Home › Forums › OvidDx Live Workshop Forum › Seventy year old woman with Neurologic symptoms
- This topic has 3 replies, 2 voices, and was last updated 3 weeks, 4 days ago by abatson.
May 4, 2023 at 7:18 pm #2379rhollanderParticipant
I have an interesting case to share that I believe is most likely a mind-body condition. The patient is a seventy year-old woman who I have gotten to know through a community organization. I am not her physician so I don’t have access to any medical reports, but she is a good historian. August 2022, while on what she reports was a Relaxing vacation at a lake with friends, she had new severe onset of right sided headache over her right eye radiating to the back of the head. This headache lasted chronically. After urgent and ongoing extensive testing, all normal, which I will outline later, She Had adjustment in her BiPAP Machine for sleep apnea which seemed to help But not completely. A few weeks later in fall 2022, she developed sudden right tongue deviation, right arm weakness, and right facial weakness. I wish I knew what she was doing at that moment, but I will have to ask her next time I see her. She was seen immediately at an ER and all testing was normal. I might add for non-physicians that these symptoms don’t fit the right pattern for a stroke. these neurologic symptoms resolved in fairly short order, although I don’t recall if it was less than 24 hours or more. except the tongue deviation continues to persist now and although her speaking has improved greatly to the point that no one notices a difference, she still feels that her tongue is large in her mouth and speaking is still not quite the same. She had to stop singing in her choir due to these symptoms. stress is significant for a son who lives out of state and estranges himself from her off and on because of issues that she relates to his bipolar disorder and he blames her for not being able to keep female relationships. She has been divorced twice and she lives alone. She did 12 years of counseling for herself more than a couple decades ago. Both her parents died when she was in her 20s. stress regarding her son fluctuates in severity off and on over the years, but she does not feel there was any significant stress shortly before or during the Times that her symptoms started. The testing that she has had since any symptoms started altogether in August 2022 include multiple brain MRIs, brain CT, lumbar puncture, extensive blood testing all normal except they found a spike protein and now a specialist has concern for a precursor to multiple myeloma. She is currently seeing this specialist in Little Rock, Arkansas Who just ordered “19 vials of blood“ to look further. Of note, Little Rock is the world leader in medical research on multiple myeloma, so you can see the bias here. I suspect this is a significant case of overdiagnosis in medicine and I’m not sure how multiple myeloma would relate to her symptoms. She otherwise has diabetes. she is open to the idea of Mind-Body syndrome and borrowed books from me including the way out by Alan Gordon and Dr. Schubiner‘s unlearn your pain workbook, but I’m not sure how convinced she is yet after talking with her and she has not read very much so far. I had to politely decline accompanying her on her visit to see the multiple myeloma specialist next week to follow up on the 19 vials of blood! I don’t have any specific questions about this case, but if anyone has comments or thoughts, I’m interested! RachelMay 4, 2023 at 7:27 pm #2380abatsonParticipant
Very interesting. I would also like to know what happened just before she got the first symptom – the R sided headache while on a “relaxing” vacation. A lot of times patients will present the appearance of everything being “lovely and normal”, but I always want to know what was being talked about, what was said, was were they thinking about just before getting the first symptom. Often times, it is not so “lovely and normal” – comments made, memories arise, thoughts going through your mind, locations and surrounding events – why was she on vacation and with whom? – other triggers that may not be as obvious to the patient, but might be triggering the neural circuits on more sub-conscious levels.May 4, 2023 at 9:01 pm #2385rhollanderParticipant
I agree, Alicia. I asked her that question specifically and she couldn’t come up with anything. She said she wasn’t anxious preparing to leave for vacation and she went with good friends. There weren’t any disturbing conversations that she could recall. I told her that sometimes something innocuous can remind our subconscious of something disturbing in our lives. I encouraged her to think about it and she seemed to be open to it. RachelMay 4, 2023 at 9:23 pm #2390abatsonParticipant
I like that you encouraged her to think about it. Sometimes, a patient will come back 1-2 visits later with an “ah-ha!” moment of realization. Also, so many times, they aren’t really sure if the stressor “counts” as a stressor. They will minimize, laugh about it, make a sarcastic statement or put themselves down – all clues that there is something deeper or something they feel uncomfortable with. Today, a patient told me his childhood was great, not stressors however, by the end it came to light that his parents NEVER hugged him or his sister or said I love you until 3 months ago (he is 44 years old!). He laughed about it. He has an adult pattern of having relationships with women with whom he “can’t see the red flags”. He doesn’t understand what normal affection looks like, sounds like or feels like. That is a very different example compared to what you were talking about, but I just bring it up to show how complex these memory associations can be.
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