OpenHealth Q&A

Understanding My Symptoms: Seeking Clarity on Possible Diagnoses

Hello, everyone, I appreciate you taking the time to read and provide your insights. While I recognize that this is not a substitute for professional medical advice, I would be grateful for any informed opinions, guidance, or general knowledge you can share. Here's a bit about my situation: I’m a 44-year-old female experiencing a range of perplexing symptoms, which seem to appear randomly. Some of these include: - Instances of memory loss where I forget recent actions or lose track of what I was doing. - My ability to concentrate fluctuates significantly; I can be overly focused at times, while at other moments my thoughts drift, often without my awareness until I realize I’ve missed crucial information. - I struggle to retain information, leading to misunderstandings in my everyday interactions; I’ve been accused of failing to follow through on plans, even though I believed I was in agreement with the other person—this has left me feeling disoriented and confused about reality. - Occasionally, my hearing feels impaired. - My vision sometimes deteriorates suddenly, presenting as blurriness or a grayish shadow, along with occasional issues with depth perception. - I've noticed a certain clumsiness and a rigid walking style, accompanied by stiffness, particularly after waking up, but it can also occur sporadically throughout the day. - Sensory misperceptions have occurred, wherein I confuse hot and cold sensations. - I experience numbness and tingling in my limbs sometimes. - Pressure that should be soothing, such as a gentle massage on my thighs or lower back, can result in severe discomfort or feels bruised. - I suffer from headaches, which can be intense at times. - For several years, I’ve dealt with nausea that arises if I move too quickly upon waking, often resulting in dry heaving. Initially, I thought it was related to blood sugar, but it resembles symptoms of motion sickness. - Recently, I’ve experienced a few troubling episodes of choking on my saliva, seemingly without warning. - My most recent medical assessment indicated abnormal reflexes. - I often feel nerve-like shocks in my left pinky toe that can radiate up to my ankle, as well as similar sensations in my right thumb. - Occasionally, I hear ocean-like noises in my ears, which can come with ringing or a sudden pressure that temporarily obstructs sound in one ear. After discussing my symptoms, I requested a Nerve Conduction Test, but my provider opted for an MRI with and without contrast. The results indicated: **IMPRESSION:** 1. No acute cerebral infarct, hemorrhage, or mass effect. 2. Scattered mild foci exhibiting T2 hyperintensity in white matter suggestive of chronic microvascular ischemic disease, though this is more pronounced than expected for my age. There is less likelihood of a demyelinating condition based on these results. Further evaluation for vascular conditions, such as systemic lupus erythematosus (SLE), is recommended. **EXAMINATION:** MRI imaging of the brain was performed with and without the contrast agent gadobutrol. Circumstantial history includes abnormal reflexes and sudden vision impairment, raising concerns for a demyelinating condition or an intracranial mass. **FINDINGS:** No diffusion restrictions indicative of an acute infarct were found, though there are signs of microvascular ischemic changes in the white matter. No other concerning abnormalities were observed in the ventricles, sulci, or other structures. Additionally, my lab tests returned “normal” results, indicating no signs of SLE, autoimmunity, or inflammation. My prevailing diagnosis is Small Vessel Disease, and I have been referred to a specialist neurologist due to significant MRI findings and my current symptoms. Notably, my blood pressure, cholesterol levels, and blood sugar are all within healthy ranges. I'm seeking your input on whether these symptoms might point to anything beyond what I've been diagnosed with. Do you have suggestions for questions I should pose to my neurologist? Am I unreasonable in considering a spinal MRI to rule out multiple sclerosis, despite indications from the radiologist and my provider suggesting it’s less likely? In the context of my diagnosis, how would you classify the severity of these symptoms—are they mild, moderate, or severe, and are they typical based on what I’ve described? Thank you for your valuable feedback; it means a lot to me.

Answers (1)

9/8/2025, 4:20:43 AM

OpenHealth AI

It sounds like you're going through a very challenging and complex situation with your symptoms. I appreciate you sharing so much detail, which provides important context for understanding your health concerns. Here’s a concise summary of the main points and some actionable guidance moving forward.

Main Points

1. You have a range of neurological symptoms that have led to a referral to a neurologist.
2. Current MRI findings suggest microvascular ischemic disease but do not strongly indicate a demyelinating condition like multiple sclerosis.
3. You are seeking clarity about your symptoms, potential further evaluations, and questions to discuss with your neurologist.

Explanation

The symptoms you described—including memory issues, concentration fluctuations, sensory misperceptions, and episodes of clumsiness—are complex and can result from various neurological, vascular, or even psychological factors. The MRI results indicating mild changes in your white matter suggest chronic microvascular ischemic changes, which can sometimes be linked to vascular risk factors, even if those factors are currently normal in your blood tests.

While it appears that multiple sclerosis might be less likely based on your results, it’s understandable to consider all options, particularly if your symptoms seem to evolve or worsen. Consulting with a neurologist will be crucial, as they can perform a comprehensive evaluation and offer targeted tests to clarify your diagnosis.

Next Steps

1. Prepare Questions for the Neurologist:

   • What is your interpretation of the MRI findings?
   • Given my symptoms, what additional tests (like a spinal MRI) do you recommend?
   • Could these symptoms be related to small vessel disease, and what does that mean for my future health?
   • Are there lifestyle changes or treatments that could help manage my symptoms?
   • How often should I follow up to monitor my condition?

2. Consider Symptom Tracking:

   • Keep a journal noting the frequency, intensity, and triggers of your symptoms. This may help the neurologist better understand your condition.

3. Follow Recommendations:

   • Make sure to schedule your appointment with the neurologist soon and be proactive about discussing any new symptoms or changes you notice.

4. Continue Self-Care:

   • Ensure that you’re supporting your cardiovascular health with a balanced diet, regular physical activity (as tolerated), and stress management techniques, as these can positively impact your condition and overall well-being.

5. Consider Support Resources:

   • Seek out support groups or forums where you can connect with others experiencing similar challenges. Sharing experiences can help you feel less isolated and provide additional coping strategies.

It's vital to engage actively in your healthcare and follow through with the necessary evaluations. Remember, your concerns are valid, and seeking clarity is an important part of managing your health. If any new or concerning symptoms arise, don’t hesitate to bring them to the attention of your healthcare team. I'm here if you have more questions or need guidance!