OpenHealth Q&A

Seeking Clarity on Abnormal Blood Work and Cranial Nerve Issues

At 33 years old and residing in the UK, I find myself increasingly frustrated with the National Health Service's lack of support, which has prompted me to seek help here. **Medical Background:** I welcomed a new baby not long ago through an elective C-section and had a straightforward recovery, aside from some minor stitch issues. Previously, I was diagnosed with vaso-vagal syncope during my teenage years, but I have managed it successfully and haven’t experienced an episode in a long time. I also have ADHD for which I take Concerta at a dose of 36mg. To aid my sleep, I take Trazodone at 200mg and a daily multivitamin. Aside from my C-section, I've had two surgeries—a skin abscess removal two years ago and the extraction of an impacted wisdom tooth around the same time. My nutritional habits could be classified as average; I consume a good variety of fruits, vegetables, and meats, though I do occasionally indulge in sweets. Standing at 5’6” and weighing about 70kg, I’m currently on the higher end of a healthy BMI, particularly as I’m postpartum. Recently, I discovered I'm expecting again, but I have experienced some bleeding, raising concerns about a possible miscarriage. I have an appointment with my doctor this week to check my HCG levels. **Recent Health Crisis:** In late May, I experienced an unprecedented migraine. Unlike my usual bilateral migraines that relate to my menstrual cycle, this one struck unilaterally on the left side and was the most intense pain imaginable. It was accompanied by ptosis of the left eye, a tremor in my left hand, slurred speech, double vision, and heightened sensitivity to light, making reading or typing impossible. Following a visit to my GP, where I was dismissed, my mother took me to the hospital. There, an emergency CT scan ruled out a stroke. I was scheduled for an MRI and received pain relief in the form of cocodamol before being sent home. Just two days later, my migraine escalated to a debilitating level, and I felt incredibly ill. Again, I returned to the hospital, where I was given more pain relief prescriptions, including amitriptyline and diazepam. Four days later, unable to endure my symptoms any longer, I implored for assistance and was transferred to a different hospital for further evaluation by an eye specialist, who identified my problems as neurological rather than ocular. During my inpatient stay, I underwent an emergency MRI scan that revealed inflammation in the 3rd, 5th, and 6th cranial nerves, along with thickening of the optic nerve. Alongside this investigation, a range of blood tests were conducted. After previously being prescribed pain relief, I was changed to sumatriptan, which provided some temporary relief but didn’t eliminate the returning migraines or the persistent headaches, alongside ongoing double vision and eyelid drooping. Currently, I'm relying on paracetamol for pain management and use sumatriptan as needed for migraine symptoms when they emerge. Following some improvement, I was discharged with instructions to rest at home. I have had outpatient scans, including MRIs and contrast-enhanced CT scans, though I am still awaiting those results. However, several concerning blood test results arrived post-discharge. Among the findings, a full blood count indicated low red blood cell levels at 3.75 (normal range: 3.8-5.5) and low hematocrit at 0.355 (normal range: 0.37-0.47), along with elevated lymphocytes at 5.64 (normal range: 1-4). Additionally, my liver profile displayed an ALT level of 42 (normal range: 1-35), and there’s a borderline acetylcholine receptor antibody serum result at 5.3 (normal range: 0-6). I'm continuing to experience regular headaches and muscle weakness. Mornings tend to feel better, but overall, I’m struggling immensely and feeling lost amid these troubling blood test results. If anyone has insights or advice on what might be happening, I would greatly appreciate it.

Answers (1)

6/23/2025, 1:10:48 PM

OpenHealth AI

I'm really sorry to hear about the challenges you're facing, especially with your health compounded by your recent pregnancy. It seems like a very complex situation, and I want to provide you with the clarity and direction you're looking for.

Main Points:

You have several concerning symptoms and abnormal blood test results, which need careful consideration. Your symptoms—including migraines, neurological issues, and abnormal blood findings—may indicate a need for further investigation to determine the underlying causes. It's essential to follow up closely with your healthcare providers, especially with pending MRI and CT results.

Explanation:

1. Neurological Symptoms: The inflammation in your cranial nerves and the symptoms you're experiencing, such as slurred speech and ptosis, indicate that there might be an underlying neurological issue. Conditions like multiple sclerosis, myasthenia gravis, or even autoimmune disorders could be considered. The borderline acetylcholine receptor antibodies suggest the need for further evaluation for myasthenia gravis.

2. Blood Results:

   • Low Red Blood Cell Count/Hemoglobin: This may indicate anemia, which can cause fatigue and weakness. Possible causes include nutritional deficiencies or blood loss.
   • Elevated Lymphocytes: This could suggest an ongoing infection or an inflammatory process.
   • Elevated ALT Level: This may indicate liver inflammation or issues, which could also be due to medications or an underlying condition.

Next Steps:

1. Stay Hydrated and Nourished: Focus on a balanced diet with adequate iron-rich foods (like red meat, beans, and spinach) and ensure you’re hydrating well. As you're postpartum, it's also vital that you maintain good nutrition for both your recovery and the health of your new pregnancy.

2. Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their intensity, and any potential triggers. This information will be valuable for your healthcare team.

3. Prepare for Your Upcoming Doctor Appointment:

   • List all your symptoms, their timelines, and any changes you've noticed in your condition since your last visit.
   • Bring up your blood test results and ask about their implications. Specifically, inquire about follow-up tests for your elevated acetylcholine receptor antibody and any necessary evaluations for autoimmune diseases.

4. Pain Management Adjustments: Continue to use paracetamol for mild pain management as needed. For more severe pain, coordinate with your doctor regarding the continued use of sumatriptan or explore other options that may be suitable given your current condition.

5. Consider Mental Health Support: The stress of your symptoms, combined with being a new parent, can be overwhelming. If you're feeling particularly anxious or low, reach out for mental health support; it may greatly improve your overall well-being.

6. Keep a Flexible Mindset: Be open to the possibility of multiple factors contributing to your symptoms, which may require a team approach to address effectively.

I know this is a lot to process, but prioritizing these steps may help clarify the situation and put you on the path toward feeling better. You're doing a great job seeking help, and I truly hope you find the answers and relief you need soon. If you need further details or clarification, feel free to ask.