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    Suggest treatment for pain in neck with intense pressure in head

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Posted on Thu, 2 Jun 2016 in Hypertension and Heart Disease
Question: IDDM x 49 years (53 yo now). Good glucose control but I haven't been to see an MD since 2010 and before that I think it was ~2004. Two weeks ago, I had pain/tenderness on the left side of the back of my neck and intense pressure in my head. A few days later, I noticed I had very light brown circles around my eyes. 3 days ago I suddenly had pitting edema in both lower legs and a whooshing sound in my ears that is there again now. I took some lisinopril daily the past 3 days. My BP a few hours ago was 127/67 but maybe the 3 days of lisinopril brought my BP down. Whooshing stopped last 24 hrs but started again 30 min ago while I was just sitting here. Given that the left side of my neck is still painful, and given my history, could this be narrowing of the carotid artery? I have some pitting in lower limbs but not nearly what it was 2 and 3 days ago. My cholesterol is right around 200 without meds. I eat a vegetarian diet and not much "goody garbage" and no salt. Didn't know if I should ask a cardiologist or nephrologist.
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Answered by Dr. Ilir Sharka 3 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that it is important performing a comprehensive differential diagnosis between different causes that may lead to your symptomatology:

- Blood pressure changes. High blood pressure can lead to this symptomatology. Low blood pressure too can cause whooshing sound and headache.
- An infection can lead to this symptomatology
- Thyroid dysfunction or any other metabolic disorder (chronic anemia, kidney or liver dysfunction)
- The pain in your neck could be caused by a musculo-skeletal disorder including inflammation of the soft tissues or a cervical column degenerations, which can lead to occipital neuralgia. Cervical arteries dissection (which is a damage in the cervical arteries) can lead to acute neck pain which headache and other symptoms including stroke, but it doesn't seem to be the cause of your symptomatology.

The pitting in your limbs may be related to increased water retention (which can be related to heart disease, liver and kidney disorders, etc.).

I would exclude an artery narrowing as the possible cause of your symptoms as they are painless (except for dissection). Besides, the whooshing is in both your ears and not unilateral, which indicates a more generalized disorder (like hypertension, metabolic disorders, infection or inflammation, etc.).

I recommend consulting with your family doctor for a careful physical exam and some tests:

- a resting ECG and a cardiac ultrasound to examine your cardiac function and structure.
- a chest X ray study
- a Doppler ultrasound of the cervical arteries (to exclude possible dissection, even though exceptional with your symptomatology)
- a cervical column X ray study to examine for possible chronic degeneration
- blood lab tests (complete blood count, PCR, sedimentation rate, thyroid hormone levels, blood electrolytes, fasting glucose, kidney and liver function tests).

I would also advise you to closely monitor your blood pressure in sitting and standing up position frequently during the day and refer those values to your doctor.

Hope you will find this answer helpful!

Kind regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 7428 Questions

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