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DrThomasMd
DrThomasMd, Board Certified MD
Category: Neurology
Satisfied Customers: 63757
Experience:  Internal medicine doctor, diagnose and treat neurology patients, many years
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65 year old female post colon ca 3 yrs ago former heavy

Customer Question

65 year old female post colon ca 3 yrs ago former heavy smoker presents with leg weakness bilaterally hands have muscle atrophy unsteady gait. Has had some falls. Some headaches no fever.
Has had 3-5 MRI of brain without contrast due to kidney function not meeting criteria
Has had full body pet scan with no evidence of disease
Findings
Fluid within mastoiditis ? Second to trauma. In Jan 2015 she fell down a flight of stairs when rushing. In dec 2014 was dancing and no problems
In April 2015 presented to dr with leg muscle weakness unsteadiness no hand atrophy
Sept 2015 same symptoms but also hands muscle atrophy
In spite of many doctors she is without a diagnosis and seems like slowly worsening
MRV of brain shows possible thrombosis right sided. This is where she had port for ca treatment
Symptoms are headache. Memory loss severe difficulty walking. Still doing stairs ok if holding railing. Still driving short distances
Impression on report
Fluid inside mastoiditis ? Second to trauma. Ct scan of temporal bones suggested to evaluate for possible fracture
Follow up on juggler thrombosis
Few foci of increased T2/FLAIR signal within both cerebral hemispheres could be due to traumatic white matter tract injury
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. David replied 1 year ago.

This is Dr. David

she could be suffering from mastoiditis infection with fluid in the mastoid area.

she might need a course of antibitoics or perhaps a long course of IV antibitoics to clear off the infection in the mastoid area since it can be hard for antibiotics to get into this area.

she should get an D dimer test and MRI angiogram of the brain to check for proper brain blood flow and blood clot risk.

she should get CBC blood counts to see if she has elevation of her WBC white blood cells which can be a sign of infection from mastoiditis.

let me know if you have questions.

Customer: replied 1 year ago.
I do not accept this response as I requested a neurologist
Expert:  Dr. David replied 1 year ago.

sorry, there was no neurologist available when the question was asked.

I am happy to opt out

and you can wait for a neurologist to see if they will take up the question.

Expert:  DrThomasMd replied 1 year ago.

Hello

I am a double board certified US doctor.

One of my board certifications in internal medicine.

We are required to train and test in neurology. Internists are specialists in adult medicine with training and testing in all of the adult subspecialties, and we take care of the patients.

Your question covers several areas of internal medicine, not just neurology.

Infection of the mastoid would be fairly characteristic on imaging. If there is this question, an internist or infectious disease internist would evaluate this for the correct treatment.

However, the report states this is secondary to trauma.

Cancer treatment itself can contribute to her symptoms.

A clotted cerebral vein can contribute to headache.

An MRA rather than an MRI alone can look at arterial vessels in the brain and this should be done.

An EMG/NCS needs to be done regarding the muscle atrophy, as this can be muscle disease and/or neuropathy.

A blood test, CPK should be done to look for muscle inflammation.

These are the starters.

You can save time on the site, get accurate, safe, up to date and comprehensive answers by finding me in medical by request. I am here daily.

I can answer all of your medical and integrative medical questions.

OK, so that is an initial answer….

Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.

Customer: replied 1 year ago.
Thank you but all u suggested has been done
As I requested we want a nerologist
Expert:  DrThomasMd replied 1 year ago.

I have opted out then. Cognitive problems from chemo are not something that conventional neurologists, hematologists, or other doctors have a good solution for. If you want to go into this, since I am opting out, you will need to find me in the medical category. Say, Dr. Thomas, I have a question, and use a request lock to me.

Good luck.