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Sumanth Amperayani
Sumanth Amperayani, Board Certified MD
Category: Medical
Satisfied Customers: 1883
Experience:  Consultant Pediatrician at Kanchi Kamakoti CHILDS Trust Hospital
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I have been having a lot of unusual symptoms. I had a

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Hi – I have been having a lot of unusual symptoms. I had a digestive issue, which as a parent to morph into a neurological concerns. Isabella been having whooshing in my ear at night-pullsaite tinnitus and POTs -tachardyia when standing up, i had an MRI/MRA no contrast which said mostly normal but that I have a fed hyper intense small foci
In the supratentoroal white latter which are non specific which could represent changes of mild small vessel ischemic disease. MRA mosltly normal except: theire is an irregular appearance of the vertebral arteries which is likely arifactual but was suboptimally evaluated/without contrast. I had a carotid artery ultrasound which was normal. Would this account for evaluation of vertebral arteries?
Customer: replied 6 months ago.
Hi-also have tingly headache-month straight and numbness in legs which comes and goes.
Hi...Welcome to Just Answer. I am Dr. Sumanth Amperayani and I am here to help you today. I have 13 years of experience in the field of Health Care at a tertiary care referral hospital. I will do my level best to alleviate your health concern. I am currently reviewing your question. I will be back in a moment to guide you further.Kind regards ***** ***** Sumanth Amperayani
Customer: replied 6 months ago.
Ok thanks!
Hi...I understand your concern.
MRA was suggestive of irregular appearance of vertebral arteries and this was without contrast.
Carotid artery ultrasound was normal.
You are symptomatic with headache and neurological symptoms in lower limbs.
You will require an MRA with contrast for complete evaluation please.
Whatever has been done will not account for complete evaluation of vertebral arteries please." I sincerely ***** ***** I have helped you, and that I have earned my 5 star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen (this is the only way we professionals get credited for our time and professional effort). We can continue here until you are satisfied, simply use the reply box and let me know.A bonus is highly appreciated....Thank you!".If you are happy with my interaction and guidance, next time if you have any health concern, you can approach me directly at the following link please -https://www.justanswer.com/medical/expert-drsumanth/?rpt=3800Kind regards ***** ***** Sumanth Amperayani
Customer: replied 6 months ago.
What could irregular arteries mean. How about small ischemic vessel disease? Should I get MRI with contrast?
Hi...
1. Irregular arteries without a contrast angiography does not mean anything. It could just be tortuous arteries, that's all. They may or may not be pathological.2. Small vessel ischemic disease means the blood supply to the watershed areas of brain is getting hampered and this again requires Contrast MRA as I had suggested earlier.3. Rather than an MRI with contrast, an MRA with contrast would be giving a clearer picture.Best regards ***** ***** Sumanth Amperayani
Customer: replied 6 months ago.
Last question-what do you make of hyperintense foci? Could any of this play into numb legs, headache, and internal tremors I have had-forgot to mention. Will leave tip when I get home.
Hi... hyperintense foci in supratentorial white matter means that these could be the areas which are getting less blood supply due to ischemia of the small blood vessels.In my first interaction itself I have suggested that as you are symptomatic, you need further evaluation with contrast. The symptoms are definitely neurological, including tremors and be related to the MRI findings please.
Best regards ***** ***** Sumanth Amperayani
Customer: replied 6 months ago.
Thanks-the review of the scam turned out to be nkrmsl. The only thing found was hyper intense foci on white matter. Being that I have signs of POTs, tremmor at night, urinary icontenence, and tingly headache, would you recommend autonomic system testing? Would MSA be a concern or autonomic failure? Briefly spoke with my doc but he just said autonomic nervous system and not much else.
Customer: replied 6 months ago.
Sorry for typos-small phone

Yes please, autonomic nervous system testing would be prudent here as the tachycardia, tremors and urinary incontinence are pointing towards it.

MRA may not pick up autonomic abnormalities.

For autonomic system testing - Standard laboratory testing evaluates cardiovagal, sudomotor and adrenergic autonomic functions. Cardiovagal function is typically evaluated by testing heart rate response to deep breathing at a defined rate and to the Valsalva maneuver. Sudomotor function can be evaluated with the quantitative sudomotor axon reflex test and the thermoregulatory sweat test. Adrenergic function is evaluated by the blood pressure and heart rate responses to the Valsalva maneuver and to head-up tilt. Tests are useful in defining the presence of autonomic failure, their natural history, and response to treatment.

Best regards ***** ***** Sumanth Amperayani

Customer: replied 6 months ago.
Does this sound like as something as severe as MSA?
Customer: replied 6 months ago.
Would MRI pick up autonomic issues?
Customer: replied 6 months ago.
Thanks-will add tip.
Customer: replied 6 months ago.
Excellent!

No...MRI will not pick up autonomic issues. That is the reason why I had suggested you the next steps please.

First let us see the response of tests to autonomic system and then we will talk about multiple system atrophy.

I believe it is not right in too much of negative thinking before data about multiple system atrophy.

It is capital mistake to theorize before data.

Best regards ***** ***** Sumanth Amperayani

Sumanth Amperayani and 6 other Medical Specialists are ready to help you
Customer: replied 6 months ago.
Thanks!
Customer: replied 6 months ago.
One more question -I have some buzzing and tremors at night. It’s lije a movin mg sensation. I forgot to mention I have some stenosis and herniated disc in the back. Could that account for leg stiffness and pain as well as urinary incontenence. Here are results:
Customer: replied 6 months ago.
There are no order-level radpath link.
Study ResultMRI CERVICAL SPINE WO CONTRAST
HISTORY: cervical radiculopathy
COMPARISON: None.
TECHNIQUE: Multiplanar multisequence MRI of the cervical spine was performed without contrast.
FINDINGS:
Alignment: Normal vertebral alignment. Straightening of the cervical lordosis.
Vertebral heights: Normal.
Vertebral marrow signal: Normal.
Intervertebral discs: Normal disc heights.
Disc findings by level:
C2-C3: No focal disc protrusion, spinal canal stenosis, or neural foraminal stenosis.
C3-C4: No focal disc protrusion, spinal canal stenosis, or neural foraminal stenosis.
C4-C5: No focal disc protrusion, spinal canal stenosis, or neural foraminal stenosis.
C5-C6: No focal disc protrusion, spinal canal stenosis, or neural foraminal stenosis.
C6-C7: No focal disc protrusion, spinal canal stenosis, or neural foraminal stenosis.
C7-T1: No focal disc protrusion, spinal canal stenosis, or neural foraminal stenosis.
Spinal canal: No evidence of epidural fluid collection or hematoma.
Spinal cord: Cervical cord demonstrates normal caliber and T2-weighted signal.
Facet joints: Normal facet joints.
Paraspinal soft tissues: Normal.
Other findings: None.
IMPRESSION:
Unremarkable MRI of the cervical spine. No significant disc protrusion, spinal canal stenosis, or neural foraminal stenosis.MR lumbar spine wo contrast
Status: Final result
Order-Level RadPath Link:There are no order-level radpath link.
Study ResultMRI LUMBAR SPINE WO CONTRAST
HISTORY: lumbar radiculopathy
COMPARISON: None
TECHNIQUE: Multiplanar multisequence MRI of the lumbar spine was performed without contrast.
FINDINGS:
Alignment: Normal lumbar lordosis. No spondylolisthesis.
Vertebral heights: Normal.
Vertebral marrow signal: There is degenerative hypointense signal the superior endplate of L2 and inferior endplate of L1. Otherwise, unremarkable.
Intervertebral discs: There is moderate intervertebral disc space height loss at L1-L2, with associated Schmorl's nodes. Mild disc space narrowing at L3-L4 and L4-L5
Disc findings by level:
T12-L1: No focal disc protrusion, spinal canal stenosis, or neural foraminal stenosis.
L1-2: No focal disc protrusion, spinal canal stenosis, or neural foraminal stenosis.
L2-3: Small disc bulge, without significant spinal canal or foraminal stenosis.
L3-4: Small disc bulge, without significant spinal canal stenosis. There is mild left subarticular zone narrowing. Mild foraminal stenosis bilaterally. Mild facet degeneration.
L4-5: Small disc bulge, with superimposed right paracentral and foraminal disc protrusion, resulting in mild to moderate right foraminal stenosis, and right subarticular zone stenosis. No significant mass effect on the traversing right L5 nerve.
There is also a central disc protrusion and annular fissure. No spinal canal stenosis.
L5-S1: No focal disc protrusion, spinal canal stenosis, or neural foraminal stenosis.
Spinal canal: No evidence of epidural fluid collection or hematoma. Normal position of the conus medullaris and spinal nerve roots.
Facet joints: Normal facet joints.
Paraspinal soft tissues: Normal.
Other findings: None.
IMPRESSION:
Right paracentral and foraminal disc protrusion at L4-5, resulting in mild to moderate right foraminal stenosis, and right subarticular zone stenosis. No significant mass effect on the traversing right L5 nerve.
No spinal canal stenosis at any lumbar level.

It will account for pain and sensation in legs.

But bladder abnormality is usually either autonomic related or related to center of spine problem like syringomylia.

Customer: replied 6 months ago.
twitching, jolts, moving, electrical pulse feeling? Is this pinched nerve or something else?

These symptoms can be attributed to spinal cord compression...like a pinched nerve.

Customer: replied 6 months ago.
Makes sense. So last thing I am thinking. Can tingly persistent headache and even POTs be related to spine? If so, would physical therapy or chiropractic help. It seems like the pukksaite tinnitus and POTs came in recently and legs are acting up agaim.
Customer: replied 6 months ago.
Almost feels like “out of body” experience when I sleep. I amgerrig sleep study to see if jolting and a bit of gasping my sleep apnea or something else. Pulsate feeling goes through chest.
Customer: replied 6 months ago.
My eyes also hard to open like they are stuck when I wake up- muscles feel stuck not like sleep in the eyes.
Customer: replied 6 months ago.
Nothing wrong found with eyes.

Hi...you need to work yourself up for - autonomic nervous system evaluation.

The other problem is - myasthenia gravis.

I want you to mention this to the treating physician and if the physician is convinced get evaluated for that too.

I am putting this as a possibility is as the eye lids are difficult to raise.

Best regards ***** ***** Sumanth Amperayani

Customer: replied 6 months ago.
Tjhank you!
Customer: replied 6 months ago.
Thanks:)

Hi..I am happy that my interaction was helpful for you and put your mind at ease. In future you can opt me as your favorite medical expert so that you can ask me a question directly. I will be happy to help anytime.

Kind regards ***** ***** Sumanth Amperayani

Customer: replied 6 months ago.
I got a message from you. The last question I have (I see an infectious disease doctor) is that I got back my GI report which says I have Entamoeba histolytica and some other intestinal/pancreatic imbalances. This test was sent off and they made a mistake processing, so not sure if amoeba is still present to the same degree because of improved symptoms. Can parasites be correlated with numbness and tingling in leg, rib pain, and non-specific neurological concerns such as headaches?

Hi... entamoeba cannot be correlated with the above pain or non specific neurological symptoms please.

Best regards

Customer: replied 5 months ago.
I I am having intense migraines that don’t respond to over the counter.’eds. In head, tingling and numbness. Now a burning sensation. Also twitching of eye when I sleep and bobbing over head. Feels like a pulse runs through me when I sleep and out of body sensation.
Customer: replied 5 months ago.
Provisional diagnosis fibromyalgia with autonomic dysfunction -mild. I feel like I am falling and jolt awake when I sleep. Heart skips a beat or feels like it-falling sensations.

I am responding in the other thread please.