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Suffering from narcolepsy. Had stroke with left side paralysis and weakness. Due to depression?

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General & Family Physician
Practicing since : 2009
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My daughter,now 20, was hospitalized twice with unexplained disease process. The first time her body went limp and she could not walk and only lifted her arms and head for short periods of time.She was discharged after a battery of tests came back normal. Later we discovered she suffered from narcolepsy and it was felt that episode was called cataplexy. Soon after coming home from the hospital that time she was back to herself within 3-4 days.
After several years and now being treated for the narcolepsy she had an attack which mimicked a stroke with left side paralysis and weakness, She was in the hospital again with multiple tests and scans either normal or inconclusive, She was transferred to inpatient physical therapy for a month, She then did another month of outpatient therapy. It was like nothing ever happened. Then 6 months later she embarked on a trip to Brazil to improve her Portuguese and stay with friends and have a great Summer. eight weeks into the trip she began to have full body aches and weakness. Within 3 days she could not walk and talking became difficult .It took several more days but were able to change her flight to get her home. Her neurologist examined her 3 days after arriving back to the States. His diagnosis was psychogenic movement disorder or conversion disorder but she was homesick for a few days while in Brazil.
Initially I was accepting this diagnoses, however after much reading I am still concerned.1.) The fact that she has generalized pain throughout her body ranging from a 4 to a 10 has never been taken into the situation. I have not found any information that this type of pain would be related to this disorder. 2.) Also from my understanding the symptoms are associated with depression or a SUDDEN act not the blues or homesick for a few days. She will be starting physical therapy along with counseling and start on anti depressants(because I don't know what else to do). She will also be seeing a Rheumatologist to rule out fibromyalgia or anything else he can consider. If there are ANY suggestions, PLEASE I BEG FOR YOUR HELP, She is a 20 year old who has become totally dependent on others for care for no apparent reason,

Posted Thu, 12 Sep 2013 in Stroke
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Possible depression, need your help

Detailed Answer:
Hello sir/ma'am.

I can understand your concern, especially as your daughter is too young to be experiencing such conditions. If you do not mind, could you attach the investigations conducted to our conversation, as I would like to confirm whether there were any abnormalities or whether they were completely normal.

I greatly appreciate the effort you have put in, to relate your daughter's symptoms to her diagnosis. Firstly, patients who have suffered from a stroke or paralysis, do experience generalized pain, so this would be normal if she has indeed suffered from a stroke.

But a very important fact, which I would like to clarify, is that most of her test results are normal. We cannot make a diagnosis of 'condition which mimicked a stroke', it is either a stroke or not. This does put forward a possibility of this being depression or other psychiatric condition-related. I appreciate your understanding and consideration for the same. It is important to note that your daughter (is she an only child?), likes/prefers being under the care of someone and does in fact enjoy the attention.

Could you also help me with the following: Has she shown signs of loneliness before? Does she have many friends? Signs of hurting herself? Any mental trauma in the past? Insomnia? Irritability? Sudden mood changes? Is she the appropriate weight for her height? Cries frequently?

Awaiting your response. Do not worry, we shall together find the cause to your daughter's problems and help her out of this.

Best wishes.
Above answer was peer-reviewed by
Follow-up: Suffering from narcolepsy. Had stroke with left side paralysis and weakness. Due to depression? 3 days later
She definitely is not the type of person seeking attention. She is very independent and is a social butterfly. She has many friends(good friends). She makes generally wise decisions and we have a very good relationship(her thoughts,not mine).
She has been to see a therapist regarding any depression. Afterwards,with Stephanies permission, the Therapist told us that she really did not feel that she was suffering from depression and deferred any follow up until after her appointment with the Psychiatrist. The Physical Therapist that has the equipment to help her is backed up so her appointment will not be until September 4. In the meantime we have found wheelchair videos on YouTube.
The Rheumatologist ordered bloodwork which we should have by Monday.He ordered Lyme as an afterthought so hopefully the phlebotomist received the order in time,ortherwise we will go back on Monday.
As per her Neurology report: Unremarkable MRI of brain.Chest pain diagnosed as costochondritis. Her recent CBC as CMP have all come back normal.
She currently is overweight but had been losing weight due to lap band surgery about 2 years ago. The only time she cries is appropriate sadness.
Answered by Dr. Shoaib Khan 4 hours later
Brief Answer:
Depression not ruled out; consider other condition

Detailed Answer:
Hello once again ma'am.

Thank you so much for that information.

A few facts from the information provided that can be related to depression:
-Obesity/overweight: Individuals usually suffer from depression
-Medication or therapy or treatment for obesity: Medication used to promote weight loss always has one side-effect, no matter which medication it is; depression. Other forms of therapy or treatment also result in depression
-Laparoscopic band surgery can also have an initial side effect of aggravating already present depression; which subsides in a while (6 months-1 year)

I would like to put forward a differential diagnosis for your daughter ma'am. If you do not mind, please take these conditions up with your daughter's doctor, and start ruling them out, to narrow down the search for the cause:
-Lyme disease
-Guillian-Barre Syndrome
-Multiple scelrosis
-Nutritional or vasculitic neuropathy
-Cauda equina and Conus Medullaris syndromes
-Heavy metal toxicity
-Metabolic myopathies
-Myasthenia Gravis
-Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)

Please go through these conditions, and see if your daughter can relate to them in anyway, but it would be best if a doctor would make the comparison or similarity.

Hope this helps you ma'am. Really hope your daughter recovers to lead a beautiful and healthy life thereafter.

Best wishes.
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