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Constant headaches, fatigue, nerve pains, disk issues, acid reflux. Had neck surgery for cord compression, heart ablation. What does it tell ?

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Orthopaedic Surgeon
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I am asking about a 4 yr ongoing illness. I used to run races and was very health. I have been to various doctors, neurologist, neurosurgeon, endocrinologist, etc. I am 50 yrs old and 4 yrs ago, had several problems with a constant headache, vision, dizzyness, constipation, walking, fatigue, memory and nerve pains. I had surgery on my neck to relieve cord compression. I have various levels of disk issues. I later had 3 SVTs (heart arythemia) and had a heart ablation. I also have severe acid reflux and have had 2 surguries on my voice box. This has all happened in the 3 yrs. My brain MRI shows white matter, more than 25 spots. I was tested for cadisil brain disease which was negative. The only things that help are only allowing very little stress and lots of bed rest. I can almost feel normal with that, but it begins to decline within a hour. At this point, I feel I need to get back to the brain issues. One report on the MRI says the scan looks like that of an older person. I am planning on seeing a cerebral vascular neurologist to see if he can make any determinations. I did have a severe concussion when I was 8 when I was hit by a bus. This seems to be something that must be catching up to me. I am now looking at things like alzheimers, small vessel disease, or other brain related issues. I have been in this for 4 yrs now and am just looking for the right answer.
Posted Sun, 29 Apr 2012 in Brain and Spine
Answered by Dr. Praveen Tayal 4 hours later

Thanks for posting your query.

I have noted down the details provided by you. I understand that your symptoms are concerning and living with them must be frustrating too.

Since I do not have all the details and a privilege to examine you my assessment is severely limited.

"All white matter lesions do not represent a disease".
The lesions found in your case are non progressive. Thus are more indicative a benign chance finding. In the absence of any clinical signs and symptoms, the significance of these white hyperintense lesions are difficult to assess.

A lot of work has been done to determine the significance of white matter lesions. The thinking now is that they represent ischemia (lack of blood flow) in the small blood vessels of the brain. Hence they are also at times referred to as ischemic small vessel disease. Hence these lesions are more commonly seen in the MRI of patients who have cerebrovascular risk factors like hypertension, diabetes and high cholesterol as well those that smoke. Their incidence increases with age.

These lesions are responsible for memory impairment (vascular dementia) in some individuals. A neurological examination to look for cognitive impairment is needed to diagnose the condition.

Hence I advise you to follow with your neurologist. He would be the best person to guide further diagnostic workup and treatment.

I hope this answers your query effectively. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.

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