Brief Answer:
Neurological symptoms

Detailed Answer:
good afternoon. My name is Dr. Dariush Saghafi and I am a neurologist from XXXXXXX Ohio. I would like to address the concerns that you've written in your note.

you list symptoms of numbness and tingling mainly on the left side of the face, the back of the head, left arm, and both feet. you are also feeling some of the sensations in your left ear and also you are reporting electric shock like sensations in the left leg and left foot.

The left side of the back is sore and occasionally has a burning sensation associated. you are also complaining of itchy sensations, tightness in the throat, difficulty with concentration, and feelings of anxiousness.

You are waiting to see a neurologist and also have an MRI scheduled, is that correct?

you did not mention for any length of time that you've had all of the symptoms nor did you say how this all started. I would be curious to know whether or not any of the symptoms have been there the whole time while others have come and gone or do the symptoms seem to change?

It would also be helpful to know whether or not you have had any labs drawn such as blood work, urine, and any other testing accomplished to date and if so what have been the results?

as far as what I think this could be the list is difficult to generate simply because we have no other information nor do I even have the benefit of knowing the results of any neurological examination done on you to this point since you have not seen the neurologist yet.

by the same token, laboratory abnormalities such as electrolyte disturbances or nutritional deficiencies such as B12, vitamin D, folate, and other possibilities would not likely give such focal and one sided symptomatology.

Still, these are all worth checking out and getting results for by making a trip to the laboratory as soon as possible and getting them done including thyroid hormones and sedimentation rates as well as an AN a panel and other similar test

with virtually all of the symptoms being left-sided the suggestion is that if in fact there is a problem within the brain or the spinal cord it would most likely be on the right side or at least the majority of any active type of disorder would be affecting mainly the right side of the brain.

Certainly, one could hypothesize that stress or anxiousness in and of itself could produce such symptoms but the likelihood of everything being so one sided over the body is something that cannot be ignored.

Nevertheless, these labs should be done and checked before making any final conclusions as to what could be causing your symptoms.

there is no question that your symptoms do strongly suggest something that is going on either in the brain or the spinal cord and one of the most plausible or common diagnoses in situations like this would have to be some form of demyelination such as multiple sclerosis or Sarcoidosis. But again, I don't think I'm saying anything to you that you didn't already read or know about since you seem to be an intelligent and pretty with it type of individual.

And so what I must emphasize and ask you to think about is the fact that at this point there is no single diagnosis that can be given with any certainty until all of the testing has been completed. This will only occur after you have seen the neurologist. what you can certainly do in the interim to be of the most help and value to figuring out what's going on is to keep track of things such as exactly what types of symptoms are occurring in which parts of the body and whether or not there seem to be any precipitating factors surrounding the intensity of the symptoms or even their presence.

such documentation will go along way with the neurologist when he looks at it and tries to classify the symptoms as well as categorize them according to his neurological examination. that sort of activity in my mind would be much more productive and useful rather than to harbor a lot of uncertainty and anxiety or fear over something which we do not have an hand just yet.

let me also offer you this as another possibility. I am also on a network by the name of HealthTap.com. You can find me at www.HealthTap.com/drsaghafi doing telemedicine live WebCam consultations on Wednesday through Saturday mornings from 3 AM to 6 AM (Eastern standard time).

You are more than welcome to look me up and in fact I will be on the web tonight at 3 AM as well as tomorrow night at 3 AM and also I am on Sunday evenings from 11 PM through 3 AM again this is Eastern standard time in the United States which would be the same as New York City.

I would be happy to speak with you and do whatever and examination neurologically can be done with a WebCam connection which actually is quite a bit more than you probably think.

in the meantime, I noticed you are from Calgary and I just happen to know the concertmaster and the timpanist of the Calgary symphony and if you like symphony music and you go to any of their concerts please tell XXXXXXX and XXXXXXX Cohen that I send my best regards and hope to see them back home in XXXXXXX one of these days very soon.

if this consult has provided you with useful information I would very much appreciate your written feedback and a star rating of the discussion. Also, if you do not have any further questions on this thread I would greatly appreciated if you would close aquarium as this will allow the network to process, archive, and credit the transaction appropriately.

---

Brief Answer:
Well, let's see where things go with the new scan

Detailed Answer:
Hey back. Well, to start with....you didn't tell me whether or not you've ever gone to hear the Calgary Symphony? You've now got a connection to the Head Honchess over there and her brother! I know 27 year olds don't typically go classical on Fridays and Saturdays.....except since I play violin and still gig out and do stuff even with my patients with music therapy... that's that..

Now, with the story from 2011 I have a couple of questions:

1. Did your symptoms go away completely at that time? How long did it take for them to leave and did you see a neurologist at that time? Did they recommend getting a spinal tap?

2. Was the MRI done WITH GADOLINIUM? (Don't forget that the new standards for gadolinium require that a person get renal function studies including what's called an Estimated Glomerular Filtration Rate (EGFR) before doing the XXXXXXX If the study you had done back then, did not use gadolinium contrast then, I wouldn't necessarily be convinced that you had NOTHING going on in the brain that you could see.

3. Did they get a cervical spine at that time? I always get imaging studies of the brain and AT LEAST the C-spine or even LS-spine depending upon symptoms. If the C-spine is negative then, I'd consider getting the thoracolumbar and lumbosacral spine films just for completeness and also because there is a nontrivial chance that something can definitely show up. Similarly, I would ask for gadolinium contrast.

4. Any family history of autoimmune diseases? (Thyroid, rheumatoid arthritis, Lupus, Celiac Disease, Vasculitis, MS, Crohn's)

5. I think you deserve a spinal tap as well even if the MRI of the brain is clean. Remember, you now also need at least the C-spine films to be done as well and with gadolinium.

While a clean MRI of the brain and also of the c-spine could be interpreted as NOT HAVING MS at that moment.....it says nothing of what could potentially could happen in the future....but for the present it means that there is no radiographically proven diagnosis.

I think you are wise to kind of talk to yourself about the possibility that the next set of scans may show something you hadn't seen before. I think it's a GREAT IDEA that you are keeping your mind open for any type of diagnosis.

But you need to stay positive (PMA the way Coach DeCarlo used to tell us (Positive Mental Attitude); XXXXXXX DeCarlo was one of the finest Head wrestling coaches XXXXXXX XXXXXXX University has every seen.

If you'd like to come on to webcam tonight or tomorrow night I'm on duty at 3a-7a. On Sundays I'm on 11p-3a:


So, just that you understand that a NEGATIVE MRI in no way GUARANTEES things into the future. Please don't forget about grading my responses to your questions with a little feedback and a STAR RATING. And if we're all "answered out" on this network then, why not consider coming onto the webcam network. I'm on tonight and Saturday from 3a-7a.

This query required 35 min. physician directed action required for review, research, and final documentation for final draft envoy.

---