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Suggest Treatment For Mental Confusion And Torn Rotator Cuff
Question: I have several ongoing issues. I'm being bounced around, tests run, but no one can seem to come up with an answer. I just seem to be an enigma. I've got mental confusion, where I have wandered off, or I'll get up out of bed and cook, clean hold conversations, but I don't remember or know that I'm doing it. My kids have said I'm glassy eyed, and they can tell I'm not there. I've got a partially torn rotator cuff, but I was told that is not causing my pain. I've had a headache for 2-3 months, neck pain upper and lower back pain. Extremity numbness and weakness. I've lost 70 pounds in 6 months, and I'm struggling to GAIN. My labs are coming up normal. I went to the ER because the pain got so bad and I had a couple of bowel accidents. MRI came back with no significant changes in my spine. History: R oopherectomy, gallbladder removed almost 20 years ago, bilateral hip replacement 4 years ago, laminectomy 2 years ago. HPV , clear pap 18 years
Brief Answer:
Likely to be due to brain disorder
Detailed Answer:
Hello,
Welcome and thanks for your query.
I understand your concern.
Your symptoms are suggestive of a brain disorder and it would be helpful if you a MRI of the brain. It may be related to decreased blood flow or a neurological problem.
Your neck and back pains may be due to spodylosis and pressure on the nerves from degenerated discs.
Likely to be due to brain disorder
Detailed Answer:
Hello,
Welcome and thanks for your query.
I understand your concern.
Your symptoms are suggestive of a brain disorder and it would be helpful if you a MRI of the brain. It may be related to decreased blood flow or a neurological problem.
Your neck and back pains may be due to spodylosis and pressure on the nerves from degenerated discs.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Zachariah: Thank you so much for such a prompt response. My last MRI was of my neck. I have the results, but I don't understand them. I see the orthopedist on Friday and I need to know what to ask to do next. Every thing I suggest is shot down by all my doctors, yet I can feel it in my body that there is something serious going on. I feel like everyone wants to treat the symptoms one at a time, rather than find a cause. Honestly I believe it's all connected. Other than the pain, I was healthy until I had my hips replaced. Since then, I've been hospitalized two or three times a year for serious reasons. My chart to see the latest MRI's is mychart XXXXXXX org/mychart user name: madwmn63 password: nicole63 You should be able to see what is going on with my neck, shoulder and lower back. I really hope you can help, at least point me in the right direction. Last I talked to my GP he was talking about doing a colonoscopy! I just had a normal abdominal CT with XXXXXXX I feel like throw drugs at me, but NO ONE IS TRULY LISTENING. I'm ready to give up the fight. Maybe if I were a man people would take this so much more seriously. Please help me before I just throw in the towel permanently.
Brief Answer:
You may require to see a neurologist
Detailed Answer:
Dear Ms . XXXX,
I can imagine what you are going through and would very much like to tie things together and give you helpful advice. Unfortunately I am not able to access it now. I shall try from a different computer later. If you could copy paste the reports , I can interpret them.
From your symptoms, the doctor who can help you most is a Neurologist and you would require a MRI of the brain.
Once I have the information, I hope to give more helpful suggestions.
Good day
You may require to see a neurologist
Detailed Answer:
Dear Ms . XXXX,
I can imagine what you are going through and would very much like to tie things together and give you helpful advice. Unfortunately I am not able to access it now. I shall try from a different computer later. If you could copy paste the reports , I can interpret them.
From your symptoms, the doctor who can help you most is a Neurologist and you would require a MRI of the brain.
Once I have the information, I hope to give more helpful suggestions.
Good day
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Zacchariah,
Here are the results from my MRI's and lab work.
Narrative
EXAM:
MRI CERVICAL SPINE WITHOUT CONTRAST
EXAM DATE: 4/1/2015 12:19 PM.
CLINICAL HISTORY: Brachial neuritis or radiculitis, bilateral upper cavity weakness , neck and shoulder pain.
COMPARISONS: 09/13/2013.
TECHNIQUE: Multiplanar, multisequence T1-weighted and fluid-sensitive sequences of the cervical spine without contrast.
FINDINGS:
Neurologic Structures: The visualized posterior fossa structures are unremarkable. No signal abnormality in the visualized spinal cord.
Alignment: Reversed lordosis, apex of the reversed curvature is at C5-C6.
Mild grade 1 anterolisthesis at C7 on T1, T1 on T2 on T3 are unchanged.
Bone Marrow: No fractures or bone lesions. Mild bone marrow edema at the inferior plate of C5, superior and inferior endplates of C6 and superior endplate of C7, related to degenerative disk disease, unchanged.
Interspace Levels/Facets:
C1-C2: Atlantoaxial and atlantooccipital intervals maintained.
C2-C3: Mild broad-based disk and osteophyte, left greater than right facet and UV joint hypertrophy, mild right but no left neural foraminal stenosis. No spinal canal stenosis, unchanged.
C3-C4: Broad-based disk and osteophyte with left greater than right facet and UV joint hypertrophy leading to mild to moderate left neural foraminal stenosis, unchanged. no right neuroforaminal stenosis or spinal canal stenosis.
C4-C5: Broad-based disk and osteophyte touch the right of the spinal cord the do not deform the spinal cord or cause spinal cord signal abnormality. Left greater than right mild to moderate UV and facet arthropathy cause mild left neuroforaminal
stenosis, unchanged. No right neuroforaminal or spinal canal stenosis.
C5-C6: Broad-based disk and osteophyte flatten the left side of the spinal cord , slightly progressed. No spinal cord signal abnormality. Left UV and facet arthropathy are worsened, now with moderate to marked left neural foraminal stenosis.
No spinal canal or right neural foraminal stenosis. Focal hyperintensity measuring 3 x 5 mm in the lateral aspect of the right neural foramen is likely a pseudomeningocele, not definitely seen on the prior exam (series 8 image 18).
C6-C7: Broad-based disk and osteophyte with right greater than left UV and facet arthropathy which is at least mild causes severe left and moderate to severe right neuroforaminal stenosis, perhaps worsened. Motion artifact on the prior exam makes this
determination uncertain.
C7-T1: Broad-based disk and osteophyte with left greater than right moderate facet and UV arthropathy cause mild to moderate left neural foraminal stenosis and mild right neuroforaminal stenosis. No spinal canal stenosis. Findings may be improved at this
level.
T1-T2:
Left-sided facet arthropathy with thickening of the ligamentum flavum flattens the posterior lateral aspect of the right side of the spinal canal and cause mild left neural foraminal stenosis. No right neuroforaminal stenosis or spinal canal stenosis.
Musculature: Normal. No edema or fatty atrophy.
Other: The paravertebral and prevertebral soft tissues are normal.
IMPRESSION-
Persistent, and for the most part unchanged or minimally worsened neural foraminal stenosis at multiple cervical spinal levels.
No spinal canal stenosis or spinal cord signal abnormality.
Persistent grade 1 degenerative anterolisthesis of C7 on T1, T1 on T2 and T2 on T3.
RADIA
Dictated By: Bardo XXXXXXX MD 2015-04-01 17:06:46.6
Signed By: Bardo XXXXXXX MD 2015-04-01 17:06:46.0
Transcribed By: Bardo XXXXXXX 2015-04-01 17:06:46.653
SITE ID: 003
Referring Provider Line: 855-371-0425
Component Results
There is no component information for this result.
General Information
Collected:
04/01/2015 12:19
Resulted:
04/01/2015 17:09
Ordered By: XXXXXXX XXXXXXX MD
Result Status:
Final result
EXAM:
Right Shoulder MRI Arthrogram with Contrast
EXAM DATE: 2/20/2015 09:47 AM.
CLINICAL HISTORY: Disorders of bursae and tendons in shoulder region, unspecified.
COMPARISON: None.
TECHNIQUE: Multiplanar, multisequence T1-weighted and fluid-sensitive sequences of the shoulder after an arthrographic injection of dilute gadolinium, dictated under a separate exam. Other: None.
FINDINGS:
Acromioclavicular Region: The acromion is Type II Unipartite. The AC joint shows moderately prominent marginal osteophytosis, with prominent synovial hypertrophic changes. No AC joint effusion is also seen. The coracoacromial and coracoclavicular
ligaments are intact. Small amount of fluid but no contrast material is seen in the bursa.
Glenohumeral Region: No subluxation. No loose bodies. The articular cartilage is unremarkable. The glenohumeral ligaments and joint capsule are unremarkable.
Bone Marrow: No fracture, marrow edema or bone lesions.
Labrum: The posterior labrum shows an extensive tear extending into the biceps labral attachment and a type II SLAP configuration. The anterior labrum is somewhat truncated but otherwise intact and normal.
Biceps Tendon: The long head of the biceps tendon and biceps pulley are intact.
Musculature/Rotator Cuff: Partial-thickness undersurface tearing of the distal supraspinatus involves about 80% of the tendinous thickness. This partial-thickness tear is 1.6 x 1.2 cm on series 7, image 16; series 4, image 17. The subscapularis shows
some tendinopathy and no tear. Teres minor and infraspinatus are normal. No proximal edema or fatty atrophy is seen.
Other: The subcutaneous tissues are unremarkable.
IMPRESSION-
1. Type II unipartite undersurface osseous acromion shape. Prominent marginal osteophytosis are present. No AC joint effusion. Small amount of fluid but no contrast material is seen in the bursa.
2. Partial-thickness undersurface tearing of the distal supraspinatus involves about 80% of the biceps tendinous thickness. No proximal edema or fatty atrophy. No full-thickness tear.
3. Posterior labrum shows an extensive undermining tear extending into the biceps labral attachment with a type II SLAP configuration appearance. Anterior labrum is somewhat truncated but otherwise unremarkable.
4. Bones show no erosive or destructive changes. No fractures.
RADIA MUSCULOSKELETAL RADIOLOGY SECTION
Dictated By: Harmon XXXXXXX MD 2015-02-20 13:15:49.437
Signed By: Harmon XXXXXXX MD 2015-02-20 13:21:10.0
Transcribed By: Patricelli XXXXXXX 2015-02-20 13:19:48.22
SITE ID: 027
Referring Provider Line: 855-371-0425
Component Results
There is no component information for this result.
General Information
Collected:
02/20/2015 9:47
Resulted:
02/20/2015 13:24
Ordered By: XXXXXXX XXXXXXX MD
Result Status:
Final result
This test result has been released by an automatic process.
Narrative
EXAM:
MRI LUMBAR SPINE WITHOUT CONTRAST
EXAM DATE: 3/23/2015 03:30 AM.
CLINICAL HISTORY: Acute back pain.
COMPARISON: 05/29/2013.
TECHNIQUE: Multiplanar, multisequence T1-weighted and fluid-sensitive sequences of the lumbar spine from T11 to S1 without contrast. Other: None.
FINDINGS:
Spinal Cord: The conus terminates at L2. No signal abnormality in the visualized spinal cord.
Alignment: Levoscoliosis at the thoracolumbar junction
Bone Marrow: Five non-rib-bearing lumbar vertebral bodies are assumed. No gross fractures or bone lesions. No bone marrow edema.
Disk Levels/Facets:
T12-L1: Unremarkable.
L1-L2: Unremarkable.
L2-L3: Unremarkable.
L3-L4: Mild disk space narrowing. Bulging disk . Mild central stenosis. Foramina appear patent
L4-L5: Left-sided laminectomy . No significant central or foraminal stenosis .
L5-S1: Mild disk space narrowing. Grade 1 spondylolisthesis . Bilateral facet osteoarthritis. Moderate left-sided foraminal stenosis . Mild central spinal stenosis.
Musculature: Normal. No edema or fatty atrophy.
Other: The visualized pelvic cavity is unremarkable.
Stable degenerative disk disease at T11-T12 about cord impingement
IMPRESSION-
Postoperative changes at L4-L5 on the left . No evidence of residual/recurrent disk herniation or significant appearing central or foraminal stenosis .
Bilateral facet osteoarthritis at L5-S1. Grade 1 spondylolisthesis at L5-S1 , new since the prior study from 2013 .
Comment: The following findings are so common in adults without low back pain that while we report their presence, they must be interpreted with caution and in the context of the clinical situation. (Reference Jarvik et al, Spine 2001)
Prevalence of findings in patients without low back pain:
Disk degeneration (any evidence): 92%
Disk desiccation/T2 signal loss: 83%
Disk height loss: 56%
Disk bulge: 64%
Disk protrusion: 32%
Annular tear/high intensity zone: 38%
RADIA
Dictated By: Vieco XXXXXXX MD 2015-03-23 04:16:36.607
Signed By: Vieco XXXXXXX MD 2015-03-23 04:16:36.0
Transcribed By: Vieco XXXXXXX 2015-03-23 04:16:36.87
SITE ID: 020
Referring Provider Line: 855-371-0425
Component Results
There is no component information for this result.
General Information
Collected:
03/23/2015 3:30
Resulted:
03/23/2015 4:19
Ordered By:
Arunachalam Einstein, MD
Result Status:
Final result
Here are the results from my MRI's and lab work.
Narrative
EXAM:
MRI CERVICAL SPINE WITHOUT CONTRAST
EXAM DATE: 4/1/2015 12:19 PM.
CLINICAL HISTORY: Brachial neuritis or radiculitis, bilateral upper cavity weakness , neck and shoulder pain.
COMPARISONS: 09/13/2013.
TECHNIQUE: Multiplanar, multisequence T1-weighted and fluid-sensitive sequences of the cervical spine without contrast.
FINDINGS:
Neurologic Structures: The visualized posterior fossa structures are unremarkable. No signal abnormality in the visualized spinal cord.
Alignment: Reversed lordosis, apex of the reversed curvature is at C5-C6.
Mild grade 1 anterolisthesis at C7 on T1, T1 on T2 on T3 are unchanged.
Bone Marrow: No fractures or bone lesions. Mild bone marrow edema at the inferior plate of C5, superior and inferior endplates of C6 and superior endplate of C7, related to degenerative disk disease, unchanged.
Interspace Levels/Facets:
C1-C2: Atlantoaxial and atlantooccipital intervals maintained.
C2-C3: Mild broad-based disk and osteophyte, left greater than right facet and UV joint hypertrophy, mild right but no left neural foraminal stenosis. No spinal canal stenosis, unchanged.
C3-C4: Broad-based disk and osteophyte with left greater than right facet and UV joint hypertrophy leading to mild to moderate left neural foraminal stenosis, unchanged. no right neuroforaminal stenosis or spinal canal stenosis.
C4-C5: Broad-based disk and osteophyte touch the right of the spinal cord the do not deform the spinal cord or cause spinal cord signal abnormality. Left greater than right mild to moderate UV and facet arthropathy cause mild left neuroforaminal
stenosis, unchanged. No right neuroforaminal or spinal canal stenosis.
C5-C6: Broad-based disk and osteophyte flatten the left side of the spinal cord , slightly progressed. No spinal cord signal abnormality. Left UV and facet arthropathy are worsened, now with moderate to marked left neural foraminal stenosis.
No spinal canal or right neural foraminal stenosis. Focal hyperintensity measuring 3 x 5 mm in the lateral aspect of the right neural foramen is likely a pseudomeningocele, not definitely seen on the prior exam (series 8 image 18).
C6-C7: Broad-based disk and osteophyte with right greater than left UV and facet arthropathy which is at least mild causes severe left and moderate to severe right neuroforaminal stenosis, perhaps worsened. Motion artifact on the prior exam makes this
determination uncertain.
C7-T1: Broad-based disk and osteophyte with left greater than right moderate facet and UV arthropathy cause mild to moderate left neural foraminal stenosis and mild right neuroforaminal stenosis. No spinal canal stenosis. Findings may be improved at this
level.
T1-T2:
Left-sided facet arthropathy with thickening of the ligamentum flavum flattens the posterior lateral aspect of the right side of the spinal canal and cause mild left neural foraminal stenosis. No right neuroforaminal stenosis or spinal canal stenosis.
Musculature: Normal. No edema or fatty atrophy.
Other: The paravertebral and prevertebral soft tissues are normal.
IMPRESSION-
Persistent, and for the most part unchanged or minimally worsened neural foraminal stenosis at multiple cervical spinal levels.
No spinal canal stenosis or spinal cord signal abnormality.
Persistent grade 1 degenerative anterolisthesis of C7 on T1, T1 on T2 and T2 on T3.
RADIA
Dictated By: Bardo XXXXXXX MD 2015-04-01 17:06:46.6
Signed By: Bardo XXXXXXX MD 2015-04-01 17:06:46.0
Transcribed By: Bardo XXXXXXX 2015-04-01 17:06:46.653
SITE ID: 003
Referring Provider Line: 855-371-0425
Component Results
There is no component information for this result.
General Information
Collected:
04/01/2015 12:19
Resulted:
04/01/2015 17:09
Ordered By: XXXXXXX XXXXXXX MD
Result Status:
Final result
EXAM:
Right Shoulder MRI Arthrogram with Contrast
EXAM DATE: 2/20/2015 09:47 AM.
CLINICAL HISTORY: Disorders of bursae and tendons in shoulder region, unspecified.
COMPARISON: None.
TECHNIQUE: Multiplanar, multisequence T1-weighted and fluid-sensitive sequences of the shoulder after an arthrographic injection of dilute gadolinium, dictated under a separate exam. Other: None.
FINDINGS:
Acromioclavicular Region: The acromion is Type II Unipartite. The AC joint shows moderately prominent marginal osteophytosis, with prominent synovial hypertrophic changes. No AC joint effusion is also seen. The coracoacromial and coracoclavicular
ligaments are intact. Small amount of fluid but no contrast material is seen in the bursa.
Glenohumeral Region: No subluxation. No loose bodies. The articular cartilage is unremarkable. The glenohumeral ligaments and joint capsule are unremarkable.
Bone Marrow: No fracture, marrow edema or bone lesions.
Labrum: The posterior labrum shows an extensive tear extending into the biceps labral attachment and a type II SLAP configuration. The anterior labrum is somewhat truncated but otherwise intact and normal.
Biceps Tendon: The long head of the biceps tendon and biceps pulley are intact.
Musculature/Rotator Cuff: Partial-thickness undersurface tearing of the distal supraspinatus involves about 80% of the tendinous thickness. This partial-thickness tear is 1.6 x 1.2 cm on series 7, image 16; series 4, image 17. The subscapularis shows
some tendinopathy and no tear. Teres minor and infraspinatus are normal. No proximal edema or fatty atrophy is seen.
Other: The subcutaneous tissues are unremarkable.
IMPRESSION-
1. Type II unipartite undersurface osseous acromion shape. Prominent marginal osteophytosis are present. No AC joint effusion. Small amount of fluid but no contrast material is seen in the bursa.
2. Partial-thickness undersurface tearing of the distal supraspinatus involves about 80% of the biceps tendinous thickness. No proximal edema or fatty atrophy. No full-thickness tear.
3. Posterior labrum shows an extensive undermining tear extending into the biceps labral attachment with a type II SLAP configuration appearance. Anterior labrum is somewhat truncated but otherwise unremarkable.
4. Bones show no erosive or destructive changes. No fractures.
RADIA MUSCULOSKELETAL RADIOLOGY SECTION
Dictated By: Harmon XXXXXXX MD 2015-02-20 13:15:49.437
Signed By: Harmon XXXXXXX MD 2015-02-20 13:21:10.0
Transcribed By: Patricelli XXXXXXX 2015-02-20 13:19:48.22
SITE ID: 027
Referring Provider Line: 855-371-0425
Component Results
There is no component information for this result.
General Information
Collected:
02/20/2015 9:47
Resulted:
02/20/2015 13:24
Ordered By: XXXXXXX XXXXXXX MD
Result Status:
Final result
This test result has been released by an automatic process.
Narrative
EXAM:
MRI LUMBAR SPINE WITHOUT CONTRAST
EXAM DATE: 3/23/2015 03:30 AM.
CLINICAL HISTORY: Acute back pain.
COMPARISON: 05/29/2013.
TECHNIQUE: Multiplanar, multisequence T1-weighted and fluid-sensitive sequences of the lumbar spine from T11 to S1 without contrast. Other: None.
FINDINGS:
Spinal Cord: The conus terminates at L2. No signal abnormality in the visualized spinal cord.
Alignment: Levoscoliosis at the thoracolumbar junction
Bone Marrow: Five non-rib-bearing lumbar vertebral bodies are assumed. No gross fractures or bone lesions. No bone marrow edema.
Disk Levels/Facets:
T12-L1: Unremarkable.
L1-L2: Unremarkable.
L2-L3: Unremarkable.
L3-L4: Mild disk space narrowing. Bulging disk . Mild central stenosis. Foramina appear patent
L4-L5: Left-sided laminectomy . No significant central or foraminal stenosis .
L5-S1: Mild disk space narrowing. Grade 1 spondylolisthesis . Bilateral facet osteoarthritis. Moderate left-sided foraminal stenosis . Mild central spinal stenosis.
Musculature: Normal. No edema or fatty atrophy.
Other: The visualized pelvic cavity is unremarkable.
Stable degenerative disk disease at T11-T12 about cord impingement
IMPRESSION-
Postoperative changes at L4-L5 on the left . No evidence of residual/recurrent disk herniation or significant appearing central or foraminal stenosis .
Bilateral facet osteoarthritis at L5-S1. Grade 1 spondylolisthesis at L5-S1 , new since the prior study from 2013 .
Comment: The following findings are so common in adults without low back pain that while we report their presence, they must be interpreted with caution and in the context of the clinical situation. (Reference Jarvik et al, Spine 2001)
Prevalence of findings in patients without low back pain:
Disk degeneration (any evidence): 92%
Disk desiccation/T2 signal loss: 83%
Disk height loss: 56%
Disk bulge: 64%
Disk protrusion: 32%
Annular tear/high intensity zone: 38%
RADIA
Dictated By: Vieco XXXXXXX MD 2015-03-23 04:16:36.607
Signed By: Vieco XXXXXXX MD 2015-03-23 04:16:36.0
Transcribed By: Vieco XXXXXXX 2015-03-23 04:16:36.87
SITE ID: 020
Referring Provider Line: 855-371-0425
Component Results
There is no component information for this result.
General Information
Collected:
03/23/2015 3:30
Resulted:
03/23/2015 4:19
Ordered By:
Arunachalam Einstein, MD
Result Status:
Final result
Brief Answer:
MRIs explain some but not all.
Detailed Answer:
Hello,
Thank you for posting your MRI results.
I studied them and the changes explain your neck, shoulder,back and limbs pain and numbness. These do not explain your headache, memory impairment, confusion or loss of weight.
I could not see your lab work. Those might give a clue.
Your orthopedic doctor would be able to give you medicines/ advice regarding physiotherapy for relief of the symptoms due to the neck, back and shoulder lesions.
You require to see a neurologist/ internist for your loss of weight and problems of memory and confusion. They may advise MRI of the brain with contrast.
If you could post the lab results also, I shall comment on them.
Hope you will get better soon.
MRIs explain some but not all.
Detailed Answer:
Hello,
Thank you for posting your MRI results.
I studied them and the changes explain your neck, shoulder,back and limbs pain and numbness. These do not explain your headache, memory impairment, confusion or loss of weight.
I could not see your lab work. Those might give a clue.
Your orthopedic doctor would be able to give you medicines/ advice regarding physiotherapy for relief of the symptoms due to the neck, back and shoulder lesions.
You require to see a neurologist/ internist for your loss of weight and problems of memory and confusion. They may advise MRI of the brain with contrast.
If you could post the lab results also, I shall comment on them.
Hope you will get better soon.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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