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Have Gastroparesis, Non Alcoholic Fatty Liver Disease And Pcod. Worried For Creutzfeldt Jakob Disease?

Posted on Tue, 18 Dec 2012

Question: I'm a 20 year old female and 3 months ago after smoking a hookah for 3 nights in a row I developed insomnia, memory loss, muscle twitches, cognitive decline much like brain fog where I cant think straight or quickly, depression, anxiety and visual disturbances. Two weeks later I had an MRI done which came back normal except for total blockage in my sinuses, I was given steroids and antibiotics but my condition did not improve. I have had a an abdominal and pelvic CT scan and everything was normal. My blood work was normal except for elevated white blood count, elevated proteins, low vitamin D. This past summer I was diagnosed with gastroparesis, non alcoholic fatty liver disease and polycystic ovary disease, I have not had a period in 5 years. I recently had an EEG done by a neurologist and it was abnormal, he said I had diffused slowing and spikes in the background. He thinks I may have had an acute case of bacterial meningitis due to my severe sinusitis and these are the after effects. His final diagnosis was metabolic encephalopathy, he scheduled a follow up sleep deprived EEG to rule out a seizure disorder. I'm afraid it something worse like Creutzefeld XXXXXXX Disease. I have no family history of neurological illness. I still have sinusitis and I am taking estradiol and progesterone.

Answered by Dr. Sudhir Kumar (6 hours later)

Hi XXXXXXX

Thank you for posting your query.

First of all, I would like to reassure you that your symptoms do not suggest a diagnosis of Creutzfeldt XXXXXXX disease (CJD). All the 20 cases of CJD that I have seen have been older people, mostly above 60. Rapidly progressive dementia is the hallmark of CJD, and most patients have severe dementia within 3-6 months of onset.

In your case, metabolic encephalopathy is a possibility, especially related to thyroid disease (Hashimoto's encephalopathy). It can be detected by a blood test- thyroid antibodies. If positive, it responds well to steroid therapy.

Regarding meningitis, it is unlikely. However, the same can be ruled out with a lumbar puncture (CSF analysis).

EEG would be useful in excluding epilepsy.

Please also check serum vitamin B12, as its deficiency can lead to cognitive decline.

I hope it helps. Please get back if you have any more queries.

Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (5 minutes later)

Thank you for your response. My B12 has been checked and it was normal as well as my thyroid and parathyroid, unless Hashimotos requires a different test? What other illness could have such a sudden onset in a 20 year old? I'm really scared I'm dying.

Answered by Dr. Sudhir Kumar (7 minutes later)

Thank you for getting back with more details.

For diagnosing thyroid encephalopathy (Hashimoto's encephalopathy), we need to do thyroid antibody testing- anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin antibodies.

Since your MRI brain is normal, it excludes any serious disease of brain, such as vasculitis, multiple sclerosis, tumors, etc.

Hope it helps. Please get back if you have more queries.

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (13 minutes later)

Wouldn't I have gotten better when I took steroids for my sinus infection?

Answered by Dr. Sudhir Kumar (1 hour later)

Hashimoto's encephalopathy requires high dose steroid therapy. The typical dose is 1000 mg daily given intra venous as infusion for 3-5 days, which is much higher than what is given for other indications.

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar