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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Autism, Migraines, Head Concussion, Blurred Vision And Vomiting

Have 22 year old granddaughter, initially diagnosed w/autism at 2 yrs old because she could not verbalize-came out of that after intense speech therapy. She is extremely bright, graduated university this year in digital arts, graphic design. Has migraines, father s family history, had seizure in high school sophomore biology class, fell off chair, hit head, had concussion and vomited afterwards. walking across dorm room sophomore college, had headache, blurry vision, fell to ground, hit head on small dorm refrig--concussion and vomited afterwards. came to work, was getting out of car just about 3 weeks ago, had blurry vision, bad headache, got inside building restroom, vomited and found by person on the floor of restroom. her speech was impaired this time significantly. her words are hesitant, she can text, type, etc, but cannot verbalize easily--cannot sing either w/o hesitation or read aloud from a book. has low blood pressure, died on table for 2 pages at cardiologist 2 years ago when running tilt table test on her. he said may need pacemaker but too young as going in not a problem but changing out is more difficult at her young age. has been on lacmital and several other drugs since college, but still had seizure . what do we need to do to insure drs are looking in correct place--it appears from reading she had a mini-stroke that impacted speech this time and not a seizure . she s had 2 eegs which show significant seizure activity. my question-what tests need to be run to distinguish seizure vs stroke as she may be misdiagnosed? do you know of a neurologist dr who gives suggestions like this on line or we could make appt to see and just ask questions. 2 or 3 opinions are safer than one. we have a daughter in law pediatrician and she is also checking with her colleagues. or is there a website that can give suggestions for options, rather than attempting to induce another seizure to see where the specific activity is in the brain. should speech therapy not be 1st priority to regain as much speech as possible, prior to finding where seizures are happening when they are infrequent? granddaughter may have been having mini seizures or mini strokes as a child and these went unnoticed because she was thrown into the autism spectrum and it may not have been autism at all. thank you for any website or insight into this major concern or any suggestions, which are just potential possibilities, not absolutes. i would think a neurologist and cardiologist should work together with her to get to the issues at hand??? do you have any recommendations of the best neuorologist and cardiologist and any hospital you would recommend in the USA or southern california? is there any stem cell research available?
Fri, 15 May 2020
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General & Family Physician 's  Response
Hi,

It is a difficult situation and requires proper therapeutic plan. It is great that you are looking for different medical opinions to help you form an informed decision. In your question, you have submitted many sub-questions. I will focus on one of those questions for this preliminary query. Specifically, I will provide an answer what do you need to do to insure that doctors are looking in correct place. There are two major acute issues here:
1. Stroke 2. Epilepsy

For the stroke:
1. MRI scan
2. EKG: long duration EKG for like 72 hours and trans-esophageal echocardiography to rule out any heart arrhythmia
3. keep her on aspirin, if heart arrhythmia is confirmed, treat those too

For epilepsy:
1. Revise medication plan: reduce seizure medications and reintroduce them carefully to determine most suitable with least side effects.
2. MRI with specific sequences to detect scar tissues that could be provoking seizures. If such a brain region is found neurosurgical intervention could help.

For the speech issue, in my opinion rehabilitation should start also parallel and as soon as possible regardless of the underlying reason. In such a case, a multi disciplinary team of neurologist, neurophysiologist, cardiologist, neurosurgical team, speech therapists is needed.

Hope I have answered your question. Let me know if I can assist you further.

Regards,
Dr. Ahmad Nazzal, General & Family Physician
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Suggest Treatment For Autism, Migraines, Head Concussion, Blurred Vision And Vomiting

Hi, It is a difficult situation and requires proper therapeutic plan. It is great that you are looking for different medical opinions to help you form an informed decision. In your question, you have submitted many sub-questions. I will focus on one of those questions for this preliminary query. Specifically, I will provide an answer what do you need to do to insure that doctors are looking in correct place. There are two major acute issues here: 1. Stroke 2. Epilepsy For the stroke: 1. MRI scan 2. EKG: long duration EKG for like 72 hours and trans-esophageal echocardiography to rule out any heart arrhythmia 3. keep her on aspirin, if heart arrhythmia is confirmed, treat those too For epilepsy: 1. Revise medication plan: reduce seizure medications and reintroduce them carefully to determine most suitable with least side effects. 2. MRI with specific sequences to detect scar tissues that could be provoking seizures. If such a brain region is found neurosurgical intervention could help. For the speech issue, in my opinion rehabilitation should start also parallel and as soon as possible regardless of the underlying reason. In such a case, a multi disciplinary team of neurologist, neurophysiologist, cardiologist, neurosurgical team, speech therapists is needed. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Ahmad Nazzal, General & Family Physician