Brief Answer:
Encephalitis unlikely.

Detailed Answer:
I read your question carefully and I understand your concern.

I do not think encephalitis is a likely diagnosis. Encephalitis is usually detected on MRI. Furthermore the clinical picture doesn't suggest encephalitis at all, there is no fever, no seizures, no neurological deficits or change in behavior described. In 6 months it would have progressed to show some signs. I do not see any need to have any investigation (like lumbar puncture) in that direction.

As for a neurosurgeon visit that as well is not likely to be of much benefit. A neurosurgeon comes at play when there is something to intervene upon, some abnormality on imaging of the brain or blood vessels, there is not much he/she can offer at this stage. Usually it is the neurologist who is responsible for investigating the diagnosis, not the neurosurgeon.

It seems to me your doctors have been pretty thorough in their test, having excluded brain lesions, blood vessel changes, skull related causes. I suppose some blood tests to screen for anemia, infections or metabolic alterations have been conducted as well. I assume that he is being correctly treated for his heart rhythm issue and the possibility of symptoms being related to heart arrhythmia affecting blood supply to the brain has been excluded. I also suppose medication side effects from the treatment initiated for the arrhythmia in November have been excluded.
So at this stage I think the possibility simply a primary headache, a headache with no identifiable cause, must be considered before pursuing unnecessary tests. Judging from the description a diagnosis of tension type headache seems to justify those symptoms. It is the most common type of headache, which is usually describe precisely in the form of pressure or squeezing sensation. It is commonly triggered or exacerbated by stress and anxiety so the fact that it started at the time when the other health issues appeared may have contributed to stress and tension. Most cases are managed with the occasional Ibuprofen and relaxation exercises. Since you describe this to have become a chronic issues though lasting for over 6 months I suggest you discuss with the neurologist the initiation of a preventive treatment, usually an antidepressant is preferred.

I remain at your disposal for other questions.

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Brief Answer:
Read below

Detailed Answer:
Thank you for the additional information.

Judging from that description of changing location of the symptoms, burning feeling etc, I still do not feel there is any indication of a brain lesion. If anything that change in location and burning feeling would be another point against that, burning sensations are not typical for brain lesions, such sensations actually are common companions of tension type headache, which is often associated with increased tension in neck and scalp muscles, causing such manifestations. The TMJ dysfunction may be a contributing factor as well in increasing scalp muscle tension (though wouldn't justify all the symptoms alone).

Neuropathy may manifest burning sensations, but it doesn't manifest in those areas, I do not think it to be related.

As for screening for infections and metabolic alterations I meant routine tests which I am sure have been done before going to expensive tests like MRI and CT. I referred to tests such as CBC, ESR, CRP, blood glucose, liver and kidney function, electrolyte panel, thyroid function. But as I said I am sure they have been done.

Lyme may cause many different neurological manifestations, so it can't be completely excluded, it may be considered as a cause of neuropathy as well. I do not see it as likely though, usually there are some changes on MRI and some neurological signs such as cranial nerve deficits. So a screening blood test for it may be done but I wouldn't have high expectations, I expect it to be normal.

Anxiety may cause such symptoms, may cause some mild elevation in BP as well, in the absence of other causes it should be considered. That is why I suggested you discuss with your doctor the possibility of trying antidepressants, which are first line treatment for anxiety and headache prevention. Regarding where to go I believe a neurologist would be the most appropriate specialist in excluding the presence of any other additional signs and managing him.

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Brief Answer:
You're welcome.

Detailed Answer:
You're welcome. Hope your husband feels better soon.

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