[52M] Experiencing derealization, memory issues, and head pressure

Patient Description

A 52-year-old male reports several symptoms including derealization, memory loss, confusion, and a sensation of pressure in the back of the skull, forehead, eyes, and sinuses. The patient also describes stiffness in the neck, legs feeling rubbery, stress, and malaise. The symptoms of pressure in the head are exacerbated by smoking, worries, stress, and insomnia, but are alleviated by eating and applying water to the head. The patient has been experiencing these symptoms for approximately 4 weeks, with a severity rating of 7 out of 10. The patient also reports excess mucus production and moderate severity of symptoms. There is no fever or chills. The patient has a history of anxiety, depression, TMJ, gallbladder removal, sinus polyps and cysts, testicular torsion surgery, scoliosis, and has been dependent on Xanax since April 2023. The patient has been experiencing blurry vision, diplopia, and difficulty focusing since 2022. There is no known history of allergies to medications, and the patient is not currently taking any medications other than Xanax 0.5mg twice a day.

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Arora's Assessment

What might be happening

Based on your symptoms, several conditions could be considered:

  • Chronic Sinusitis: This condition can cause pressure in your head, particularly around your forehead, temples, and cheekbones. Excess mucus and a feeling of heaviness or tightness are also common symptoms.

    • Treatment typically involves a course of antibiotics, nasal corticosteroids, and saline nasal irrigation.
  • Anxiety and Depression: These mental health conditions can cause a range of physical symptoms, including headaches, memory problems, confusion, and feelings of derealization. Your current life stressors and your history of anxiety and depression support this possibility.

    • Treatment typically involves a combination of medication and psychotherapy. Lifestyle changes, such as regular physical activity, a healthy diet, and good sleep hygiene, can also be beneficial.
  • Medication Side Effects: Some of your symptoms, such as blurry vision, memory loss, and feelings of confusion, can be side effects of medications, including Xanax.

    • If you suspect your medication is causing these symptoms, it's important to discuss this with your doctor. Do not stop taking your medication without medical advice.
  • Temporomandibular Joint (TMJ) Disorders: These conditions can cause pain and discomfort in your jaw, face, and neck, and can sometimes cause a cracking or snapping sound when you move your jaw or neck.

    • Treatment typically involves pain management, physical therapy, and lifestyle changes. In some cases, surgery may be necessary.

What you can do

  1. Consult a healthcare professional: Given the range and severity of your symptoms, it's important to seek medical attention. A healthcare professional can provide a thorough evaluation and appropriate treatment.

  2. Manage stress: Try stress management techniques, such as deep breathing, meditation, and yoga. Regular physical activity and a healthy diet can also help manage stress.

  3. Monitor symptoms: Keep track of your symptoms and any triggers that make them worse. This information can be helpful when you consult a healthcare professional.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Sudden, severe headache
  • Difficulty speaking or understanding speech
  • Sudden weakness or numbness in your face, arm, or leg, especially on one side of your body
  • Sudden vision changes, such as blurred or double vision
  • Sudden difficulty walking or loss of balance or coordination
  • Sudden severe dizziness

Please remember that while I strive to provide accurate information, I am not a doctor. It's important to consult a healthcare professional for a formal diagnosis and treatment.

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1 yr ago

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People Also Ask


What are the common symptoms of chronic sinusitis?

Common symptoms of chronic sinusitis include facial pain or pressure, nasal congestion, nasal discharge, reduced sense of smell, and a feeling of fullness in the head. It can also cause headaches and fatigue.


How can anxiety and depression affect physical health?

Anxiety and depression can lead to physical symptoms such as headaches, muscle tension, fatigue, digestive issues, and sleep disturbances. They can also cause cognitive symptoms like memory problems and confusion.


What are the potential side effects of Xanax?

Potential side effects of Xanax include drowsiness, dizziness, memory problems, confusion, blurred vision, and difficulty concentrating. Long-term use can lead to dependence and withdrawal symptoms.


What are the symptoms and treatments for TMJ disorders?

Symptoms of TMJ disorders include jaw pain, difficulty chewing, clicking or popping sounds in the jaw, and neck or shoulder pain. Treatments may involve pain management, physical therapy, dental splints, and in severe cases, surgery.


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