Seeking Guidance After Nine Months of Unexplained Neurological Disturbances
I’m a 27-year-old male weighing 210 pounds, and I’m not currently taking any medication. Nine months back, I visited the dentist for some fillings. During the procedure, after receiving an anesthetic injection of prilocaine, I began to experience an unusual sensation. It was as if warmth enveloped my body and I was slipping into an altered state of consciousness. Assuming it was a temporary side effect, I tried to dismiss it, but the sensations never faded. That altered state of awareness and some facial numbness have lingered for nine months, accompanied by a range of other neurological and psychiatric symptoms. These include memory issues, incessant burping sometimes leading to vomiting, and episodes that feel vividly surreal, almost psychedelic in nature. While I remain aware of reality, these occurrences are extremely unsettling, rendering me unable to function normally. There are previous posts that elaborate further on my symptoms (one of which can be found in my history). My life is virtually on hold; I cannot work and endure frequent, inexplicable panic throughout the day. My thought processes are muddled, and despite trying numerous medications—such as clonazepam, lamotrigine, oxcarbazepine, clonidine, gabapentin, and various antibiotics (to rule out infections), alongside multiple steroid treatments—I have seen no improvements. I am also set to begin antipsychotics in a few weeks. Both MRI and CT scans returned normal results, and although I was originally diagnosed with temporal lobe epilepsy, that diagnosis is no longer in play, leaving me without a clear medical explanation. What I experience is akin to a perpetual state of neither being fully awake nor entirely asleep; it feels like I am in a perpetual dream-like haze. Additionally, I notice a significant difference between the sensations on each side of my body—my left side feels as though it's been “sedated,” while my right side seems to function normally. Still, both sides share the same strength physically. At this point, I am uncertain about my next steps. My symptoms are unbearable, and it seems like I’m not progressing toward any viable treatment options, as nothing alleviates my discomfort. In fact, medications that are supposed to be calming or anxiety-reducing often exacerbate my perceptual disturbances, leading me to prefer anxiety over the intensified confusion. I would greatly appreciate any recommendations or insights into possible next measures.
Answers (1)
9/1/2025, 12:13:55 AM
OpenHealth AI
I understand that you're going through a deeply unsettling experience with persistent neurological symptoms and a lack of effective treatment. Your situation is complex, but I will aim to provide some structured guidance to help you identify the next steps you might take.
Main Points:
- Your symptoms could indicate an underlying neurological issue that requires targeted investigation.
- Continued evaluation and possible referral to specialists are essential next steps.
- Exploring non-medication-based strategies for symptom management may also provide some relief.
Explanation:
The symptoms you describe, particularly the altered state of consciousness, facial numbness, and surreal experiences, can be distressing and significantly impactful on your daily life. Given the current state of your health and the treatments you have already tried, it’s important to focus on what options are available for further evaluation and management. The unusual sensations might imply that the root cause is not clearly identified, which means further assessment could be beneficial.
Specific Next Steps:
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Neurology Referral: Request a referral to a neurologist with expertise in rare neurological conditions, especially if you haven't seen a specialist recently. They may conduct advanced testing, like neuropsychological assessments, and consider the possibility of other conditions such as complex regional pain syndrome, autoimmune disorders, or even rare side effects from the anesthetic.
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Symptom Diary: Maintain a daily diary tracking your symptoms, including their onset, duration, and any potential triggers. This can provide valuable insights both for you and your healthcare team. Note any correlations between symptoms and foods, activities, or emotional states.
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Mental Health Evaluation: Since you are experiencing significant anxiety and confusion, a consultation with a psychiatrist might help refine your treatment plan. This can be especially important given your mention of medications that have not been effective. Some psychotherapy techniques, like cognitive behavioral therapy (CBT), can also help you manage anxiety and provide coping strategies.
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Lifestyle Adjustments: Focus on small changes that might improve your overall wellness, such as:
- Mindfulness Practices: Techniques such as meditation or gentle yoga may help ground you during episodes of anxiety.
- Hydration and Nutrition: Ensure you are well-hydrated and eating balanced meals as sometimes dietary influences can affect neurological health.
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Support Groups: Consider joining a support group for individuals with chronic neurological symptoms. Connecting with others who understand your experience can provide comfort and could generate new ideas for coping strategies.
The combination of these evaluations and adjustments could help clarify your situation further and aid in symptom relief. Stay hopeful; sometimes it takes time to find the right path to healing, and your efforts to seek solutions are commendable. Please keep track of your symptoms, stay in touch with your healthcare provider, and lean on your support network as you navigate this challenging situation.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.