What is the cause of decreased appetite with complete loss of interest in sex?
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I am a nurse practitioner student so I will do this in a typical medical style Chief complaint: Decreased appetite and sense of taste HPI: sudden onset about 7 weeks ago Very little to no appetite and sense of taste no interest in food Sense of smell intact complete loss of interest in sex complete loss of anxiety complete loss of depression no sense of happiness or sadness complete loss of desire for alcohol (not a bad thing, just interesting) Not apathetic but just no emotions No sense of grandiosity Past Medical History: Allergies: none Exercise-walk regularly Immunizations: influenza vaccine in November Medications: lisinopril 20 qd HCTZ 25 mg qd Lexapro 10 mg daily Ambien 5 mg at hs Ativan 1 mg prn (I haven't taken this for six weeks because I don't need it). I have not needed it for about three months but I did take to sleep Still have impaired sleeping without ambien Fish oil 1000 mg daily Daily multiple vitamin Asa 0ne daily (The fish oil and aspirin are my choice-never have been prescribed) Medical: HTN for six years-well controlled Depression: long history of this but my depression has vanished Anxiety: I used to have a long history of anxiety but it is now gone I had a minor cold in mid December I have Mal de debarquement syndrome-diagnosed in 2004 by balance specialist-intermittent problems but not really bothersome Varicose veins right leg-nothing bothersome I had dental work in November with a permanent bridge placed on all of my upper incisors I used to "need a drink" of alcohol when I came home from work or class. Not now. (Again, not complaining..just interesting No pain Surgeries Appendectomy 40 years ago Breast biopsy 7 years ago-benign Carpal tunnel-two years ago Tubal ligation-20 years ago Post-menopausal for two years-no problems with that Up until now I would have described myself as extremely type A. Not now Social history: don't smoke or use illegal drugs. Used to consume alcohol daily but no desire or need to at this time. Married-happyily-three grown successful children Family history-Hypertension, diabetes, depression, colon cancer ROS: Constitutional: nil Skin: nil HEENT: sinus congestion (I have had this for years. It is not bothersome). No vision changes. Neck: nil Cardio: nil no palpitations, no chest pain Pulmonary: nil (don't smoke) Gi: nil GU: nil MS: nil Neuro: nil Psych: anxiety and depression has vanished I had my routine physical exam in October. I really do not go to the doctor except for routine six month blood pressure check. At this time I had PAP (normal); colonoscopy-normal; mammogram-normal; CMP-normal: TSH normal; Lipid panel-normal (total cholesterol 178, HDl 61; LDL 96; Fasting blood sugar 96) EKG normal My exam: Height 64" Weight 140 no recent weight loss B/P-120/77 (I just took it) pulse 77 My preceptor did a fundoscopic exam of eyes and ears, nose and mouth (normal) I cannot palpate any lymphadenopathy My lungs are clear Cardiac Reg rhythm-murmers Normal sensation Normal muscle tone No dysmetria, no balance problems nothing unusual in cranial nerves Probably too much information. I am not complaining. I just think it's odd.
Posted Sat, 1 Mar 2014 in Brain and Spine
Answered by Dr. Sudhir Kumar 11 hours later
Brief Answer: Could be a viral infection sequelae Detailed Answer: Hi, Thank you for posting your query. I appreciate your detailed history, examination and investigations, and I must admit you have done a better job than the best residents in Neurology/Internal Medicine. From my side, you get a FIVE STAR for this presentation. Now, coming back to your problem, the main issues are lack of taste (subserved by facial nerve-chorda tympani branch) and change in emotions (subserved by hypothalamus/limbic system of brain) and lack of appetite/decreased sexual drive (controlled by hypothalamus). The most common cause for this is a systemic viral infection, which also affects brain and cranial nerves, and this can explain most of your symptoms. Generally, the symptoms would improve on own in a few weeks. Further investigations that could help in excluding other cases (such as ischemia-lack of blood supply to brain; considered in view of sudden onset of symptoms) and also to assess the severity would be MRI of brain, along with angiogram. There is no need to worry at present, as your symptoms do not suggest any serious brain disease. I hope my reply has helped you. I would be pleased to answer, if you have any follow up queries or if you require any further information. Best wishes, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar My blog: http://bestneurodoctor.blogspot.com/