[27F] With progressive dysphagia, muscle weakness, and chronic headaches
Patient Description
A 27-year-old female has been experiencing progressive difficulty swallowing (dysphagia) over the past few years, which has worsened recently. This occurs with both food and drinks, and sometimes she has trouble initiating the swallow, leading to spitting out food or drink. Additionally, she reports muscle weakness and fatigue, with muscles giving out suddenly (e.g., legs when walking, hands losing grip), and muscle cramping at random times. She also experiences daily headaches, typically described as an aching pressure across the forehead, temples, and neck, which can escalate to sharp pain rated as 8/10 in severity. Being in a dark and quiet environment helps prevent flare-ups, but nothing relieves the pain. She has balance issues, poor coordination, and an unsteady gait, which have worsened over the past year. Memory issues are also present, with difficulty remembering recent events and hazy memories even with prompting. Her appetite has decreased over the past few months, but no weight loss has been noted. She has not experienced changes in her voice during swallowing difficulties. There have been no recent diagnostic tests or evaluations for her swallowing issues. She also has difficulty finding words, numbness and tingling in her limbs, and changes in vision (double vision or blurred vision) for years. Family history includes dementia, epilepsy, celiac disease, rheumatoid arthritis, colitis, osteoporosis, hypothyroidism, and vitiligo. Chronic conditions include irritable bowel syndrome with mixed constipation and diarrhea, asthma, gastroparesis, Hashimoto's thyroiditis, and dysautonomia. She is allergic to penicillin. Current medications are Lamictal (200mg once at night), Pristiq (100mg once at night), Buspar (20mg twice daily), Synthroid (125mcg once in the morning), Xyzal (5mg once at night), Zofran (4mg as needed), Amlodipine (10mg once in the morning), Naproxen (500mg as needed), and Albuterol (as needed).
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Arora's Assessment
What might be happening
Based on the symptoms and history you've provided, here are some possible explanations for your condition:
Difficulty Swallowing (Dysphagia)
- Neurological Disorders: Given your history of concussions and current symptoms, a neurological disorder such as Myasthenia Gravis or Multiple Sclerosis (MS) could be contributing to your swallowing difficulties. These conditions can affect the muscles and nerves involved in swallowing.
- Gastrointestinal Issues: Conditions like gastroparesis can also contribute to swallowing difficulties, although this is less likely given your symptoms.
Muscle Weakness and Fatigue
- Neuromuscular Disorders: Conditions like Myasthenia Gravis or Amyotrophic Lateral Sclerosis (ALS) could explain the muscle weakness, fatigue, and cramping. These disorders affect the communication between nerves and muscles.
- Thyroid Dysfunction: Given your history of Hashimoto's thyroiditis, it's possible that your thyroid hormone levels are not well-controlled, contributing to muscle weakness and fatigue.
Headaches
- Post-Concussion Syndrome: Given your history of concussions, it's possible that you are experiencing post-concussion syndrome, which can cause persistent headaches, dizziness, and cognitive difficulties.
- Chronic Migraine: Your symptoms could also be consistent with chronic migraine, especially given the sensitivity to light and sound.
Balance Issues and Poor Coordination
- Neurological Disorders: Conditions like Multiple Sclerosis (MS) or Cerebellar Ataxia could explain your balance issues and poor coordination. These conditions affect the central nervous system and can lead to unsteady gait and coordination problems.
Memory Issues
- Cognitive Impairment: Your memory issues could be related to post-concussion syndrome or a neurodegenerative condition. Given your family history of dementia, this is something that should be evaluated further.
What you can do
Difficulty Swallowing
- See a Specialist: Consult a neurologist or a gastroenterologist for a thorough evaluation. They may recommend tests like a barium swallow study or an endoscopy.
- Modify Your Diet: Stick to softer foods and liquids that are easier to swallow. Avoid dry or tough foods that can exacerbate the problem.
- Stay Hydrated: Ensure you are drinking enough fluids to help with swallowing and digestion.
Muscle Weakness and Fatigue
- Consult a Neurologist: A neurologist can perform tests to diagnose conditions like Myasthenia Gravis or Multiple Sclerosis.
- Physical Therapy: Engage in physical therapy to strengthen your muscles and improve coordination.
- Monitor Thyroid Levels: Follow up with your endocrinologist to ensure your thyroid hormone levels are well-controlled.
Headaches
- Neurological Evaluation: Given the severity and persistence of your headaches, a neurologist can help determine if they are related to post-concussion syndrome or chronic migraine.
- Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help, but consult your doctor for a tailored treatment plan.
Balance Issues and Poor Coordination
- Neurological Evaluation: A neurologist can perform tests to diagnose conditions like Multiple Sclerosis or Cerebellar Ataxia.
- Physical Therapy: Engage in balance and coordination exercises to improve your stability.
Memory Issues
- Cognitive Assessment: A neuropsychologist can perform a cognitive assessment to evaluate the extent of your memory issues.
- Memory Aids: Use tools like calendars, reminders, and journals to help manage daily tasks and improve memory retention.
What you should look out for
Given the complexity and severity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Difficulty Breathing: If you experience shortness of breath or difficulty breathing, seek immediate medical attention.
- Severe Muscle Weakness: If you experience sudden, severe muscle weakness or paralysis, seek immediate medical attention.
- Severe Headache: If your headache becomes unbearable or is accompanied by other severe symptoms like vision changes or confusion, seek immediate medical attention.
- Fainting or Dizziness: If you experience fainting or severe dizziness, seek immediate medical attention.
Remember, while I can provide information and suggestions, it's crucial to consult with healthcare professionals for a formal diagnosis and treatment plan. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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4 mo ago