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Dr. David
Dr. David, Board Certified MD
Category: Neurology
Satisfied Customers: 46724
Experience:  Experienced physician in Neurology
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4 months ago 10 minutes after headache sudden left sided

Customer Question

4 months ago
10 minutes after headache sudden left sided heaviness, weakness, muscle twitches, muscle spasms left side only.. leg ,trunk, arm but not the face.
Nausea, difficulty focusing while reading, unsteadiness, head pressure, intreverted feeling
Nasea lasted 2 months strait and now only returns after lifting something heavy and I get hissing in my head and ears in tune with my pulse.
daily right temporal pulating pain multiple times per day but only lasts 2 seconds
avoiding heavy lifting and sexual intercourse
Joints and ligaments on entire left side of my body are tightening and shorting. Painfull
to componsate for weakness.
strength is 3 out of 5 on left side and 5 out of 5 on right side.
all other neurological tests are normal. reflexes are normal. Needle emg, brain mri, brain mra, cervical mri, coratid ultrasound, all normal.
can you review some of my mri images and give your opinion?
given my sysmptoms, My area of concern is in the posterior limb of the internal capsule
Please advise
Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. David replied 2 years ago.
This is Dr. David

yes, I can review your MRI scan

I hope they used IV contrast.

do you have an MRI scan report? was the MRI scan report normal?

how old are you?

do you have a history of excessive anxiety or panic attacks?

are you right handed?
Customer: replied 2 years ago.

Hi Dr.

I need to speak with a neurologist or a neuro radiologist.

Please advise

Expert:  Dr. David replied 2 years ago.
I have extensive experience in neuro radiology.

I'm happy to look at your MRI images.

did you have IV contrast with your MRI scan?
Customer: replied 2 years ago.

the most recent mri was on 1/19/2015 and was done 3 days after the weakness started.

Due to the symptoms, my area of concern is in the posterior limb of the right internal capsule. I see something on my mri and have put an error pointing to it. I have compared with 4 previous mri done with other reasons before the this event happend, I cannot see anyting simular to what I see on the most recent one.

Please review the images and let me know if it is of any convern.

Expert:  Dr. David replied 2 years ago.
I see that spot

that is not an abnormality of the brain

I don't see any IV contrast done in the MRI scan.

without IV contrast, many issues can be missed.

also you have only showed T1 non contrasted weighted images

there are also T2 and FLAIR and images on most brain MRI scans

T2 and FLAIR give indication where swelling is in the brain.
Customer: replied 2 years ago.

Expert:  Dr. David replied 2 years ago.
those are the T2 images

there is no brightness in that right insular capsule area

which means there is no mass and no swelling and no abnormality in that area causing your symptoms.

you never told me how old you were

and if you have a history of excessive anxiety

what medications are you taking?

you could have a problem in your cervical spine possibly

and you never answered if this MRI scan was with contrast. it looks like it was a non contrast MRI scan which means if you are still having symptoms you should get it repeated with IV contrast.
Customer: replied 2 years ago.

thanks

male 40 years old

non contrast mri

Had bad retention with gad retention, will not use again

in 2011 had a bad concussion on right tempal, nausea, head pressure, pusatile tenitis, for eight months straight. then nausea only after exertions. took 2 years to be able to lift heavy things again..

hit my hit in the exact same spot 2 days prior to this wekaness starting.

have all the same symptoms except I now have left sided heaviness and weakness. 3 out 5. muscle twictch and spams.

Next mri was normal.

what are your thoughts on the following scans

1. Diffusion DTI mri to better evalute concussion and white matter

2. MRA/ MRV to evalute vessals and possible benign intracranial hypertension.

3. MRA of the neck

4. Lumbar Puncture ( last resort beacuse it's invasive.. do not harm first")?

my right side is perfiect, just need the other half working....

your thoughs.

Expert:  Dr. David replied 2 years ago.
non contrast MRI scan is not good to look for concussion damage to the brain

if you have had a history of concussion and symptoms of concussion, you have concussion, even if the brain MRI scan doesn't show it

MRI scans don't always show concussion.

you need gadolinium if you want to get a MR Angio. you had urinary retention before with gadolinium?

you never told me if you were right handed or left handed .

you might benefit from physical therapy to help strengthen your left side.

your lumbar puncture most likely will be normal
Customer: replied 2 years ago.

yes, massive gad retention. bad

both handed, but I write with my right.

I was a cross country mountain biking and rock climbing athlete before this. and was in great shape..

there has to be an explanation for the weakness...

and am stumped

Expert:  Dr. David replied 2 years ago.
there is an explanation for you weakness.

bad cerebral concussion can cause one sided weakness

concussion are often not seen on brain MRI scan.
Customer: replied 2 years ago.

a few more questions:

1. Considering I have daily right sided temporal headaches and head pressure, I could link that to the left side of my body correct?

2. if there is no evidence of physical damage to the nervous system then will will the weakness go away.?

3. would you recomend a spinal tap for the head pressure, pulsatil tinitis, and right sided headache?

4. Would a dti mri scan be best to this?

thanks

Expert:  Dr. David replied 2 years ago.
right headed concussion would cause right side headaches and left arm weakness possibly

you have had concussions before. your concussions have taken months to years to get better.

I don't recommend a spinal tap. it most likely will be normal and could worsen your headaches and cause spinal headaches for a period of time

diffusion tensor MRI scan could help

but if you are going to have another MRI scan, I would get a 3 tesla high resolution MRI scan with contrast if possible. your prior MRI scan looks like a 1.5 tesla MRI scan

3 tesla MRI machines are higher resolution.

let me know if you have other questions.

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me with "a question for Dr. David" if you have any other questions

here is my website if you need to reach me again:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com
Customer: replied 2 years ago.

so, my initial questions was:

Mri was done on a 3t

1. is this area on the mri normal beacuse it appears different then any previous mri. What exactly is that I am seeing? it seems a bit hyperintense for a t1?

2. I can't find any link to one sided weakness with concussion on the internet, unless there is visable brain damage.

Considering that there is twitching along with this only on the left side, one would assume that this is upper motor neuron in nature?

3. if there any where else in the brain or spinal tract that could cause weakness in the arm trunk and leg but not the face on one side?

4. symptoms seems to fluctuate in serverity but never normal, could this be a mild perfusion issue? Should I evaluate MRA/MRV of head and neck?

5. agree on the spinal tap..and the dti

Expert:  Dr. David replied 2 years ago.
1. you could be seeing part of the hippocampus. it could be from how the brain was sliced. it is normal.

you can see a neurologist and get nerve conduction studies to see if they are normal on your left side

the twitching could be benign fasciculations of mild twitching of nerves and muscles right below the skin which can be seen in patients who have excessive anxiety or fatigue or dehydration or electrolyte imbalances.

fluctuating symptoms means that this is not from an upper motor neuron damage

you didn't answer if you had excessive anxiety or worry symptoms

from your questions it sounds like you are having lots of anxiety over this

excessive anxiety can manifest mild weakness symptoms and make you worried about mild symptoms.

excessive anxiety can also fluctuate.
Expert:  Dr. David replied 2 years ago.
let me know if you have other questions.

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me with "a question for Dr. David" if you have any other questions

here is my website if you need to reach me again:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com