[32F] With worsening cognitive issues and multiple systemic symptoms
Patient Description
A 32-year-old female has been experiencing cognitive issues and weakness in her legs and arms. These cognitive problems have been present for most of her adult life but have worsened in the last month. They are more noticeable in the mornings and evenings and significantly affect her daily activities, making it difficult to complete tasks and causing her to forget what she is doing or saying. These episodes occur at least 5-6 days a week and can last for hours or an entire day. She reports memory loss, difficulty concentrating, recent headaches, occasional changes in vision, dizziness, balance problems, and numbness or tingling in her extremities. She does not have a history of neurological conditions or surgeries but uses cannabis daily (less than half a gram) to help with agitation, anxiety, and pain. She mentioned a loss of appetite and sometimes forgetting to eat and drink. She has no recent travel history to areas with infections affecting the nervous system and no known family history of neurological conditions, autoimmune diseases, or psychiatric illnesses. Her past medical history includes gastrointestinal pain, bowel problems without a diagnosis, and a chronic cough that produces gray/brown phlegm. She has adverse reactions to depression medications, feeling sick and nauseous when taking them. She is currently taking Adderall Extended Release 30mg in the morning and Adderall 30mg in the afternoon. She also takes several supplements (Turmeric, 5-HTP, L-Thyroxine, GABA, and Magnesium) every night before bed but is unsure of the exact dosages. Recently, she started experiencing random rashes on her neck and arms for the past 2 months. These rashes are described as bright red spots in clusters that are not itchy or painful, and sometimes raised red areas with no itch or pain. She has also experienced bright red rectal bleeding, all-over body pain (especially in her right rib area and back/neck), swollen lymph nodes, and sharp pelvic pain. Her cognitive issues seem to worsen with too much noise, activities that require multiple steps, in the evening (between 5-8 p.m.), stress, processed foods, and alcohol. She had a miscarriage 5 months ago and has never had regular periods for more than a few months at a time. Her period pain and bleeding have increased as she has aged. She is currently undergoing evaluation for potential autoimmune disorders.
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Arora's Assessment
What might be happening
Based on the information you've provided, it seems like your symptoms could be related to multiple underlying issues. Here are some possible diagnoses and explanations:
Cognitive Issues, Weakness, and Neurological Symptoms
- Multiple Sclerosis (MS): MS is an autoimmune disease that affects the central nervous system. It can cause cognitive issues, weakness, numbness, tingling, dizziness, and balance problems. The worsening of symptoms in the morning and evening could be related to fatigue, which is common in MS.
- Chronic Fatigue Syndrome (CFS): CFS can cause severe fatigue, cognitive issues, and muscle weakness. It often worsens with physical or mental activity and doesn't improve with rest.
- Medication Side Effects: Adderall can sometimes cause cognitive issues, especially if the dosage is high or if there are interactions with other substances like cannabis.
Gastrointestinal and Bowel Problems
- Irritable Bowel Syndrome (IBS): IBS can cause gastrointestinal pain and bowel problems. Stress and diet can significantly impact IBS symptoms.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis could explain your GI pain, bowel problems, and rectal bleeding.
Skin Rashes
- Autoimmune Disorders: Conditions like lupus or psoriasis can cause skin rashes. Given that you are undergoing evaluation for autoimmune disorders, this is a possibility.
- Allergic Reactions: The rashes could also be due to an allergic reaction to a substance or medication.
Other Symptoms
- Fibromyalgia: This condition can cause widespread pain, cognitive issues (often referred to as "fibro fog"), and fatigue. It can also cause sensitivity to noise and stress.
- Thyroid Issues: Hypothyroidism or hyperthyroidism can cause cognitive issues, fatigue, and skin changes. You mentioned taking L-Thyroxine, which is a thyroid medication, so it's important to ensure your thyroid levels are well-managed.
What you can do
Cognitive Issues and Weakness
- Consult a Neurologist: Given the severity and duration of your symptoms, seeing a neurologist for a thorough evaluation is crucial. They may recommend imaging studies like an MRI or CT scan and other tests to diagnose conditions like MS or CFS.
- Medication Review: Discuss your current medications and supplements with your healthcare provider to ensure there are no interactions or side effects contributing to your symptoms.
- Lifestyle Adjustments: Try to maintain a regular sleep schedule, manage stress through relaxation techniques, and avoid triggers like processed foods and alcohol.
Gastrointestinal and Bowel Problems
- See a Gastroenterologist: A specialist can help diagnose and manage conditions like IBS or IBD. They may recommend dietary changes, medications, or further testing.
- Dietary Changes: Keep a food diary to identify and avoid foods that trigger your symptoms. Ensure you are eating a balanced diet and staying hydrated.
Skin Rashes
- Dermatologist Consultation: A dermatologist can help diagnose the cause of your rashes and recommend appropriate treatments.
- Avoid Triggers: Identify and avoid any potential allergens or irritants that may be causing the rashes.
Other Symptoms
- Pain Management: Over-the-counter pain relievers, physical therapy, and gentle exercise can help manage body pain.
- Regular Monitoring: Keep track of your symptoms, including any new or worsening symptoms, using the MDandMe journal. This can help your healthcare provider make more informed decisions about your care.
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:
- Sudden or severe worsening of cognitive issues or weakness
- New or worsening vision changes
- Severe or persistent headaches
- Unexplained weight loss or fever
- Severe abdominal pain or persistent rectal bleeding
- Swelling or pain in your lymph nodes
Remember, while I can provide information and suggestions, it's crucial to consult with real healthcare professionals to receive a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.
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5 mo ago