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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 7746
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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I have been and still am experiencing unsteadiness, a feeling

Customer Question

I have been and still am experiencing unsteadiness, a feeling of fullness in the head, minor leg tremors, and tingling in the face that seems to be more prominent in the morning but does occur at night as well. Went to my PCP and he sent me for an MRI of the brain. Results stated findings are compatible with mesial temporal sclerosis for which clinical correlation is recommended. It also noted that a low grade glioma cannot be ruled out. Saw my neurologist shortly after and he didn't seem to concerned and dismissed the possibility of a low grade glioma and did not seem to concerned with mesial temporal sclerosis. Is that something to be concerned with? Neurological examination was normal. I had a normal EEG as part of a general epilepsy (long history of such) work up. I also obtained a brain MRI I had in 2007 and submitted it to the imaging center for comparison. The addendum noted the same abnormal findings but there were no changes. If I didn't feel like garbage everyday I would gladly ignore all this and move on but I don't feel good at all. All I want to do is sleep because I'm miserable. What should be my next course of action? Should I get a second opinion? Explore other possible causes of these symptoms?
Submitted: 10 months ago.
Category: Medical
Expert:  Dr. Rick, MD replied 10 months ago.
Hi. My name isXXXXX and I am online and available to help you today. Thank you for your patience.
Do you have any medical problems or take any medications?
This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
Customer: replied 10 months ago.

I take 500mg daily of Tegretol.

Customer: replied 10 months ago.

History of Epilepsy since I was a young child and have been on Tegretol for most of my life. Every time I was slowly taken off the medication I had a seizure but while on the medication I have never had a seizure.

Expert:  Dr. Rick, MD replied 10 months ago.
Matt,

Thank you for that extra information. I am glad to hear that the Tegretol is controlling your seizure activity so well.

When it comes to MRI, Xray findings etc clinical correlation is always the "gold standard" for figuring out if something seen on these studies is anything to worry about. In your case, from what you have posted, including your other test results and the fact that this "lesion" was noted 6 years ago and is now without change, I have to agree with your Neurologist:

Do not give this MRI finding a second thought. It is nothing to worry about and has nothing to do with how you are feeling.

So. What to do? That is an excellent question. I do think another opinion is a good idea. But who to consult with?

At this point I would suggest going to a Professor of Neurology at a Large University Teaching Hospital.

Why a Teaching hospital? Because at an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.

The Mayo Clinic in Rochester, Minnesota is an excellent example of just such a place as this. That being said there are many excellent teaching hospitals all across the country and I am sure that there is one near you.

Does this make sense to you?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Customer: replied 10 months ago.

So it is likely these symptoms are related to a neurological issue but not the issues identified on this MRI since there has been no progression or change of said lesion correct? For informational purposes what exactly is mesial temporal sclerosis? Is it actually a lesion?

Expert:  Dr. Rick, MD replied 10 months ago.
Matt,

Mesial temporal sclerosis just means that there is scarring in the inner portions of the temporal lobe, which is a part of your brain. It is a very common finding in patients with a seizure history like yours. It is a lesion, but not the type that would cause the symptoms you are reporting.

I'm not saying that this is a neurological issue, Per se, but rather that with your history and complaints I think that would be a good place to start at the University should you choose to go that route.

Does this make sense?


It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 7746
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
Dr. Rick, MD and 10 other Medical Specialists are ready to help you
Customer: replied 10 months ago.

Thank you for all the information. I started getting bad anxiety about this being a tumor and decided to give this site a try and you relieved a lot of my anxiety. I will take your advice and go to a university medical center to see if I can find out the cause of these symptoms and get it resolved. There is actually one a few miles from where I live. Again thank you for your help. Much appreciated.

Expert:  Dr. Rick, MD replied 10 months ago.
Matt,

I'm glad I could help to relieve your anxiety over the MRI finding and point you in the right direction to, hopefully, get some good answers.

Take care and have a good evening.

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