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What causes fogginess of brain with normal blood work and liver tests?

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Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 11331 Questions

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Posted on Wed, 27 Aug 2014 in Back Pain
Question: Hi, my name's XXXXXXX and I'd like to ask you for help with the diagnosis of my symptoms. I don't take or have ever taken any drugs, except alcohol in small amounts (max. one glass of wine in one evening) and very occasionally. No history of any illness or epilepsy. No family history of any illness.

I have two presumably separate problems:
1) For the last 2 years I've been suffering from unbearable fatigue, which has been getting worse and worse. My body feels ok, the fatigue seems to be mostly psychological. I can go for a run or swimming and it has no impact whatsoever on the fatigue. Actually, I sometimes feel better after exercise. I also have brain fog (difficulty with concentration, memory, sometimes to the point of not remembering my friends' names!). The fatigue is the worst in the morning, after eating and it's least bad at about 9pm and it's slightly better after drinking a glass of wine (but not more). The fatigue feels as if I am drunk or as if there's some pressure behind my eyes making me tired. I have some other neurological symptoms including body tremors and jerks and sometime trouble with reading. Also, I have what my neurologist believes to be either occasional temporal lobe seizures or derealisation episodes.

I saw a neurologist a month ago, who ran the following blood tests: basic bloodwork (red, white cells, lymphocytes, basophil, and many others), liver function test, Serum electrolytes, Thyroid function test, urine microscopy, vit B12, serum ACE, folate, Serum C protein, Complement C3 C4, erythrocyte sedimentation rate
ALL TESTS CAME OK WITHIN RANGE. In addition, the neurologist did a physical examination (including eye examination) and no signs of any disease or inflammation were found. I also had a 3T MRI of brain done, and NOTHING WAS FOUND. I further saw an otorhinolaryngologist, who did one sleep study and found no fluctuation of oxygen in blood or heart rate during sleep (measured on finger). My neurologist and my psychiatrist have run all the tests possible within their respective realms of expertise and they can't find any neurological or psychiatric cause to my symptoms. (no combination of medications for anxiety and depression helped either.) I seem normal.

Strangely enough, most of the symptoms coincide with my orthodontic treatment (braces). Especially the epileptiform-like episodes, which I tend to get after my orthodontic appointments. I have had problems with my hyoid bone and my jaws for a long time now and the orthodontics have probably made them worse. My hyoid bone is constantly on the left side and it clicks when I move my mouth. Once it happened that I turned my head, something cracked in my neck (presumably the hyoid bone) and I lost consciousness for a few seconds. My neck and facial muscles on my left side are constantly aching and cramped. I do special exercise to relieve the stiffness but partial relief only lasts for several hours and then the symptoms reappear. (for your information, I played the violin for 15 years but stopped 3 years ago)

My first question for you is: Do you think that somehow something could be slightly compressing the arteries that provide blood flow to my brain? For example, the orthodontic treatment pushed back my chin. Could it compress the arteries in the temporomandibular joint area? Could the hyoid bone or extremely strained neck muscles be slightly reducing blood flow to the brain? Could anything else be reducing blood supply to the brain?
--- if so, what would be the best way to diagnose this?
the reason why I'm asking this is that I read an article where scientists found a correlation between CFS and insufficient brain blood supply. And when I was a teenager and I stood up suddenly from a sitting position, I felt exactly the same as I'm feeling now all the time when I'm sitting. Groggy.


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2) my second question is related to my urination problems. I experience post-void dribbling with constantly wet underwear. This does NOT happen when I'm standing or walking. Only when I sit for a prolonged period of time do I start to get dribbling (even if it's not straight after urination). I went to see a physiotherapist who said that my coccyx was dislocated from excessive sitting (and truth be told I have been sitting way way way too much for the last year). I've never had any accident though. She also said that the urination problems that I'm experiencing could be related to my coccyx problem. Would you agree? By the way, I also have scoliosis but not too bad. Alternatively, what kind of orthopedic issue could be causing my problems and what diagnosis would you suggest?

I do take exercise recommended by the physiotherapist and the problems get better after exercise but anytime I sit down they get worse again.
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Thanks so much for your help.

Kind regards,
XXXXXXX
doctor
Answered by Dr. Praveen Tayal 2 hours later
Brief Answer:
Details below.

Detailed Answer:
Hello,
Thanks for posting your query.
1. The problem related to the fogginess of the brain can be due to a decrease in the blood supply to the brain or hypoglycemia.
Since all the organic causes have been ruled out after the investigations anxiety can also be considered as a possible cause. To diagnose the blood circulation compromise MRI scan of the neck can help in diagnosis.
2. The dribbling of the urine can be related to coccyx problem as it can be caused by a minor nerve compression that gets better after physiotherapy. The problem only during sitting further confirms that it is a nerve related problem. You can get MRI scan of the lower back to find out the cause.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 36 minutes later
Tahnk you for your quick answer!

I understand your answer to q2 perfectly, however, I'm not sure about q1.

Am I right in saying that some sort of brain circulation compromise is possible in my case? Has someone had that before?

You also mentioned hypoglycemia. My sugar levels are fine. How could that be possible?

Thanks again!

Best regards,
XXXXXXX
doctor
Answered by Dr. Praveen Tayal 7 minutes later
Brief Answer:
Rare cause but possible.

Detailed Answer:
Hello.
Thanks for writing again.
A compromise of brain circulation is possible and that can be studied by MRI scan by seeing if the different positions of neck cause any compression of the arterial supply to the brain. It is a rare cause and difficult to prove. Anxiety and hypoglycemia are more common causes. The blood glucose levels at the time of maximum fogginess need to be done to rule that out.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

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