After having had every test in the book, I was diagnosed with PACNS almost 3 years ago, and the course has been unremitting. The original presentation was headache (not thunderclap) loss of executive function and memory, visual disturbances, 7 strokes 9ischemic) and a drop of at least 40 !Q points on neuropsyche testing. I have tried both MTX and AZA, but both make me violently ill. I'm back to the CTX -150 mg/day,now, and it seems to be finally keeping the brain fog away. I did nothing for the deadaches, and I am now taking divaloprox for them. This is helping too. I am also on verapamil, prednisone,avapro, vit B-12, vit-D, calcium, cymbalta, plavix, and ambien. I'm a walking grugstore I have recently develped Hoener's Syndrome, choking on liquids, a chronic cough, fecal urgency, and regurgitation. I fel as though I will drown if I lay flat. My neurologist says he just doesn;t know anymore. my symptoms are so scattered. I'm due to have a barium swallow sooner or later, but what else could be going on? is all this related? please help. Any advice would be appreciated.