swollen lymph node under my left jaw for nearly two years, as originally pointed out to me by my dentist, then confirmed by another dentist, a speech therapist, and a GP. This lymph node doesn't hurt, but I finally mentioned it to my ENT, whom I'm seeing for trouble swallowing for the past two years. He determined that my difficulty with swallowing was due to nerve damage on the right side of my throat, but a neck CT scan a year ago turned up no tumor or suspicious lesion in my neck (and no lymphadenopathy, I believe). I asked him about the swelling under my left jaw that was noticed by different healthcare professionals, and he begrudgingly ordered a neck MRI with contrast (gadolinium).
The results came back stating, "There is evidence for reactive adenopathy but no submandibular mass identified." [My ENT thought the swelling under my left jaw might've been a mass so he ordered the MRI for the reason "left submandibular mass?"]. The results continued, "Bilateral level 2 and left level 1B nodes are identified. Discrete mass is not identified within the submandibular glands. Floor of mouth is normal. Parotid glands are symmetric."
Should I be at all concerned? I've been sick for awhile (2yrs) with extreme fatigue, swollen joints, essential tremor favoring my left arm, occasional night sweats, general feeling of malaise, bad headaches, inability to concentrate, brain fog, muscle weakness, dizziness, and ventricular tachycardia, mostly attributed to subclinical hypothyroidism, yet my symptoms haven't gone away despite thyroid hormone treatment and normal TSH levels, so I think something else is going on...I'm just not sure what. My neck doesn't hurt and I have no pain under my jaw, either.
Any thoughts would be greatly appreciated!
The results came back stating, "There is evidence for reactive adenopathy but no submandibular mass identified." [My ENT thought the swelling under my left jaw might've been a mass so he ordered the MRI for the reason "left submandibular mass?"]. The results continued, "Bilateral level 2 and left level 1B nodes are identified. Discrete mass is not identified within the submandibular glands. Floor of mouth is normal. Parotid glands are symmetric."
Should I be at all concerned? I've been sick for awhile (2yrs) with extreme fatigue, swollen joints, essential tremor favoring my left arm, occasional night sweats, general feeling of malaise, bad headaches, inability to concentrate, brain fog, muscle weakness, dizziness, and ventricular tachycardia, mostly attributed to subclinical hypothyroidism, yet my symptoms haven't gone away despite thyroid hormone treatment and normal TSH levels, so I think something else is going on...I'm just not sure what. My neck doesn't hurt and I have no pain under my jaw, either.
Any thoughts would be greatly appreciated!
I'm actually wondering if the TIAs are being caused by the two venous malformations I have in the left side of my brain. I've read that they can bleed (although this type only causes problems in 1/3 of people who have it) and when they do, it doesn't always show up on CT/MRI. They are also known to cause one-sided numbness or weakness and headaches. Fits me to a T!
Unfortunately, something small showed up on one CT scan in the ER, but I didn't get an MRI until 3 weeks later, at which point nothing showed up so they figured it was an artifact.
I'm pretty sure they're not seizures since I had an EEG done. What a weird test that was.
I've been getting a lot more headaches since stopping Propranolol, sadly, and I'm taking the tartrate version of Metaprolol. I used to have a home blood pressure monitor but I rarely used it, so I got rid of it. My blood pressure seemed ok during any episodes of VT I had during the cardiac stress test; the last stress test indicated that Metaprolol (50mg twice daily) seems to be working to prevent my arrhythmias. They also told me if it was sarcoidosis causing the arrhythmias, they would've seen damage on my echocardiograms and heard crackling sounds when listening to my lungs (usually it's advanced disease that would cause the RVOT VT).
I don't think I have any episodes of amnesia, but I do have a lot of memory problems...like taking a minute or two to come up with the right word to say, forgetting to bring with me something important that is due in class, or even not remembering what I ate yesterday without thinking about it really hard!
The RVOT isn't that recent...I've been feeling the arrhythmia for awhile now, but I can't pinpoint when it started, exactly. Maybe 1 - 1.5 years ago? I mentioned it briefly as a symptom to a few doctors, but none of them commented on it so I figured it wasn't worrisome. Ironically, it's turned out to be one of my more worrisome symptoms to this day! My problem is that I have so many symptoms over such a long period of time (2+ years) that I think doctors become overwhelmed and cut me off before I have a chance to finish remember all of my problems. I've even tried handing them a list of the progression of my symptoms and instead of reading it, they say, "Why don't YOU tell me what's been happening?" It's very frustrating since they only want to hear the first 30 seconds of "what's been happening".
Topamax was for migraines; I'm thinking about trying it again because I'm in a brain fog as it is and the only reason I dropped it was because it made me feel stupid. I don't think my cognitive function could get much worse at this point, anyway!
The drugs causing some symptoms is definitely plausible...but the fact that I've had the left-sided weakness/numbness, headaches, mild paralysis of upward gaze, essential tremor, joint swelling and pain, fatigue, throat problems, and other hypo symptoms (brittle nails, dry skin, issues with being too hot or too cold) before being on any drugs...well, that means there was definitely something going on and maybe the drugs have clouded it at this point. I really wish I had smarter doctors who would factor in all of these things like you are. =(
I'm hoping this neurosurgeon I'm seeing at the end of September is really helpful because I honestly feel my case is mainly neurological, and that the endocrinological symptoms are either separate and easily treatable, or caused by my neurological issue(s) (the hypothalamus and pituitary being affected by blood flow changes in my brain or something).
Unfortunately, something small showed up on one CT scan in the ER, but I didn't get an MRI until 3 weeks later, at which point nothing showed up so they figured it was an artifact.
I'm pretty sure they're not seizures since I had an EEG done. What a weird test that was.
I've been getting a lot more headaches since stopping Propranolol, sadly, and I'm taking the tartrate version of Metaprolol. I used to have a home blood pressure monitor but I rarely used it, so I got rid of it. My blood pressure seemed ok during any episodes of VT I had during the cardiac stress test; the last stress test indicated that Metaprolol (50mg twice daily) seems to be working to prevent my arrhythmias. They also told me if it was sarcoidosis causing the arrhythmias, they would've seen damage on my echocardiograms and heard crackling sounds when listening to my lungs (usually it's advanced disease that would cause the RVOT VT).
I don't think I have any episodes of amnesia, but I do have a lot of memory problems...like taking a minute or two to come up with the right word to say, forgetting to bring with me something important that is due in class, or even not remembering what I ate yesterday without thinking about it really hard!
The RVOT isn't that recent...I've been feeling the arrhythmia for awhile now, but I can't pinpoint when it started, exactly. Maybe 1 - 1.5 years ago? I mentioned it briefly as a symptom to a few doctors, but none of them commented on it so I figured it wasn't worrisome. Ironically, it's turned out to be one of my more worrisome symptoms to this day! My problem is that I have so many symptoms over such a long period of time (2+ years) that I think doctors become overwhelmed and cut me off before I have a chance to finish remember all of my problems. I've even tried handing them a list of the progression of my symptoms and instead of reading it, they say, "Why don't YOU tell me what's been happening?" It's very frustrating since they only want to hear the first 30 seconds of "what's been happening".
Topamax was for migraines; I'm thinking about trying it again because I'm in a brain fog as it is and the only reason I dropped it was because it made me feel stupid. I don't think my cognitive function could get much worse at this point, anyway!
The drugs causing some symptoms is definitely plausible...but the fact that I've had the left-sided weakness/numbness, headaches, mild paralysis of upward gaze, essential tremor, joint swelling and pain, fatigue, throat problems, and other hypo symptoms (brittle nails, dry skin, issues with being too hot or too cold) before being on any drugs...well, that means there was definitely something going on and maybe the drugs have clouded it at this point. I really wish I had smarter doctors who would factor in all of these things like you are. =(
I'm hoping this neurosurgeon I'm seeing at the end of September is really helpful because I honestly feel my case is mainly neurological, and that the endocrinological symptoms are either separate and easily treatable, or caused by my neurological issue(s) (the hypothalamus and pituitary being affected by blood flow changes in my brain or something).
COMMUNITY LEADER
hi, I'd asked about the beta blocker because the homogeneity of your TIA symptoms (if it truly is TIA and not, say, seizures) would make me guess that they are not embolic, but rather have an intracranial origin right in one localized area.
Plus, it's now known that non-vasodilating Beta Blockers result in *more* MI, not less. So it was possible that your BBs were perhaps contributing to those putative CVAs. But, it seems a long shot that increased "central pressure" from the BBs can be causing CVAs -- but still possible. (Dr. Cockroft from UK is the guy doing that research.)
CT done in ER is mainly to check for current (and more deadly) hemorrhagic events, they won't show ischemic events until the affected tissue has become changed over 24-48 hours.
Speaking of which, if I were you I'd look up 'reperfusion injury' and start taking lots of anti-oxidants as insurance. (I.e., most damage is not from the initial ischemia but from the ROS that get created.)
But your CT and MRI would have shown accumulated infarcts from old CVAs, or maybe/probably microangiopathic conditions.
120 mg propranolol seems like a lot. Btw, that BB tends to hypoglycemia whereas atenolol etc go to hyperglycemia. Do you ever get spells with amnesia? (that could be hypoglycemia)
Do you have a home BP monitor so that you can immediately check your BP if you feel funny? (hypotensive episodes can be mistaken for TIA)
"until this cardiology issue arose a few weeks ago and I dropped it to start on Metaprolol"
Do you mean the RVOT is only that recent?
Btw, propranolol is not cardio-selective, but metoprolol is. You probably know that, I'm just tossing things in. Are you on the succinate instead of tartrate?
Was your Topamax for migraines?
Because this is something to consider... the proliferation of symptoms, as mentioned being seemingly against Ockham's Razor, could possibly be drug reactions. I suppose you have already researched all that. Did it come out as being plausible?
more later :)
Plus, it's now known that non-vasodilating Beta Blockers result in *more* MI, not less. So it was possible that your BBs were perhaps contributing to those putative CVAs. But, it seems a long shot that increased "central pressure" from the BBs can be causing CVAs -- but still possible. (Dr. Cockroft from UK is the guy doing that research.)
CT done in ER is mainly to check for current (and more deadly) hemorrhagic events, they won't show ischemic events until the affected tissue has become changed over 24-48 hours.
Speaking of which, if I were you I'd look up 'reperfusion injury' and start taking lots of anti-oxidants as insurance. (I.e., most damage is not from the initial ischemia but from the ROS that get created.)
But your CT and MRI would have shown accumulated infarcts from old CVAs, or maybe/probably microangiopathic conditions.
120 mg propranolol seems like a lot. Btw, that BB tends to hypoglycemia whereas atenolol etc go to hyperglycemia. Do you ever get spells with amnesia? (that could be hypoglycemia)
Do you have a home BP monitor so that you can immediately check your BP if you feel funny? (hypotensive episodes can be mistaken for TIA)
"until this cardiology issue arose a few weeks ago and I dropped it to start on Metaprolol"
Do you mean the RVOT is only that recent?
Btw, propranolol is not cardio-selective, but metoprolol is. You probably know that, I'm just tossing things in. Are you on the succinate instead of tartrate?
Was your Topamax for migraines?
Because this is something to consider... the proliferation of symptoms, as mentioned being seemingly against Ockham's Razor, could possibly be drug reactions. I suppose you have already researched all that. Did it come out as being plausible?
more later :)
My brief neurological progression with regards to TIA:
August 26, 2008 -- Saw neurologist for first time; prescribed Topamax (25mg)
September 30, 2008 -- Saw neurologist for second time; prescribed propranolol (60mg ER) which I probably began taking sometime during the first week of October
--> I had already noted decreased sensation and muscle weakness on my left side prior to even taking Inderal--so a potential minor stroke or TIA might have already occurred in the past and left lasting damage
October 14, 2008 -- Went to ER for TIA; CT without contrast indicated a focal region of hypodensity within the central pons, later believed to be artifact due to a clean MRI on November 3, 2008
November 11, 2008 -- Visited neurologist for third time; propranolol increased to 80mg/day; also asked to take 81mg aspirin/day
December 8, 2008 -- Second TIA; no ER visit
February 24, 2009 -- Third TIA; CT without contrast done in ER was clear
October 14, 2009 -- Fourth TIA; no ER visit
Sometime in mid-2009 (maybe around April?) my Propranolol was increased to 120mg/day, which I've been taking ever since, until this cardiology issue arose a few weeks ago and I dropped it to start on Metaprolol
August 26, 2008 -- Saw neurologist for first time; prescribed Topamax (25mg)
September 30, 2008 -- Saw neurologist for second time; prescribed propranolol (60mg ER) which I probably began taking sometime during the first week of October
--> I had already noted decreased sensation and muscle weakness on my left side prior to even taking Inderal--so a potential minor stroke or TIA might have already occurred in the past and left lasting damage
October 14, 2008 -- Went to ER for TIA; CT without contrast indicated a focal region of hypodensity within the central pons, later believed to be artifact due to a clean MRI on November 3, 2008
November 11, 2008 -- Visited neurologist for third time; propranolol increased to 80mg/day; also asked to take 81mg aspirin/day
December 8, 2008 -- Second TIA; no ER visit
February 24, 2009 -- Third TIA; CT without contrast done in ER was clear
October 14, 2009 -- Fourth TIA; no ER visit
Sometime in mid-2009 (maybe around April?) my Propranolol was increased to 120mg/day, which I've been taking ever since, until this cardiology issue arose a few weeks ago and I dropped it to start on Metaprolol
COMMUNITY LEADER
quick question, Jules: what came first, the beta blocker or the TIAs?
I saw my ENT today, and he said he'd like to do an FNA of the lymph node that's been swollen for a long time, as well as an x-ray swallowing study. Sounds like fun!
I don't have any unusual dietary habits; I've been eating fairly well ever since graduating from college 2 years ago. I do know the importance of Na and K in voltage-gated channels and muscle cell action potentials, as well as Ca and Mg's roles--so I'll keep taking the magnesium supplements and double-check this with my cardiologists on Thursday.
I've been exercising a little more each week (played tennis for an hour with my sister this past weekend), but trying not to do anything too crazy since my cardiologists seemed to really caution against any exertion until they know the Lopressor is actually working. I definitely think it'd be wise to incorporate more exercise into my schedule. But I wanted to make sure the abnormal heartbeats whenever I exercised weren't a problem...and of course, it turns out that they are.
Speaking of which, my cardiologists already looked into PFO--the echo I had done looked clean. When I do have a TIA, oh boy do I feel it. It's the strangest thing in the world (even more odd than accidentally overdosing on niacin, which I did today!...now that's a funny story). Half of my tongue will start to tingle, almost as though it's falling asleep. My head will feel simultaneously heavy and light, accompanied with some dizziness. Half of my body will feel warm, while the other half will feel cold. I feel generalized weakness on the left side, accompanied by some tingling sensation. I am able to walk, although not as easily as usual. My left pupil becomes 'blown', the left side of my face droops slightly due to the feeling of muscle numbness and weakness on that side, and I feel slightly confused about things, yet focused. Occasionally, there is a sharp pain in my head that disappears almost as suddenly as it arises. I don't have any issues with speech during this time, fortunately, and all the symptoms subside in about 30 minutes. These symptoms vary slightly from episode to episode, but the aforementioned ones (except for pain in my head) tend to always occur. It's frightening, but I've learned to pay attention and be sure that the symptoms do subside...if not, I'd head to the hospital in case it was an actual stroke.
Ironically, I've tried turmeric and that didn't do anything for me. I still take it every now and then, because I know it helps, in general. I eat lots of ginger whenever I go out for sushi, but I haven't made a habit out of it. =)
I noticed the "new" symptoms (throat discomfort, difficulty swallowing, tremor, really bad headaches, weakness on left side, swollen/painful joints) crop up around March/April of 2008. The "old" symptoms (fatigue, vision problems, headaches, dry skin, brittle nails) had been around for quite some time--particularly the fatigue and the headaches. In January 2008, oddly enough, I visited California and Nevada for the first time, for about 10 days.
I'm in agreement with you in thinking that it's autoimmune. It just seems so probable that I can't ignore it, yet all of the tests are coming back "ok". I don't want to rule out other possibilities, though, since the last time I had bloodwork done I was running a low RBC while my WBC count had risen from 5 or 6 in 2008 up to 8.5 in 2009 (I watched it increase over the course of a year and several CBCs). With autoimmune disease, WBC is usually on the lower side, if anything. It could definitely still be a virus...or even Lyme disease...I'm waiting to see if the lymph node FNA tells us anything, but I've learned not to bother holding my breath anymore.
I can't get my endocrinologist to measure anything other than TSH, so I'm wondering if my problem is in the conversion of T4 to T3, rather than in the production of T4. I guess I'll never know if I stick with this current endo!
I'm sorry to hear about your father, but I'm glad to hear that his illness has had a positive effect on you--and to the benefit of all of us on this site!
I don't have any unusual dietary habits; I've been eating fairly well ever since graduating from college 2 years ago. I do know the importance of Na and K in voltage-gated channels and muscle cell action potentials, as well as Ca and Mg's roles--so I'll keep taking the magnesium supplements and double-check this with my cardiologists on Thursday.
I've been exercising a little more each week (played tennis for an hour with my sister this past weekend), but trying not to do anything too crazy since my cardiologists seemed to really caution against any exertion until they know the Lopressor is actually working. I definitely think it'd be wise to incorporate more exercise into my schedule. But I wanted to make sure the abnormal heartbeats whenever I exercised weren't a problem...and of course, it turns out that they are.
Speaking of which, my cardiologists already looked into PFO--the echo I had done looked clean. When I do have a TIA, oh boy do I feel it. It's the strangest thing in the world (even more odd than accidentally overdosing on niacin, which I did today!...now that's a funny story). Half of my tongue will start to tingle, almost as though it's falling asleep. My head will feel simultaneously heavy and light, accompanied with some dizziness. Half of my body will feel warm, while the other half will feel cold. I feel generalized weakness on the left side, accompanied by some tingling sensation. I am able to walk, although not as easily as usual. My left pupil becomes 'blown', the left side of my face droops slightly due to the feeling of muscle numbness and weakness on that side, and I feel slightly confused about things, yet focused. Occasionally, there is a sharp pain in my head that disappears almost as suddenly as it arises. I don't have any issues with speech during this time, fortunately, and all the symptoms subside in about 30 minutes. These symptoms vary slightly from episode to episode, but the aforementioned ones (except for pain in my head) tend to always occur. It's frightening, but I've learned to pay attention and be sure that the symptoms do subside...if not, I'd head to the hospital in case it was an actual stroke.
Ironically, I've tried turmeric and that didn't do anything for me. I still take it every now and then, because I know it helps, in general. I eat lots of ginger whenever I go out for sushi, but I haven't made a habit out of it. =)
I noticed the "new" symptoms (throat discomfort, difficulty swallowing, tremor, really bad headaches, weakness on left side, swollen/painful joints) crop up around March/April of 2008. The "old" symptoms (fatigue, vision problems, headaches, dry skin, brittle nails) had been around for quite some time--particularly the fatigue and the headaches. In January 2008, oddly enough, I visited California and Nevada for the first time, for about 10 days.
I'm in agreement with you in thinking that it's autoimmune. It just seems so probable that I can't ignore it, yet all of the tests are coming back "ok". I don't want to rule out other possibilities, though, since the last time I had bloodwork done I was running a low RBC while my WBC count had risen from 5 or 6 in 2008 up to 8.5 in 2009 (I watched it increase over the course of a year and several CBCs). With autoimmune disease, WBC is usually on the lower side, if anything. It could definitely still be a virus...or even Lyme disease...I'm waiting to see if the lymph node FNA tells us anything, but I've learned not to bother holding my breath anymore.
I can't get my endocrinologist to measure anything other than TSH, so I'm wondering if my problem is in the conversion of T4 to T3, rather than in the production of T4. I guess I'll never know if I stick with this current endo!
I'm sorry to hear about your father, but I'm glad to hear that his illness has had a positive effect on you--and to the benefit of all of us on this site!
Have an Answer?
You are reading content posted in the Leukemia and Lymphoma Community
An interview with the co-discoverer of one of the biggest breakthroughs in cancer research
From causes to treatment options, get answers to your questions about CML, a type of blood cancer
New drug options on the horizon may make CML, a type of blood cancer, one of the few success stories in cancer treatment
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
test bands: what about the one microbe that's most often associated with Lyme? babesiosis... but then, what can you do about it?
sometimes migraines get cured by Mg
Mg as per muscles + nerves: Ca rushes in to a nerve or muscle cell and Mg rushes out, creating pulse conduction. Similarly Na and K are sort of like opposites. How does that relate? I don't know. But do you have any unusual dietary habits, like vegetarian? High sugar diet (which causes mineral excretion)?
pineal cyst: I think often times a person can somehow just "know" what's wrong with them. That's why I asked about your intuitive perception. Otherwise I know very little about it. What is the width x length of yours?
How about milk or legume allergy? If you have gut permeability because of that, then lots of other molecules can cross the barrier and then create problems.
lecithin granules might have some minor benefit. Sort of nourishment for the nerve coverings.
Aquatic ape theory would infer that ancient humans absorbed Mg through the skin from sea water. IOW, Mg is a big requirement which most people are truly short of in modern days.
stroke: well, what could dispose someone of your age to a lacunar infarction? Could you have a Patent Foramen Ovale? That's all I can think of. Ir do you have varicose veins, indicating hypercoagulability?
Also re stroke: damage would get better or stay the same. Does yours get worse? That could argue against *a* stroke, or in favor of repeat events. Do you ever feel TIAs?
"although I can't figure out how that would cause damage to my left face and the rest of my left side...while the nerve damage is on the right?" I'd guess in your complex mystery case, we can abandon Lloyd Morgan's Canon - and say they do not have the same cause. Maybe.
"If a simple chest x-ray can generally rule out sarcoidosis (90% of people with the disease have abnormal chest x-rays), I'd be happy to have it done." You might be in the other 10%. but yes sarcoidosis is seeming unlikely.
Me? I'm on this group because my father had lymphoma some years ago. An aggressive type. So one day I dropped in to try and help for a short while. That was last autumn :)
Well, you're very brave to keep persevering. What about exercise? What if you forced yourself to exercise, then pay the price afterwards in being wiped out, then recover after days and repeat -- but over time this punishing work leads to improvement? That's one therapy you can control, anyway.
My total guess at this moment would be autoimmunity or virus. Or a spirochete because they have that hiding ability, too. Your Fx goes toward autoimmunity. I'd keep in mind maybe trying to eat strict Paleo, and taking lots of arginine as an anti-inflammatory, plus turmeric, ginger etc. That's going to the far side, but you have tried allopathic approaches.
Oh, or you might try porcine Armour (actually it's replacements, since Armour seems gone these days) for the hypoT. Or cytomel (T3).
Did you travel anyplace exotic before things went bad?