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Dr. SH
Dr. SH, Physician
Category: Neurology
Satisfied Customers: 8781
Experience:  Doctor of Medicine
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I have a history of head pain, flushing and dizziness with

Customer Question

I have a history of head pain, flushing and dizziness with bouts of intense weakness. I eventually went to a neurologist and had an MRI done - White matter hyperintensity throughout, scar tissue, and a punctuate foci on my right temporal lobe. Fast forward a month and I'm in the ER for heart palpitations, dizziness, shortness of breath. They do an MRI - now there's a 3mm lesion on my right frontal lobe. I'm admitted and the neurologists notice that my left side is presumably weaker than my right and at one point I was orthostatic hypotensive. They suggested I may have POTS and I'm going back for an autonomic test. Should I be worried at the presence of a new lesion in just a month? Should I also be worried about the progression of symptoms? All other blood work (and urine) came back within normal range with the exception of my cortisol which came back low, but after given synthetic, was reactive.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. SH replied 1 year ago.

Thank you for your question.

Do you have reports that you could attach on here for me please.

Thank you

Customer: replied 1 year ago.
Here is my first MRI - I copied and pasted for anonymity reasons. The second is a screen shot of my results - again, blurring the names of any doctorsLab Ref ID:
Order Date: 03/10/2016
Collection Date: 19:07:00
Requesting Physician:
INDICATION: Headache-R 51. Initial encounter.
TECHNIQUE: Multiplanar, multisequence imaging was performed at 1.5 Tesla.
A few punctate foci of T2/FLAIR hyperintensity scattered throughout subcortical
bihemisph***** ***** matter exhibit no restricted diffusion. Such nonacute findings,
slightly greater than are anticipated for the patient's stated age, are nonspecific,
representing sequela of remote ischemic, inflammatory, or demyelinating injury.
Given their distribution, migraine and vasculitis also are considerations.
Also nonspecific is a solitary punctate susceptibility-positive lesion within
the subcortical right lateral temporal lobe, occult on all other sequences,
suggesting remote microhemorrhage or old granulomatous disease.
The study is negative for infarct, hemorrhage, mass lesion, or hydrocephalus.
No extra-axial fluid collection.
Normal flow signal is present within anterior and posterior circulation. Major
dural sinuses are patent.
Marrow signal is normal. Orbits, paranasal sinuses, and temporal bones are clear.
1. Minor chronic supratentorial white matter change; differential diagnoses as above.
2. No acute intracranial abnormality.
Expert:  Dr. SH replied 1 year ago.

The MRI findings that are given are nonspecific and I do not think that your symptoms are related to your MRI findings.

I also think that POTS is a valid possibility.

MRI findings does not suggest any specific disease or anything serious or anything to worry about.

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Kindest regards