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13013217 tn?1428186866

Neurological tests/results completed (Confused w/ "diagnosis")

I realize this is long. However, I wanted to give a full, more accurate picture of procedures done

I am 48 years old. Med Hx: WPW w/ ablation, PTSD, IBS, Gastroperesis, GERD, Anxiety, Depression.

Symptoms: Dizziness (no vertigo), dysequillibrium, fatigued/weak legs resulting in pain. Rare tingling, numbing & heat in L leg.

ORIGINALLY: Went to Physical therapy & Balance Center and given several tests: PT 2x/weak w/ no/to non significant improvement.
1. CALORIC (23% UW, L ear)
2. Nystagmus Tests: Dix-Hallpike L (L beating nystagmus - asymptomatic), Positional Head (Head R = left beating nystagmus. Head L = L beating nystagmus. OTHER results: Negative
3. Oculomotor Tests: Saccade-Random = NEG, PURSUIT = Abnormal CNS-Mild saccadic intrusions., OPK-Fixed = Abnormal CNS-Weak, low gain; soft sign of CNS.

FINDING & IMPRESSIONS: VNG indicated  a MIXED(PNS+CNS) balance related impairment A significant hypofunctioning vestibular system was noted in the L inner ear. Oculomotor testing indicated a soft indication of a CNS impairment. These findings are supportive of a medical necessity for BRPT and further vestibular testing, as needed (Referred to neurologist).

Nerve Cell Biopsy:  R lower thigh and R calf. Results: R lower thigh nerve fiber density was 6.5 (normal value >6.0/mm). My R calf showed a nerve fiber density of 1.4 (normal value >5.7/mm), morphology normal.

However, my ARS w/ QSART  and Valsalva maneuver were normal w/ a comment of "blood pressure response to tilt showed a modest drop in blood pressure with inadequate heart rate increment."
CONCLUSION: "No evidence of autonomic failure...may be some degree of cardiovascular adrenergic instability (evidenced by reduction in blood pressure/head-up-tilt). This may suggest a predisposition to orthostatic intolerance or may indicate an early autonomic disorder. Repeat testing could be considered in 6-12 months if clinically indicated."

EMG (2nd one): Normal w/ comments: "Needle EMG examination revealed fibrillation potentials in the distal foot muscle, but were otherwise normal." INTERPRETATION: "This study is nearly normal. The fibrillation potentials in the foot muscles is not a diagnostic abnormality as this could be associated w/ a local process in the foot. If clinically indicated....6-12 mo repeat." .

EMG/NCV (1st EMG) Findings: "Eval. of R Sup Peron Anti Sensory nerve showed decreased conduction velocity (14cm-Ant Lat Mall, 30.3 m/s). Remaining nerves (normal limits). L vs. R side comparison for Tibial Motor nerve indicates abnormal L-R latency difference (2.0m/s). Remaining differences were w/in normal limits. All H Reflex L vs R latency differences w/in normal limits." INT: Normal

OTHER TESTS:
MRI W/WO contrast: normal (including vestibular apparatus, chochlea & otic capsules) w/ amall amount of T2/FLAIR/medial R temporal lobe. INT: Diagnostic consideraions: premature small vessel ischemic disease of aging or less likely demyelinating disease.

*Home Sleep Study: Normal
*Blood Work: RA, ANA, Sjogren's Ab's, serum protein electrophoresis, metals, Hep B/C - NORMAL
*IgG (normal), IgA (Low(74); RR(81-463), IgM (low(31);RR(48-271). NO IgE completed.
*Lumbar Puncture: Normal
*Carotid Ultrasound (EXT ART Bilateral): Normal w/ "minimal atheromatous plaque R&L carotid bifurcation
*EEG Awake/Sleep: Normal

*Neurological EVAL: Normal w/ "acrobatic contorsions w/ falling."
*CDP (ONLY): No report, but told "no evidence of vestibulopathy."
*Psychologist (Personality Assessment Inventory): High score- PTSD & increased anger (normal for me).

"DIAGNOSIS": 1. No objective evidence of neuropathy.
                           2. Somatization/conversion D/O
QUESTIONS:
1. What do you think about test results/"diagnosis?"
2. Should I consider more tests for Vestibulopathy or other?
3. Allergy Panel makes sense to me too?
3 Responses
1530171 tn?1448129593
I think a Somatization/conversion diagnosis is just a fancy way to say that mental stress and unexplained neurological factors are causing your condition, after all these tests! Oh my!

I would personally never accept this conventional diagnosis.

My suggestion is to go back to the fundamentals to get answers.
Anything else would be another wild goose chase, to my opinion, when
underlying comprehensive factors have not been investigated.

A complete hormonal panel* , allergy panel, vitamin D,  methylocobalamin and methyfolate deficiencies (MMA and/or Homosysteine CSF test)
should have been done right from the start!

Adrenal fatigue with secondary hypothyroidism, low cholesterol, low TISSUE magnesium, candidiasis, heavy metals toxicity, should all get ruled out.

My ultimate recommendation, find a really good Functional Medicine Doctor to facilitate all this for you..
I cannot see conventional doctors being much help in what I suggested.

Please note that my comments are not intended to replace medical advice.

Best wishes,
Niko
13013217 tn?1428186866
Thank you very much! For some reason I couldn't remember this website or find it. lol.
I really appreciate your comments and suggestions. I did find a naturopath who did a urine hormonal panel. He did say I had Adrenal fatigue, but it was suggested after one month to stop if I felt alright. Don't know what 'alright is' since I still have dysequilibrium.

I am working with a neurofeedback specialist now. I've been 3x's. It's very interesting and seems that it may help with PTSD, but not sure about vestibulopathy and other symptoms.

Thanks again.
1530171 tn?1448129593
Hmmm, the Naturopathic Medicine approach, usually calls for an adrenal stress profile, (4 x cortisol-24 hour and 2 x DHEA -averaged) a saliva test.

Adrenal fatigue DOES not resolve within one month! Depending which stage, it is typical to go one to two years, before any notable improvement is experienced. There are many people who suffer from AF for life!

Your disequilibrium may not have to do directly with AF though. It could be
a  separate neurological issue, on its own.

Let me know if you need any information about PTSD. I'm very familiar with this, not only as a former patient but as a practitioner.

Cheers,
Niko
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