[48F] With chronic headache, tremors, and gastrointestinal issues post-head injury
Patient Description
A 48-year-old female has been experiencing a severe, throbbing headache for over four months, which began after hitting her head. The pain is localized to the right side of her head, extending down to behind her ear and into the right side of her upper neck. The headache is rated as 9 out of 10 in severity and worsens when bending over. The patient reports no relief from any treatments tried so far. She also experiences body shakes and throbbing spasms, particularly in her right arm and hand, which feel internal and deep. These tremors started about 1.5 months ago. Additionally, she has severe muscle spasms on the right side of her body and behind her ear, persisting for over four months.
The patient has difficulty with bowel movements for over a year, with stools that are flat and sometimes accompanied by discharge and little white hairs. She has not had constipation issues like this before. Her vision has worsened, her memory is low, and her balance, which has always been off, has become more noticeable. An MRI revealed a severe infection in her brain from sinuses, for which she completed a course of antibiotics with no improvement. She has not had any follow-up appointments or additional tests since then.
The patient experiences numbness and tingling in her right arm and hand all the time. Recently, she has lost her appetite and finds it hard to eat. She has a history of two pulmonary embolisms, with the first occurring in 2001 during pregnancy. She is not currently taking any medications except for ibuprofen for pain, which does not help. She takes 800mg of ibuprofen every four hours on a waking day. She has no known drug allergies and is not taking any over-the-counter supplements, vitamins, or herbal remedies.
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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:
Severe Headache, Vision Changes, and Memory Issues
- Post-Traumatic Headache: Given that your headache started after you hit your head, it's possible that you are experiencing a post-traumatic headache. These can be persistent and severe, especially if there was a significant injury.
- Chronic Sinus Infection: Your MRI showed a severe infection in your brain from sinuses. Chronic sinus infections can cause persistent headaches, vision changes, and memory issues. However, since antibiotics did not help, further evaluation is needed.
- Neurological Conditions: The combination of severe headache, vision changes, memory issues, and balance problems could indicate a neurological condition such as a brain infection, inflammation, or even a structural issue that needs further investigation.
Body Shakes, Tremors, and Spasms
- Neurological Disorders: The internal and deep shaking, especially in your right arm and hand, along with numbness and tingling, could be related to a neurological disorder. Conditions like multiple sclerosis or Parkinson's disease can present with these symptoms.
- Post-Traumatic Effects: The trauma from hitting your head could have caused nerve damage or other neurological issues leading to these symptoms.
Difficulty with Bowel Movements
- Gastrointestinal Issues: Flat stools and discharge could indicate a gastrointestinal issue such as irritable bowel syndrome (IBS) or another form of bowel obstruction or inflammation.
- Neurological Impact: Given your other neurological symptoms, it's possible that there is a neurological component affecting your bowel movements.
Unifying Diagnoses
- Chronic Inflammatory Response: A chronic inflammatory response in your body could explain many of your symptoms, including headaches, vision changes, memory issues, and gastrointestinal problems.
- Neurological Condition: A single neurological condition could potentially explain the headaches, tremors, spasms, vision changes, memory issues, and bowel movement difficulties.
What you can do
Severe Headache, Vision Changes, and Memory Issues
- Seek Immediate Medical Attention: Given the severity and persistence of your symptoms, it's crucial to see a healthcare provider as soon as possible. You may need further imaging tests like a CT scan or a follow-up MRI, and possibly a referral to a neurologist.
- Pain Management: While waiting for your appointment, continue to manage your pain with over-the-counter medications, but be cautious with the dosage. You might also try applying a cold or warm compress to your head and neck.
Body Shakes, Tremors, and Spasms
- Consult a Neurologist: A neurologist can perform a detailed examination and may order tests like an EMG (electromyography) or nerve conduction studies to understand the cause of your tremors and spasms.
- Physical Therapy: Physical therapy might help manage some of the symptoms and improve your balance and coordination.
Difficulty with Bowel Movements
- Dietary Changes: Increase your fiber intake by eating more fruits, vegetables, and whole grains. Drink plenty of water to help with bowel movements.
- Consult a Gastroenterologist: A specialist can perform tests to determine if there is an underlying gastrointestinal issue that needs to be addressed.
General Advice
- Symptom Journal: Use MDandMe to journal your symptoms, track your progress, and get insights. This can be very helpful for your healthcare provider to understand the full scope of your condition.
- Follow-Up Care: Make sure to follow up with your healthcare provider after any initial treatments or tests to ensure that your condition is being properly managed.
What you should look out for
Given the severity of your symptoms and the potential for serious underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Worsening Headache: If your headache becomes even more severe or is accompanied by new symptoms like confusion, seizures, or loss of consciousness.
- Severe Vision Changes: Any sudden or severe changes in vision.
- Severe Tremors or Spasms: If the shaking or spasms become uncontrollable or spread to other parts of your body.
- Difficulty Breathing or Chest Pain: Given your history of pulmonary embolism, any new difficulty breathing or chest pain should be evaluated immediately.
Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and treatment plan.
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5 mo ago