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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 26383
Experience:  Over 20 yrs of Family Practice
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My wife has had issue with pain at the base of her head at

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My wife has had issue with pain at the base of her head at the neck on the right side. This has caused her bad headaches and then she experienced numbness and tingling and burning on her right arm and hand, then both arms and even her feet. She also has balance issues and fatigue and she has lost 20 pounds in a year without trying. She saw her family doctor, an orthopedist, a chiropractor, and physical therapist, an ENT doctor and a neurosurgeon to find out what is wrong. She had an xray of her head and neck, an MRI on her cervical spine, brachial plexus area and her brain. At first they thought she had an infection or virus in her mastoid joint, but this was not it. Then they thought she had a bulging disk in her neck ,but the mri was negative. They put her on prednosone which helped for a little, but my wife wanted to find out the cause and stopped taking it. PT did nothing to help. She feels pressure in her ear and head, but the brain MRI showed nothing but a minor pituitary abnormality that the surgeon said could be due to her period. No MS lesions or tumors. The surgeon said there was nothing more he can do. He suggested seeing an auto-immune doctor but my wife wants to see a neurologist yet. She is still having the following symptoms, head pain and pressure mostly in the right side and near her head base, pressure in ears, arm hand and foot numbness, coldness and tingling and burning. Sometimes face numbness on her right side. Problem with balance especially when standing still, wants to go to the left, plus some motor function impairment in her hands. Looking for direction on who to see, whether it should be a neurologist or an autoimmune doctor? What autoimmune diseases can cause these symptoms? If not a tumor or MS, then what other disorder of the CNS should she be evaluated for?
Hi--sorry to hear about your wife. May I first ask if she has any specific medical conditions and what medications she takes?
Customer: replied 3 years ago.

She has migraines sporadically. Takes excedrine migraine when needed, other than that no major medical issues.

And both MRI's--the reports came back absolutely normal? Did she have specific blood work for possible autoimmune disorders and other conditions?
Customer: replied 3 years ago.

Neurosurgeon said that there is obviously inflammation going on,but the MRI did not reveal any MS lesions or tumors. They tested her blood for Lyme disease and infections. The only thing that came back was slightly elevated liver counts due to the pain meds she was taking (Vicodin). But no other autoimmune diseases other than Lyme. She just wants to know what may be causing her symptoms and what doctor to go to.

OK--all I can do here is to give you my thoughts as to possible causes and how to work those up--will that be sufficient?
Customer: replied 3 years ago.

Yes. The radiologist had flagged her pituitary gland to have it rechecked in a year due to a small micro edoma????not sure that is the name...but that it was nothing that would cause any of her symptoms

OK--and we can continue after this if you need more information. Here are the possibilities--vitamin B12 deficiency, heavy metal toxicity as with mercury or lead, and autoimmune disorder like a polyneuralgia or polymyositis, and possibly ALS (Lou Gehrig's disease). I would get blood work for all of those plus an MRI of her entire spine, nerve conduction studies and EMG's, and I'd consider a muscle biopsy. The tests can mostly be done by her primary care physician but after that I would first have her seen by a neurologist and/or a rheumatologist depending on the results.
Customer: replied 3 years ago.

Oh one more thing I forgot...she had an EMG and it was normal. Does that change anything?

Not really as far as the possibility of ALS which can be a bit difficult to diagnose
Customer: replied 3 years ago.

Two more questions and I will be satisfied. Would CIDP be a possibility, also her main complaint is the headache and pressure, would these possible disorders cause those symptoms?

Yes I would unclude CIDP and I forgot to mention that a spinal tap would be appropriate as an additional test. The headaches could be from muscle spasms in the neck and a polyneuralgia/polymyalgia could cause that
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