Is multiple meningioma the reason for facial numbness on left and doubling the dosage of amitriptyline?
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I am a 38 year old female, who was recently diagnosed with multiple meningiomas. My non-contrast MRI showed one bioconvex mass in the right frontal region measuring 2.6cm x 12 mm thickness x 2.7 cm CC, a similar but smaller one on the contralateral side near midline, and several larger and more nodular appearing areas at the vertex on the right side. Gradient images showed multiple punctate foci of hemosiderin deposition especially at the vertices. None of the areas demonstrate restricted diffusion. An MRI with contrast and CT backed up the initial MRI. As far as symptoms go, I have what feels like constant pressure in my head and ringing in my ears. I do have occasional headaches that are sharp and stabbing, and some that make my left eye ache (making me nauseated). I have a lot of short-term memory issues (losing things, forgetting names, forgetting appointments, etc.) I also have tingling in my left arm, and mild facial numbness on the left (not completely numb, but feels different than the right side). I have episodes of being "foggy headed" and have trouble concentrating. I've had a spinal tap which was normal, as well as an EEG that was normal as well. There is nothing concerning in any of my labwork (lupus panel, thyroid, MS panel, etc). I'm healthy otherwise. My last CT did show mild cerebral atrophy. I recently started seeing a neurologist, who at the first visit said he thinks the meningiomas are too small to be the cause of any of my issues, and gave me a script for amitriptyline. I still have all of my symptoms, but the med helps me sleep well. At the second visit, he again said he doesn't think it's the meningiomas, but offered no other ideas on what is causing my symptoms and doubled the amitriptyline. Should I get a second opinion?
Posted Sun, 29 Dec 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 26 minutes later
Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. I have noted your complaints, MRI findings, and current treatment. I agree with your neurologist that meningiomas as per the report are two small and may not cause significant neurological symptoms. However, if your symptoms are transient or episodic lasting for a few seconds or minutes, then, these could be sensory seizures, precipitated by meningiomas. In this scenario, an anti-epileptic drug may be considered. In any case, these meningiomas are tow small to require operation. Part of your symptoms are also suggestive of mild cognitive impairment. Stress is a common underlying cause. You should get a detailed neuro-psychological assessment done to estimate the magnitude of memory impairment as well to assess other cognitive functions. Then, further investigations such as PET scan of brain may be planned. Amitriptyline may be continued for now. I hope my answer helps. Please get back if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in
Follow-up: Is multiple meningioma the reason for facial numbness on left and doubling the dosage of amitriptyline? 19 minutes later
Thank you very much for your answer. I definitely don't want any kind of surgery. My neurologist felt that stress could be the cause of some of my issues as well. Could I have sensory seizures if my EEG was normal? Also, what would be the cause of the tingling in my left arm/numbness in my face (left side)? The tingling is always there, mild at times, and intense at others. For example, right now, I have a localized sharp, throbbing pain on the right side of my head, the ringing in my ears is quite loud and the tingling/numbness on the left is intense. This has gone on for several hours. This has been a very calm and relaxed day, and I did not have this earlier in the day.
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer: Thank you for getting back. Detailed Answer: Yes, EEG may be normal in cases of sensory seizures in about 50% of cases. There, doing a prolonged EEG recording for 24-48 hours would help. Your symptoms of tingling in left arm, numbness of left face, etc are due to the pathology on the right side of brain. Since it is neuropathic in nature, medications such as pregabalin or gabapentin would help. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Follow-up: Is multiple meningioma the reason for facial numbness on left and doubling the dosage of amitriptyline? 1 minute later
Thank you. You have been very helpful!
Answered by Dr. Sudhir Kumar 2 hours later
Brief Answer: Thank you Detailed Answer: I would be pleased to be of help in the future too. Best wishes, Dr Sudhir Kumar MD DM (Neurology)