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What Causes Neck Lymphadenopathy And Upper Eye Edema When Diagnosed With Lymphoid Hyperplasia?
Question: i need a second opinion on my facial ct scan and cervical mri....is that possible... i have neck lymphadenopathy and upper eye edema.... also diagnosed lymphoid hyperplasia of the nasopharynx...major headaches/sinus/pressure on the right side of the head...
pain goes from the sinus to the ears and back of the head... also have major eye floaters which i did not have before.... i was a very very healthy 32 year old a.... sometime i get episode of uncontrollable shaky hand with sudden lost of coordination and memory.... pain always focused on the right side....
pain goes from the sinus to the ears and back of the head... also have major eye floaters which i did not have before.... i was a very very healthy 32 year old a.... sometime i get episode of uncontrollable shaky hand with sudden lost of coordination and memory.... pain always focused on the right side....
Brief Answer:
Possible to review CT and MRI scan, details below
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. I regularly review CT and MRI scan reports and images and will be glad to help you out. Please send me the details you want to be reviewed. If you want me to review the reports then please upload them and I will help you understand them better.
If you require review of images too then you have to upload the images from CD to Dropbox or google drive and send me download link in your follow up query.
2. Lymphoid hyperplasia in the nasopharynx relates to growth of lymphatic tissue in the region upper part of the throat which is behind the nose.
3. Neck lymphadenopathy is enlargement of lymphnodes in the neck. The neck is an area where lymphnodes are distributed and due to they enlarge due to disease.
4. Lymphoid hyperplasia and neck lymphadenopathy might cause certain non specific symptoms and you might be experiencing them.
5. The pain on right side might be due to pressure on nerve roots.
Please write back with updates.
Regards,
Dr.Vivek
Possible to review CT and MRI scan, details below
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. I regularly review CT and MRI scan reports and images and will be glad to help you out. Please send me the details you want to be reviewed. If you want me to review the reports then please upload them and I will help you understand them better.
If you require review of images too then you have to upload the images from CD to Dropbox or google drive and send me download link in your follow up query.
2. Lymphoid hyperplasia in the nasopharynx relates to growth of lymphatic tissue in the region upper part of the throat which is behind the nose.
3. Neck lymphadenopathy is enlargement of lymphnodes in the neck. The neck is an area where lymphnodes are distributed and due to they enlarge due to disease.
4. Lymphoid hyperplasia and neck lymphadenopathy might cause certain non specific symptoms and you might be experiencing them.
5. The pain on right side might be due to pressure on nerve roots.
Please write back with updates.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. XXXXXXX
First of all thanks for your kind answer. I should of definitely signed up here way before. Here is the requested link for the MRI image file. I have taken the time to export the dicoms in jpg for your convenience. Please note that this mri is 1 year old....although im scheduled to take another one since my neck pain have largely intensified. I have also palpable kind crunchy feeling masses in the back of the neck which feels like the pain is originating from and sometime unbarable almost thinking i will faint. I have had abx in the past which seemed to help.... looking forward for a professiona advice as i am out of solutions....
here is the link as requested.
https://www.YYYYbox.com/sh/0000
Regards,
XXXX
First of all thanks for your kind answer. I should of definitely signed up here way before. Here is the requested link for the MRI image file. I have taken the time to export the dicoms in jpg for your convenience. Please note that this mri is 1 year old....although im scheduled to take another one since my neck pain have largely intensified. I have also palpable kind crunchy feeling masses in the back of the neck which feels like the pain is originating from and sometime unbarable almost thinking i will faint. I have had abx in the past which seemed to help.... looking forward for a professiona advice as i am out of solutions....
here is the link as requested.
https://www.YYYYbox.com/sh/0000
Regards,
XXXX
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. The images are 79 in number and the nasopharyngeal lymphoid hyperplasia is confirmed. I suppose you have a benign cause for the nasopharyngeal lymphoid hyperplasia. Few patients have a malignancy that causes this presentation and I guess your doctors have ruled out a malignancy and therefore it is benign in nature.
In some people, benign naspharyngeal lymphoid hyperplasia might happen due to chronic smoking.
Usually patients have frequent infections and this requires symptomatic treatment.
Treatment with steroids and medicines also help some people.
Should there be difficulty in breathing and narrowing of air space then surgery might be required.
2. There is also disc degenerative changes in the cervical spine at levels C 3 - 4 and C 4 - 5 levels and this might cause some symptoms.
3. It is important to know the course of treatment and any opinions provided by your doctor.
4. The masses at the back of your neck might require a clinical examination and if required, an ultrasound scan might help.
5. I have a work station with DICOM software at my end. If there are more images than the ones already sent then I request you to please upload the complete CT contents including DICOM images to Dropbox and I will have a look at each of the series of images.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. The images are 79 in number and the nasopharyngeal lymphoid hyperplasia is confirmed. I suppose you have a benign cause for the nasopharyngeal lymphoid hyperplasia. Few patients have a malignancy that causes this presentation and I guess your doctors have ruled out a malignancy and therefore it is benign in nature.
In some people, benign naspharyngeal lymphoid hyperplasia might happen due to chronic smoking.
Usually patients have frequent infections and this requires symptomatic treatment.
Treatment with steroids and medicines also help some people.
Should there be difficulty in breathing and narrowing of air space then surgery might be required.
2. There is also disc degenerative changes in the cervical spine at levels C 3 - 4 and C 4 - 5 levels and this might cause some symptoms.
3. It is important to know the course of treatment and any opinions provided by your doctor.
4. The masses at the back of your neck might require a clinical examination and if required, an ultrasound scan might help.
5. I have a work station with DICOM software at my end. If there are more images than the ones already sent then I request you to please upload the complete CT contents including DICOM images to Dropbox and I will have a look at each of the series of images.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
All these symptoms appeared after a major root canal infection which required 2 surgeries....Could the infection have went into deep neck region which could explain the degeneration ? I also always test positive for a group C strep upon throat culture. I already had an ultrasound of the back of the neck and they could not see anything problematic... may i add that they could not see the hyperplasia either on the mri and was only diagnosed following endoscopy.... I had couple abx treatment for the tooth infection and it all seemed to ease the symptoms....although i have a lot of swollen lymph in the neck, some doctor dont feel the urge to give me abx while some tend to want to treat towards the strep c..... im very confused....
I do seem to have frequent infection and also recently tested slightly positive for EBV and filiarisis infection....could this be related ? What are the possible symptomatic treatment you are mentionning ? Can the degenerescence cause big problem in the future ? Is there anything i can do to return to a normal life ?
And can we see anything abnormal in the back of the neck region ? Sorry for all these questions.....your help is very much appreciated
I do seem to have frequent infection and also recently tested slightly positive for EBV and filiarisis infection....could this be related ? What are the possible symptomatic treatment you are mentionning ? Can the degenerescence cause big problem in the future ? Is there anything i can do to return to a normal life ?
And can we see anything abnormal in the back of the neck region ? Sorry for all these questions.....your help is very much appreciated
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. Root canal surgery due to dental infections will never cause any deep involvement leading to cervical spine disc degeneration. However the position during root canal might have been uncomfortable to you and your cervical spine discs were already having degenerative changes and extending your neck during the position might have made you aware of the symptoms. Please remember that it is not due to infection travelling deep in to the spine.
2. The nasopharyngeal lymphoid hyperplasia is present in an area of pre existing lymph tissue. On retrospection it is slightly increased in appearance and can be called nasopharyngeal hyperplasia.
3. Any infections including strepto group C might increase in frequency due to nasopharyngeal lymphoid hyperplasia.
4. Even EBV infection is closely related to nasopharyngeal lymphoid hyperplasia. Research shows that most of the nasopharyngeal lymphoid hyperplasia tissues taken from the patients with an elevated serum antibody titer carry EBV, which is harbouring in the nuclei of a few infiltrating and hyperplastic B-lymphocytes. EBV infection in these lesions is not an important event, having no substantial significance in development of NPC. Therefore these might be seen together but are of particular concern.
5. Filariasis is also a parasitic infection of lymph channels and might cause diffuse lymph node involvement.
6. The degeneration in the cervical spine is usually an age related finding. There are 7 small bones in the neck spine and nerves come out through the gap between two bones. There are discs to provide cushioning to the bones. When the disc is showing degeneration, there is a possibility of the disc moving backwards and causing pressure on the nerve roots which is experienced as pains, tingling and numbness. Treatment involves physiotherapy and medicines like pain relievers. Your condition is still in the early stages and surgery is not required. Thought if your neck spine continues to be under stress then the pressure on the nerves might have to be released through disc surgery.
7. There is nothing significantly abnormal in the back on the images sent earlier.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. Root canal surgery due to dental infections will never cause any deep involvement leading to cervical spine disc degeneration. However the position during root canal might have been uncomfortable to you and your cervical spine discs were already having degenerative changes and extending your neck during the position might have made you aware of the symptoms. Please remember that it is not due to infection travelling deep in to the spine.
2. The nasopharyngeal lymphoid hyperplasia is present in an area of pre existing lymph tissue. On retrospection it is slightly increased in appearance and can be called nasopharyngeal hyperplasia.
3. Any infections including strepto group C might increase in frequency due to nasopharyngeal lymphoid hyperplasia.
4. Even EBV infection is closely related to nasopharyngeal lymphoid hyperplasia. Research shows that most of the nasopharyngeal lymphoid hyperplasia tissues taken from the patients with an elevated serum antibody titer carry EBV, which is harbouring in the nuclei of a few infiltrating and hyperplastic B-lymphocytes. EBV infection in these lesions is not an important event, having no substantial significance in development of NPC. Therefore these might be seen together but are of particular concern.
5. Filariasis is also a parasitic infection of lymph channels and might cause diffuse lymph node involvement.
6. The degeneration in the cervical spine is usually an age related finding. There are 7 small bones in the neck spine and nerves come out through the gap between two bones. There are discs to provide cushioning to the bones. When the disc is showing degeneration, there is a possibility of the disc moving backwards and causing pressure on the nerve roots which is experienced as pains, tingling and numbness. Treatment involves physiotherapy and medicines like pain relievers. Your condition is still in the early stages and surgery is not required. Thought if your neck spine continues to be under stress then the pressure on the nerves might have to be released through disc surgery.
7. There is nothing significantly abnormal in the back on the images sent earlier.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I also tested positive for lyme disease following a western blot test after being bitten by a tick....could that be relevant ? What would be your approach to treat a patient with my condition ?
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. You might have had early stage Lyme disease as you tested soon after the tick bite.
2. Treatment for this condition includes antibiotics like doxycycline or amoxicillin or cefuroxime for adults for a 14 to 21 day course.
3. Some people have persisting symptoms like muscle pains and fatigue which do not resolve with antibiotics. It is said that activation of immune system after tick bite might cause this. This is presently under research.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. You might have had early stage Lyme disease as you tested soon after the tick bite.
2. Treatment for this condition includes antibiotics like doxycycline or amoxicillin or cefuroxime for adults for a 14 to 21 day course.
3. Some people have persisting symptoms like muscle pains and fatigue which do not resolve with antibiotics. It is said that activation of immune system after tick bite might cause this. This is presently under research.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again for your response.
I have been exposed largely to soil and birds during some work on a farm before the symptoms appeared. Could i have a cryptococcus yeast type of infection ? And what should i do next considering all the element of my case.... thank you
XXXXXXX
I have been exposed largely to soil and birds during some work on a farm before the symptoms appeared. Could i have a cryptococcus yeast type of infection ? And what should i do next considering all the element of my case.... thank you
XXXXXXX
Brief Answer:
Repeating MRI as scheduled and follow up with your doctor is important
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. There is a need of repeating your MRI scan too look for any change in findings as compared to the earlier one and please ask your doctor to suggest any imaging for the masses at back of neck if required.
2. Cryptocuccus infection is a possibility only if your immunity is low. I do not think you will be having a compromised immunity to give you cryptococcus infection. Nasopharyngeal lymphoid hyperplasia is not associated with cryptococcus infection.
3. Right now you should get back to your doctor and get treated for Lyme disease if you have not taken a longer course of antibiotics earlier.
4. If required you might also consult an infectious disease specialist and get examined clinically in detail.
5. For the cervical spine degenerative changes it is important to consult a neurosurgeon and probably your symptoms will get controlled with physiotherapy and occasional pain relief medicines and ointments.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Repeating MRI as scheduled and follow up with your doctor is important
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. There is a need of repeating your MRI scan too look for any change in findings as compared to the earlier one and please ask your doctor to suggest any imaging for the masses at back of neck if required.
2. Cryptocuccus infection is a possibility only if your immunity is low. I do not think you will be having a compromised immunity to give you cryptococcus infection. Nasopharyngeal lymphoid hyperplasia is not associated with cryptococcus infection.
3. Right now you should get back to your doctor and get treated for Lyme disease if you have not taken a longer course of antibiotics earlier.
4. If required you might also consult an infectious disease specialist and get examined clinically in detail.
5. For the cervical spine degenerative changes it is important to consult a neurosurgeon and probably your symptoms will get controlled with physiotherapy and occasional pain relief medicines and ointments.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
i might have had immunity has i was under a lot of stress after the lost of a close one and taking corticosteroid for 4 month for the hyperplasia....which in fact made it worst...and was a lot exposed to mold in soil as welll as birds. If the hyperplasia is infectious in origin isnt it counter indicated to take steroid and suppress immunity function at the site ? About lyme...i have seen an infectiologist here and this illness is not recognized under western blot test and my c6 elisa came back negative....doctor dont believe that lyme exist here... they did not treat my filiarisis either even though they have the positive result for it... they refered me to a psychiatrist....and they dont find any reason to my symptoms....even if i have severe lymphadenopathy and hyperplasia as well as unexplained severe sudden floaters in the eyes....
i also had sudden arthritis in the knees and hip and heart palpitation as well as elevated temperature for a while....all this confirmed and observed by the doctors.... had also esinophilia and a little higher than usual lymphocytes count....floaters observed by the ophtalmologist but they say its normal....always had A1 vision....always was in good health..... never got any treatment for anything...
i lost 35 pounds in the last 7 months.....i also developped a rash on the leg that really looked like shingles... never gave me anything.....i insisted to get tested for vzv.... by the time they agree to test...the skin lesion was gone.....and tested positive for VZV igG.... which they said 95% of the population had...
the word desperated is very light in my case....
along with all the other symptms.. major headaches...memory problems....brain fog... bad shivers on the head and neck... went from top shape healthy 30 year old....to near dead....
i also had sudden arthritis in the knees and hip and heart palpitation as well as elevated temperature for a while....all this confirmed and observed by the doctors.... had also esinophilia and a little higher than usual lymphocytes count....floaters observed by the ophtalmologist but they say its normal....always had A1 vision....always was in good health..... never got any treatment for anything...
i lost 35 pounds in the last 7 months.....i also developped a rash on the leg that really looked like shingles... never gave me anything.....i insisted to get tested for vzv.... by the time they agree to test...the skin lesion was gone.....and tested positive for VZV igG.... which they said 95% of the population had...
the word desperated is very light in my case....
along with all the other symptms.. major headaches...memory problems....brain fog... bad shivers on the head and neck... went from top shape healthy 30 year old....to near dead....
Brief Answer:
Stress might have lowered your immunity
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. Stress levels can severely impact your immunity and make your prone to health problems.
2. Corticosteroid is one of the requisites in the treatment of nasopharyngeal lymphoid hyperplasia or as a long term follow up for Lyme disease and was indicated in your condition after considering the benefits and risks associated.
3. Steroid treatment can also slightly reduce the immunity.
4. The herpes zoster infection is active only if the patient has rash that has a characteristic distribution. Based only on blood tests, activity of zoster infection cannot be always confirmed as most of the population might show positive tests for zoster.
5. Your doctor would have surely treated you for active Lyme disease and filariasis. I wish to know any psychiatric consultation which you have taken and any medications or treatment which has been recommended to you. In your case, please take it slow, the loss of a close one is disturbing and I am sorry about it. I hope you come out of the grief at the earliest and live your bright days ahead.
Your headaches, brain fogs, vision problem, memory and other problems will improve once you start fighting your stress. The infection like conditions will also disappear with your increasing immunity. You still have a lot of beautiful days to live.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Stress might have lowered your immunity
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. Stress levels can severely impact your immunity and make your prone to health problems.
2. Corticosteroid is one of the requisites in the treatment of nasopharyngeal lymphoid hyperplasia or as a long term follow up for Lyme disease and was indicated in your condition after considering the benefits and risks associated.
3. Steroid treatment can also slightly reduce the immunity.
4. The herpes zoster infection is active only if the patient has rash that has a characteristic distribution. Based only on blood tests, activity of zoster infection cannot be always confirmed as most of the population might show positive tests for zoster.
5. Your doctor would have surely treated you for active Lyme disease and filariasis. I wish to know any psychiatric consultation which you have taken and any medications or treatment which has been recommended to you. In your case, please take it slow, the loss of a close one is disturbing and I am sorry about it. I hope you come out of the grief at the earliest and live your bright days ahead.
Your headaches, brain fogs, vision problem, memory and other problems will improve once you start fighting your stress. The infection like conditions will also disappear with your increasing immunity. You still have a lot of beautiful days to live.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Prasad
the problems is that the doctors dont give me anything for the lyme....and its been 3 years since the bite.....
there is absolutely no medication that has been given to me except some maxalt for headaches....isoptin and amytriptiline....which i think is not appropriated considering the infectious nature of the symptoms.....I have seen many specialist....in USA, the infectiologist say they should treat me right away for lyme....here in canada.....they dont do anything and think im a nut....
there is absolutely no medication that has been given to me except some maxalt for headaches....isoptin and amytriptiline....which i think is not appropriated considering the infectious nature of the symptoms.....I have seen many specialist....in USA, the infectiologist say they should treat me right away for lyme....here in canada.....they dont do anything and think im a nut....
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. Since it is 3 years from the day of tick bite therefore it is less likely that you are still having the primary infection after taking regular courses of antibiotics.
2. Maxalt, isoptin and amitriptyline are medications for headaches and to relax your mind. Please have medications reviewed regularly.
3. The steroids, if still being taken, then it requires benefit to risk assessment and subsequent tapering before being terminated. Once this is done then your immunity and other side effects of corticosteroid therapy will improve and then you will start feeling better. Please keep your mind free from stress and engage in recreational activities and meet your friends and avoid staying alone.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. Since it is 3 years from the day of tick bite therefore it is less likely that you are still having the primary infection after taking regular courses of antibiotics.
2. Maxalt, isoptin and amitriptyline are medications for headaches and to relax your mind. Please have medications reviewed regularly.
3. The steroids, if still being taken, then it requires benefit to risk assessment and subsequent tapering before being terminated. Once this is done then your immunity and other side effects of corticosteroid therapy will improve and then you will start feeling better. Please keep your mind free from stress and engage in recreational activities and meet your friends and avoid staying alone.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I did not take the regular course of antibiotic since the doctor do not accept the western blot test. Infectiologist in usa where i did the test urges the doctors here i canada to treat me, but they refuse. This condition is not recognized here.
So i never received adequate treatment.
So i never received adequate treatment.
Brief Answer:
If possible please visit USA and get treated completely
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. Since the doctors in US urge to get treated for your suspected infection, I was thinking if spending sometime in the US and getting treated would be a better idea for your symptoms.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
If possible please visit USA and get treated completely
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. Since the doctors in US urge to get treated for your suspected infection, I was thinking if spending sometime in the US and getting treated would be a better idea for your symptoms.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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