[42F] With chronic memory problems, visual disturbances, and neurological symptoms
Patient Description
A 42-year-old female has been experiencing progressive memory problems, particularly with words, over the past 10 years, making communication difficult. She also reports visual disturbances, including flashes of light in her eyes, which started around 2 and a half years ago, and difficulty reading, which has been a lifelong issue but has become more pronounced recently. Additionally, she experiences lightheadedness and impaired cognition, including trouble with problem-solving, planning, and understanding spatial relationships. The patient hears a noise in her ears that sounds like water going through a damaged straw, which has been present for about 10 years and is rated as 6 out of 10 in intensity. She has not experienced any hearing loss or changes in her hearing. Her left arm is extremely weak, a condition first noticed about 15 years ago, initially accompanied by a blueish color and numbness in her pinky and ring fingers, which have since resolved. She consumes alcohol about 4 days a week and smokes half a pack of cigarettes per day. She has experienced withdrawal symptoms such as night sweats, shakes, anxiety, pins and needles, and nausea when she stops drinking alcohol, although she hasn't been in withdrawal for about a month. Her medical history includes scoliosis, diagnosed 3 years ago but likely present most of her life, and past gestational diabetes, which she no longer has. She also mentioned having alcohol myopathy. She does not have any allergies or adverse reactions to medications and is currently taking 10 mg of folic acid once a day. Her family history includes epilepsy, addiction, some heart disease, and three grandparents who died from strokes. She has an appointment with her primary care physician tomorrow, who will help set her up with a neurologist.
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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:
Memory Problems, Confusion, and Difficulty Reading
- Chronic Alcohol Use and Alcohol Myopathy: Chronic alcohol use can lead to cognitive impairments, including memory problems, confusion, and difficulty with tasks like reading. Alcohol myopathy can also contribute to muscle weakness.
- Neurological Conditions: Conditions such as early-onset Alzheimer's disease, other forms of dementia, or chronic traumatic encephalopathy (CTE) could explain your cognitive symptoms. Given your history of latent nystagmus and the need for a neurologist referral, a thorough neurological evaluation is essential.
- Nutritional Deficiencies: Long-term alcohol use can lead to deficiencies in essential nutrients like thiamine (Vitamin B1), which can cause Wernicke-Korsakoff syndrome, a condition that affects memory and cognitive function.
Visual Disturbances (Flashes of Light)
- Ocular Migraines: These can cause visual disturbances such as flashes of light. They are often accompanied by other symptoms like headaches, but not always.
- Retinal Issues: Conditions like retinal detachment or vitreous detachment can cause flashes of light and should be evaluated by an eye specialist.
Hearing a Noise in the Ears
- Tinnitus: This condition can cause ringing or other noises in the ears and can be related to various factors, including hearing loss, ear infections, or neurological issues.
- Vascular Issues: Sometimes, vascular abnormalities can cause pulsatile tinnitus, which sounds like a rhythmic noise in the ears.
Left Arm Weakness
- Neurological Conditions: Conditions like multiple sclerosis, stroke, or peripheral neuropathy could explain the weakness in your left arm.
- Vascular Issues: Given your history of your hand turning blue and fingers becoming numb, vascular issues like Raynaud's phenomenon or thoracic outlet syndrome could be considered.
What you can do
Memory Problems, Confusion, and Difficulty Reading
- See a Neurologist: It's crucial to follow up with a neurologist for a comprehensive evaluation. They may recommend imaging studies like an MRI or CT scan and cognitive testing.
- Limit Alcohol Intake: Reducing or eliminating alcohol consumption can help improve cognitive function and overall health. Seek support for alcohol use if needed.
- Nutritional Support: Ensure you are getting adequate nutrition, including vitamins and minerals. Consider taking a multivitamin and eating a balanced diet rich in fruits, vegetables, and whole grains.
Visual Disturbances
- Follow Up with an Eye Specialist: Continue to follow up with your eye doctor to monitor and manage your latent nystagmus and any other eye-related issues.
- Document Symptoms: Keep a journal of your visual disturbances, noting when they occur and any potential triggers. This can help your healthcare provider make a more accurate diagnosis.
Hearing a Noise in the Ears
- Consult an ENT Specialist: An ear, nose, and throat (ENT) specialist can evaluate your tinnitus and recommend appropriate treatments or interventions.
- Avoid Loud Noises: Protect your ears from loud noises, which can exacerbate tinnitus.
Left Arm Weakness
- Neurological Evaluation: Ensure that your neurologist is aware of your arm weakness and past symptoms. They may recommend nerve conduction studies or other tests to evaluate the cause.
- Physical Therapy: Physical therapy can help improve strength and function in your left arm. Your healthcare provider can refer you to a physical therapist.
General Health
- Primary Care Follow-Up: Keep your appointment with your primary care physician and discuss all your symptoms and concerns. They can help coordinate your care and refer you to specialists as needed.
- Symptom Tracking: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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 worsening of memory or confusion
- New or worsening visual disturbances
- Sudden weakness or numbness in any part of your body
- Severe headaches or changes in consciousness
- Any new or worsening symptoms that concern you
Remember, while I can provide information and suggestions, it's essential to consult with real healthcare professionals for a formal diagnosis and treatment plan. Your primary care physician and specialists will be able to provide the most accurate and personalized care for your condition.
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3 mo ago