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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35009
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have a pulsitile lump on the right side of my neck. I have

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I have a pulsitile lump on the right side of my neck. I have had seesaw vision, more in the right eye i am very ubalanced and sometimes feel as if I am falling. Tachicardia as well as shortness of breath. I have seen many doctors with no diagnosis. Facial flushind starts about 7pm. It lasts hours. Heart and lung work ups were normal. I have also had a lot of weight gain . My uvula bounces with my pulse. Headaches are common too. Any suggestions?

Hello Amy,
I am Dr. Arun and will be helping you today.

Was a colored doppler study done (specialized ultrasound) for the pulsatile neck mass?
Have you consulted any specialist?

Hello Amy,

Did your doctor consider an MRI of the brain for your symptoms of headache, unsteadiness / imbalance and feeling of falling?
Just to confirm; the pleomorphic adenoma is of parotid salivary gland?

Customer: replied 3 years ago.

I have had 2. In the last year. They were clear.

Hello Amy,

Are your present main concerns;

seesaw vision, more in the right eye,
shortness of breath
facial flushing.

Are you stressed and anxious?

Customer: replied 3 years ago.

Some and I can't sleep. I cry and am more easy to anger.


What did your thyroid and adrenal function tests show?
Is your thyroid completely in the normal range with your medication?
Customer: replied 3 years ago.

Yes low normal. Since that time my Levothyroxine was decreased to 25mg. I don't know what my thyroid levels are now. That was about 2 weeks ago. Did I mention alpecia. Seems as if my hair has been falling more in the last 2 weeks.

Customer: replied 3 years ago.

Diagnosed with Hashimoto's Thyroiditits last Oct. Last TSH was in low normal. Cortisol has been low 4 times over the past year. I passed the adrenal function test twice. Can't remember the name but blood was drawn at 30 and 60 minutes. I passed with a low normal response at 60 minutes.


At the outset, I would consider an autoimmune disorder with all the people who have been diagnosed with a Hashimoto thyroiditis which too is immune mediated disorder. So following investigations if not done may be considered;

1) Erythrocyte sedimentation rate,

2) Thyroid function tests,

3) Muscle enzymes;

4) Anti-nuclear antibodies (ANA)

5) Adrenal function test

6) Anti-dsDNA

7) Anti-Sm

8) Anti-SSA (Ro) or Anti-SSB (La)

9) Coombs test

10) Anti-histone

Stress and anxiety can also be partly playing in your symptoms conglomerate.

The causes to consider for facial flushing are;

A. Drugs and medications; your medicines do not seem to be responsible for it and a periodic flushing is not likely due to it. The medicines responsible can be

1) nicotinic acid,

2) diltiazem

3) alcohol

4) vancomycin,

5) amyl nitrate

6) nifedipine,

7) levodopa,

8) bromocriptine

B. Anxiety; this is most important in your case.

C. Various cancers; I would not consider them here; though I am enumerating just for the completion of the list.

1) carcinoid syndrome

2) kidney cancer

3) leukemia

4) VIPoma

5) systemic mastocytosis

6) thyroid cancer (medullary)

D. Physiological reasons.

1) ingestion of hot drinks

2) ingestion of monosodium glutamate

So anxiety need to be considered as cause. For initial screening testing for plasma peptides such as gastrin, calcitonin, vasoactive intestinal polypeptide, and somatostatin, as well as urine excretion of 5-hydroxyindole acetic acid, metanephrine, or histamine and other tests of endocrine function, such as adrenocorticotropin-stimulation test for adrenal insufficiency, should be considered by your physician. Than the medical imaging like CT scan of the abdomen and MRI may be done. It is extensive, I can understand but since it is periodic, a complete evaluation will give peace of mind.

Most headaches are caused by following:

Tension-type headache

Migraine headache

Chronic daily headache

Cluster headache

Chronic daily headache is not a type of headache but frequent headaches of various kinds. Most people with chronic daily headache have migraine or tension-type headache as the underlying type of headache. Tension headaches are the most common type of primary headache. So probably this would be the first to be considered in the differential diagnosis of your headache also. A tension headache is a headache caused by tense muscles in the face, neck, or scalp. These headaches give a feeling of tightness around the head. The neck muscles can also become sore and tight. Tension headaches can be caused by staying in one position for a long time, such as reading, playing video games or using a computer.

Migraine headaches are the second most common type of primary headache. Cluster headaches are a rare type primary headache.

Instability and imbalance can occur in migraine headache but it is difficult to differentiate between migraine and tension type headache without an examination. There are other causes of headache also;

1) sinus headache.

2) Medication overuse headache

3) Post trauma headache; occur after injury or accident.

4) Secondary headache; brain tumor.

Usually a doctor's examination is sufficient to ascertain the cause of headache. But occasionally x-ray of the sinus and CT scan or MRI (done for you as you mentioned) and magnetic resonance arteriography (MRA) of the brain may be needed, especially if the headache is persisting for long is worsening and is accompanied by symptoms like vomiting, vision disturbances and imbalance. After the tension headaches commonest headache are migraine. Aura and vision disturbances are absent, many times in migraine. Please read the symptoms of the migraine in this resource;

There are two types of medications used for the treatment of migraine;

1) To abort the attack


Dopamine antagonists



2) To prevent the headache


Valproic acid, gabapentin

Calcium channel blockers

Beta-blockers, tricyclic antidepressants

There are dietary triggers known which should be avoided. Common triggers are

a) chocolate,

b) aged cheeses and meats,

c) wine and beer

d) citrus fruits.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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