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Suggest Treatment For Tingling Fingers In Condition Like Migraines
Question: hi,neurologist to answer,my 17 yr old daughter has been dealing with what we thought were migraines and siezures for the past 2-3 years. other symptoms are ringing in her ears, fingertips tingling , eyes blacking out for seconds at a time, unable to focus on a task, dizziness. She has been seeing a nuerologist and has had several ct scans with XXXXXXX .w/o XXXXXXX ,,,you name it and everything comes back negative.
We were advd about 1 yr ago, that they don't think its migrains or siezures, but they don't know what it is, however the DR has her on Topamax , 2 pills a night.
For a year she has been fine with no issues and then 3 weeks ago all of a sudden she became nauseous, clammy, her hands, tongue and face went numb and she became extremely sleepy. This has occd 3 times in the past 3 weeks. Last night was the most recent. These are also the same episodes and symptoms she went through 2 years ago. Today she says she feels ok, but fingers still a lil bit tingly. HELP!?
We were advd about 1 yr ago, that they don't think its migrains or siezures, but they don't know what it is, however the DR has her on Topamax , 2 pills a night.
For a year she has been fine with no issues and then 3 weeks ago all of a sudden she became nauseous, clammy, her hands, tongue and face went numb and she became extremely sleepy. This has occd 3 times in the past 3 weeks. Last night was the most recent. These are also the same episodes and symptoms she went through 2 years ago. Today she says she feels ok, but fingers still a lil bit tingly. HELP!?
Brief Answer:
Basilar migraine most probable.
Detailed Answer:
I read your question carefully and I understand your concern.
If I were to judge based on those symptoms my probable diagnosis would have been migraine, it does fulfill the criteria for migraine judging by its length, severity and functioning impairment as well as nausea. Looking at those symptoms of ear ringing, altered consciousness, bilateral numbness, dysarthria it is likely a special type of migraine called a basilar migraine. The symptoms can be very frightening though not dangerous.
It is a tricky condition because the most used drugs in common migraine, the triptans or ergotamines class are not indicated. Because it's a rare condition there are few studies about it. For the treatment of the attacks themselves it's used a combination of an non steroid antiinflammatory drug (like indomethacine, naproxene) with an antiemetic (like Prochlorperazine, Metoclopramide). There are commercial combinations of these components in the same pill available here in Europe I am sure there must be in US as well.
Of course the equally important question is the preventive treatment. There are many classes of drugs used in migraine and it's difficult to make precise recommendations since you say to have used many but don't remember the name. For basilar migraine it's not indicated to take beta blockers (like propranolol). Most success has been noted with a calcium channel blocker like flunnarizine, or an antiepileptic like topiramate which you have already tried with some degree of success. So if the episodes continue under topiramate and you haven't tried calcium channel blockers I suggest that as a preventive treatment.
I remain at your disposal for further questions.
Basilar migraine most probable.
Detailed Answer:
I read your question carefully and I understand your concern.
If I were to judge based on those symptoms my probable diagnosis would have been migraine, it does fulfill the criteria for migraine judging by its length, severity and functioning impairment as well as nausea. Looking at those symptoms of ear ringing, altered consciousness, bilateral numbness, dysarthria it is likely a special type of migraine called a basilar migraine. The symptoms can be very frightening though not dangerous.
It is a tricky condition because the most used drugs in common migraine, the triptans or ergotamines class are not indicated. Because it's a rare condition there are few studies about it. For the treatment of the attacks themselves it's used a combination of an non steroid antiinflammatory drug (like indomethacine, naproxene) with an antiemetic (like Prochlorperazine, Metoclopramide). There are commercial combinations of these components in the same pill available here in Europe I am sure there must be in US as well.
Of course the equally important question is the preventive treatment. There are many classes of drugs used in migraine and it's difficult to make precise recommendations since you say to have used many but don't remember the name. For basilar migraine it's not indicated to take beta blockers (like propranolol). Most success has been noted with a calcium channel blocker like flunnarizine, or an antiepileptic like topiramate which you have already tried with some degree of success. So if the episodes continue under topiramate and you haven't tried calcium channel blockers I suggest that as a preventive treatment.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for getting back to me so quickly.
This makes a lot of sense, however can you have a migraine and not have any headache and only these other symptoms ? When she is going through these episodes,,she doesn't have a headache.
Iinitially with her first neurologist ,he had also advised us along with migraines,he also believed she was having "simple to complex partial siezures" as well ,where sometimes she maintains awareness of her surroundings and during other episodes,,,she would have some or all awareness is lost.
Would these be the same type of symptoms as the "Basiliar Migraine" or something totally different?
Continuing :
After switching to our 2nd neurologist, he is the one that came to the conclusion that he didn't believe she was having migraines or complex seizures, but could not advise what else it could be and it had him stumped. This is why Im inquiring with an outside source.
I think they are migraines and/or simple or complex siezures . They seem to fit with what is going on with her.
Further background,,i didn't mention it earlier, because I didn't want it to be the first conclusion anyone came to. There is a long history of major migraines, epilepsy and aneurysms , that run in my and my husbands family.
This makes a lot of sense, however can you have a migraine and not have any headache and only these other symptoms ? When she is going through these episodes,,she doesn't have a headache.
Iinitially with her first neurologist ,he had also advised us along with migraines,he also believed she was having "simple to complex partial siezures" as well ,where sometimes she maintains awareness of her surroundings and during other episodes,,,she would have some or all awareness is lost.
Would these be the same type of symptoms as the "Basiliar Migraine" or something totally different?
Continuing :
After switching to our 2nd neurologist, he is the one that came to the conclusion that he didn't believe she was having migraines or complex seizures, but could not advise what else it could be and it had him stumped. This is why Im inquiring with an outside source.
I think they are migraines and/or simple or complex siezures . They seem to fit with what is going on with her.
Further background,,i didn't mention it earlier, because I didn't want it to be the first conclusion anyone came to. There is a long history of major migraines, epilepsy and aneurysms , that run in my and my husbands family.
Brief Answer:
Read below.
Detailed Answer:
Thank you for bringing more info. Both migraine and epilepsy have a genetic component so the fact that you and your husband have a family history increases that chance. Aneurysms as well, but luckily the imaging tests you have done have excluded that.
Regarding the first question, yes it is possible to have migraine auras without having headache. I am a little confused though, because while reading the dialogue you had with my ENT colleague, in the follow-up question you mention her to have "severe headaches, ringing in the ears...". Does that mean she has headache only during some of the episodes, or does she never have it? Would the complete lack of headache change my opinion...I still would put basilar migraine as a probable diagnosis, but with a lesser degree of certainty.
Seizures can have many types of presentations so it is hard to completely rule them out, EEG would help if positive for epileptiform changes, but it wouldn't exclude it being normal.
However alterations of consciousness are part of the possible symptoms of basilar migraine. The basilar in the name is because its signs correspond to brain territory supplied with blood by the basilar artery, the territory responsible for awareness and consciousness. The multitude of other symptoms you describe are described best by an involvement of that territory, hence why I stay by that diagnosis.
As I said it is a rare diagnosis, if no headaches is even more uncommon, but since other causes are excluded by imaging, it is left as the most likely one for me.
Read below.
Detailed Answer:
Thank you for bringing more info. Both migraine and epilepsy have a genetic component so the fact that you and your husband have a family history increases that chance. Aneurysms as well, but luckily the imaging tests you have done have excluded that.
Regarding the first question, yes it is possible to have migraine auras without having headache. I am a little confused though, because while reading the dialogue you had with my ENT colleague, in the follow-up question you mention her to have "severe headaches, ringing in the ears...". Does that mean she has headache only during some of the episodes, or does she never have it? Would the complete lack of headache change my opinion...I still would put basilar migraine as a probable diagnosis, but with a lesser degree of certainty.
Seizures can have many types of presentations so it is hard to completely rule them out, EEG would help if positive for epileptiform changes, but it wouldn't exclude it being normal.
However alterations of consciousness are part of the possible symptoms of basilar migraine. The basilar in the name is because its signs correspond to brain territory supplied with blood by the basilar artery, the territory responsible for awareness and consciousness. The multitude of other symptoms you describe are described best by an involvement of that territory, hence why I stay by that diagnosis.
As I said it is a rare diagnosis, if no headaches is even more uncommon, but since other causes are excluded by imaging, it is left as the most likely one for me.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
sorry for the confusion. She does get really bad headaches on occasion, but not typically during an "episode" as ive come to call them. Which is so confusing.
when she gets the ringing in her ears, she will sometimes loose vision for a few seconds and her fingertips go numb or get a tingly sensation.
These are the symptoms she had during the last 2 episodes:
The episode she had 3 weeks ago, her ears were ringing earlier in the day,,,it stopped after a little while and she was fine the rest of the day. I had taken her to the dr for a sinus infection and 10 mins after we left, she got nauseous and clammy and just didn't feel good,,,10 minutes later, her tongue and face went numb along with her fingertips and she was really drowsy,,,,but again no headache. within the hour, she took her Topamax and went to sleep and woke up still tired, fingers tingled a bit,,,,,but was fine the rest of the day.
The episode that occurred 2 nights ago,,,she wasn't feeling good for part of the day, didn't have any ringing in her ears at all ,but had moderate headache most of the day. She went to sleep as normal, but all of a sudden woke up , saying she was really nauseous and said her face was numb, more so on the left side of her face from the eye down to her chin and she was slurring a little bit. She was trying to eat a few crackers for the nausea and appeared to be having some difficulty chewing. Then she went back to sleep and has been back to normal since then.
when she gets the ringing in her ears, she will sometimes loose vision for a few seconds and her fingertips go numb or get a tingly sensation.
These are the symptoms she had during the last 2 episodes:
The episode she had 3 weeks ago, her ears were ringing earlier in the day,,,it stopped after a little while and she was fine the rest of the day. I had taken her to the dr for a sinus infection and 10 mins after we left, she got nauseous and clammy and just didn't feel good,,,10 minutes later, her tongue and face went numb along with her fingertips and she was really drowsy,,,,but again no headache. within the hour, she took her Topamax and went to sleep and woke up still tired, fingers tingled a bit,,,,,but was fine the rest of the day.
The episode that occurred 2 nights ago,,,she wasn't feeling good for part of the day, didn't have any ringing in her ears at all ,but had moderate headache most of the day. She went to sleep as normal, but all of a sudden woke up , saying she was really nauseous and said her face was numb, more so on the left side of her face from the eye down to her chin and she was slurring a little bit. She was trying to eat a few crackers for the nausea and appeared to be having some difficulty chewing. Then she went back to sleep and has been back to normal since then.
Brief Answer:
Read below.
Detailed Answer:
Thanks for clarifying.
Those symptoms do correspond to that territory. If it wasn't for the fact that she's had brain imaging I would have thought for sure that it was an issue with the blood vessels supplying that part of the brain leading to transitory lack of blood flow. Of course that is under the assumption since she's had contrast exam that they've studied the blood vessels. Not only in the head but the neck as well to rule some anatomical malformation leading to reduced blood flow in the posterior part of the brain. I believe that must've been considered already but just checking to make sure.
Also I assume some routine blood tests, especially electrolytes, thyroid function should have already been done as well as a cardiac screening.
If those have been done then my opinion remains the initial one.
Read below.
Detailed Answer:
Thanks for clarifying.
Those symptoms do correspond to that territory. If it wasn't for the fact that she's had brain imaging I would have thought for sure that it was an issue with the blood vessels supplying that part of the brain leading to transitory lack of blood flow. Of course that is under the assumption since she's had contrast exam that they've studied the blood vessels. Not only in the head but the neck as well to rule some anatomical malformation leading to reduced blood flow in the posterior part of the brain. I believe that must've been considered already but just checking to make sure.
Also I assume some routine blood tests, especially electrolytes, thyroid function should have already been done as well as a cardiac screening.
If those have been done then my opinion remains the initial one.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
yes all tests, CT scans, MRI's came back clear. Her thyroid came back normal. I don't believe a cardiac screening has been done and not sure if the blood tests checked for electrolytes. I will need to check in to that.
Thank You DR. Taka, for all your information, You have been a tremendous help!
Thank You DR. Taka, for all your information, You have been a tremendous help!
Brief Answer:
Thank you!
Detailed Answer:
I am sure the electrolytes have been done as well, it would be strange to jump to expensive tests like MRI and CT and not do such a routine thing, they must've come back normal.
Thank you for your appreciative words. I hope things will get better soon.
Thank you!
Detailed Answer:
I am sure the electrolytes have been done as well, it would be strange to jump to expensive tests like MRI and CT and not do such a routine thing, they must've come back normal.
Thank you for your appreciative words. I hope things will get better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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