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M Javid, MD
M Javid, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 503
Experience:  American Board of Internal Medicine Certification in Internal Medicine and Infectious Diseases
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Stroke like symptoms, yet CT, MRI, all clear, LP test relatively

Resolved Question:

Stroke like symptoms, yet CT, MRI, all clear, LP test relatively clear (11). Toxicity tests clear. Variable motor and speech functioning since onset, seems to come in ways, body tremors when "episode" is occuring. Headache, dizziness and some nauseau. BP variable but being managed on meds. Currently hospitalized but nobody seems to have any answers. Suggestions?
Submitted: 3 years ago.
Category: Medical
Expert:  M Javid, MD replied 3 years ago.

M Javid, MD :

Hi

M Javid, MD :

Has she been tested for Lyme, syphilis and HIV?

M Javid, MD :

What about vasculitis and SLE?

M Javid, MD :

Has MRI been done with contrast and MR angiogram considered?

M Javid, MD :

Testing done for West Nile?

M Javid, MD :

I see no response from you, please post and I will be back.

M Javid, MD :

There is another condition that I would also consider, mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS)

M Javid, MD :

Have you heard about this?

Customer :

The did not use the contrast because they worried that it was too risky for kidneys, creatin and bun were elevated. We live in Alaska so Lyme and West Nile are unlikely if not impossible. She has had no fever since onset of symptoms one week ago. No joint pain is associated with her symptoms and SLE has not been mentioned by anyone as of yet.

M Javid, MD :

MELAS can also produce stroke like episodes, and it can occur after the age of 40

Customer :

Regarding MELAS she shows no lesions on the MRI or CT scan, I believe that is part of that diagnosis, correct?

M Javid, MD :

If she has not had MR angiography, that could be helpful in diagnosing vasculitis

M Javid, MD :

Yes, its a cause of metabolic stroke

M Javid, MD :

(MELAS that is)

M Javid, MD :

Have they also done an EEG to exclude seizures?

M Javid, MD :

And made sure no medications are involved?

M Javid, MD :

Thats all I have to suggest. You do not have to accept any answer unless you are totally satisfied. This was posted in the 'medical' section, you could also try posting asking for a neurologist to specifically answer your question.

Customer :

They did an EEG, but it was during one of her good spells and it produced nothing interesting for them.

M Javid, MD :

They could always repeat it, and if they still think about MELAS, a muscle biopsy may help, as well as a lactic acid level (though that can be normal)

M Javid, MD :

And like you said there can be CT/MRI abnormalities with it, but remember, no contrast used

M Javid, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 503
Experience: American Board of Internal Medicine Certification in Internal Medicine and Infectious Diseases
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