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Suggest Treatment For Tooth Pain, Loss Of Appetite And Numbness In The Mouth
Question: my husband is 80 years old. 2 weeks ago he had pain in tooth densest said he had no inflammation or teeth problem. since then pain in right side of mouth numbness on right side loss of appetite,he lost 20 lbs in 2 weeks. now he has double vision
Brief Answer:
Approach to the disease
Detailed Answer:
Hi XXXX, thanks for asking from HCM.
I can understand your concern. Your husband features are suggestive of
: Trigeminal (a brain nerve , 5th cranial nerve) involvement
: Systemic illness
As he is 80 years old, he must be evaluated rapidly to know the disease before it spreads. May you please answer my few questions, it will help me to look in to it further-
: Is there any history of diabetes?
: Is any history of fever, diarrhea, abdominal pain, mouth ulcer, urine problem?
: Any history of weakness in limb?
: Any history of smoking, alcohol abuse?
: Any prolonged illness and medication use?
After knowing these answers, I will try to make some conclusion and guide you further. Hope you will get my point.
Thanks
Take care
Approach to the disease
Detailed Answer:
Hi XXXX, thanks for asking from HCM.
I can understand your concern. Your husband features are suggestive of
: Trigeminal (a brain nerve , 5th cranial nerve) involvement
: Systemic illness
As he is 80 years old, he must be evaluated rapidly to know the disease before it spreads. May you please answer my few questions, it will help me to look in to it further-
: Is there any history of diabetes?
: Is any history of fever, diarrhea, abdominal pain, mouth ulcer, urine problem?
: Any history of weakness in limb?
: Any history of smoking, alcohol abuse?
: Any prolonged illness and medication use?
After knowing these answers, I will try to make some conclusion and guide you further. Hope you will get my point.
Thanks
Take care
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Brief Answer:
Pain relieving drug
Detailed Answer:
Hi XXXX, thanks for asking again.
I got your point. If he is having such severe pain. He might be suffering from "trigeminal neuralgia". If he is having pain after touching, washing face, eating, even with wind, it is most likely neuralgia.
The treatment of it is
: Tablet Tegretol 200 to 300 mg twice a day after proper prescription by a physician
Hope it will help you. If still no relief, do let me know.
Thanks. take care
Pain relieving drug
Detailed Answer:
Hi XXXX, thanks for asking again.
I got your point. If he is having such severe pain. He might be suffering from "trigeminal neuralgia". If he is having pain after touching, washing face, eating, even with wind, it is most likely neuralgia.
The treatment of it is
: Tablet Tegretol 200 to 300 mg twice a day after proper prescription by a physician
Hope it will help you. If still no relief, do let me know.
Thanks. take care
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
what kind of test needs to be done to determine if my husband has Trigeminal, he will be going to a neurologist next week for a work up.
Brief Answer:
Trigeminal Neuralgia (TN)
Detailed Answer:
Hi XXXX, welcome back.
Trigeminal Neuralgia is almost always diagnosed on clinical features. The typical history of
: Sharp shooting, lancinating pain over one side of face which is intermittent and triggered by few factors like
touching, washing face, wind
: Patient is totally symptom free intermittently.
It is confirmed by MRI brain with CISS or T2 drive sequence. This MRI shows compression of trigeminal nerve by some vessel or tumor.
Based on it, TN is confirmed.
Nothing more is required.
Hope you got your answer. If still in doubt, do let me know.
Thanks. Take care
Trigeminal Neuralgia (TN)
Detailed Answer:
Hi XXXX, welcome back.
Trigeminal Neuralgia is almost always diagnosed on clinical features. The typical history of
: Sharp shooting, lancinating pain over one side of face which is intermittent and triggered by few factors like
touching, washing face, wind
: Patient is totally symptom free intermittently.
It is confirmed by MRI brain with CISS or T2 drive sequence. This MRI shows compression of trigeminal nerve by some vessel or tumor.
Based on it, TN is confirmed.
Nothing more is required.
Hope you got your answer. If still in doubt, do let me know.
Thanks. Take care
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
my husband has a pacemaker the MRI is not able to be used. He had 2 CT of the brain all is normal
Brief Answer:
CT not a good investigation for Trigeminal
Detailed Answer:
Hi XXXX, welcome back.
CT brain is a very poor investigation for Trigeminal Neuralgia. You can ask the radiologist to cover your husband rest body to prevent effect of MRI rays on pacemaker.
Now there are methods which can be used to do MRI in patients of pacemaker, steel implants.
Another important point is description of pain as I mentioned in last answer. If his symptoms are matching, then it must be Trigeminal Neuralgia.
MRI Brain CISS is needed to know the vascular compression site. Because, sometimes when patient does not respond to medication, surgery is done based on MRI findings.
Hope you will understand my point. If still in doubt, do let me know.
Thanks. take care
CT not a good investigation for Trigeminal
Detailed Answer:
Hi XXXX, welcome back.
CT brain is a very poor investigation for Trigeminal Neuralgia. You can ask the radiologist to cover your husband rest body to prevent effect of MRI rays on pacemaker.
Now there are methods which can be used to do MRI in patients of pacemaker, steel implants.
Another important point is description of pain as I mentioned in last answer. If his symptoms are matching, then it must be Trigeminal Neuralgia.
MRI Brain CISS is needed to know the vascular compression site. Because, sometimes when patient does not respond to medication, surgery is done based on MRI findings.
Hope you will understand my point. If still in doubt, do let me know.
Thanks. take care
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
my husband had a spinal tap and it came back with elevated protein level what can this mean. also the dr say husband has cavernous sinus how serious is this condtion
Brief Answer:
Diagnosis of elevated protein
Detailed Answer:
Hi XXXX, welcome back.
I understand your concern. Raised CSF protien can be due to
: Meningitis or CNS Infection
: Tumor
: Subarachnoid haemorrhage
: Resolving meningitis or encephalitis
Diagnosis can be confirmed after knowing CSF sugar, Cells, presence of malignant cells, culture. You can message me all these reports.
Now coming to CAVERNOUS SINUS, it is normally present in body. Its thrombosis or fistula can damage trigeminal nerve and causes numbness over face or severe pain. Kindly ask your doctor if he is having any cavernous sinus disease.
Hope it will help you. if any doubt, do let me know.
Thanks. Take care.
Diagnosis of elevated protein
Detailed Answer:
Hi XXXX, welcome back.
I understand your concern. Raised CSF protien can be due to
: Meningitis or CNS Infection
: Tumor
: Subarachnoid haemorrhage
: Resolving meningitis or encephalitis
Diagnosis can be confirmed after knowing CSF sugar, Cells, presence of malignant cells, culture. You can message me all these reports.
Now coming to CAVERNOUS SINUS, it is normally present in body. Its thrombosis or fistula can damage trigeminal nerve and causes numbness over face or severe pain. Kindly ask your doctor if he is having any cavernous sinus disease.
Hope it will help you. if any doubt, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Brief Answer:
Nasopharyngeal B lymphoma prognosis and treatment
Detailed Answer:
Hi XXXX, welcome back.
It is sad that your husband is having tumor. As it is a B cell lymphoma (non-Hodgkin), it is treated by chemotherapy and radiotherapy. The problem is his age. Because chemotherapy drugs can cause severe weakness, toxic effects in body.
It can cause serious burden to him. Radiotherapy has also a good role. It is less damaging as compared to chemotherapy because it affects only local tissue.
You can discuss the treatment with your doctor. He will first investigate him for
- complete blood counts, hemoglobin
- liver function test
- kidney function test
- bleeding, clotting time
Only after fitness, this treatment can be given. The usual protocol is combination of chemotherapy and radiotherapy if localised disease (stage I and II) and of only chemotherapy if advanced disease (stage III and IV).
Now coming to the prognosis, it will depend upon the grade.The probability of survival at 18 months was equal to
100% for stage I and II
55% for stage III
25% for stage IV.
You can tell me the grade after confirming it with your doctor.
Hope it will help you.
Thanks. Take care
Nasopharyngeal B lymphoma prognosis and treatment
Detailed Answer:
Hi XXXX, welcome back.
It is sad that your husband is having tumor. As it is a B cell lymphoma (non-Hodgkin), it is treated by chemotherapy and radiotherapy. The problem is his age. Because chemotherapy drugs can cause severe weakness, toxic effects in body.
It can cause serious burden to him. Radiotherapy has also a good role. It is less damaging as compared to chemotherapy because it affects only local tissue.
You can discuss the treatment with your doctor. He will first investigate him for
- complete blood counts, hemoglobin
- liver function test
- kidney function test
- bleeding, clotting time
Only after fitness, this treatment can be given. The usual protocol is combination of chemotherapy and radiotherapy if localised disease (stage I and II) and of only chemotherapy if advanced disease (stage III and IV).
Now coming to the prognosis, it will depend upon the grade.The probability of survival at 18 months was equal to
100% for stage I and II
55% for stage III
25% for stage IV.
You can tell me the grade after confirming it with your doctor.
Hope it will help you.
Thanks. Take care
Above answer was peer-reviewed by :
Dr. REMY KOSHY
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