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    What causes speech problem, left-sided weakness, gait disturbance and urinary incontinence?

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Posted on Thu, 6 Jul 2017 in Brain and Spine
Question: I have massive pain pressure behind my eyes and over my eyebrow past year.My speech is soft and slurred at time. My strenght on left is fading. My gait is worse . Now at this timeI"m having trouble holding my bladder. no terrors .facial expressions not good
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Answered by Dr. Dariush Saghafi 55 minutes later
Brief Answer:
Symptoms of left sided weakness and gait disturbance

Detailed Answer:
Good afternoon. Thank you for your question. I understand that over the past year your speech volume is becoming softer with occasional slurring of your speech and increasing left sided weakness. You also state that your gait is "getting worse" but there is no more detailed description such as whether the left leg drags, freezes, slaps, or is being pushed along the ground. You are also having bladder incontinence, no tremors, and facial expressions are somehow altered but again specifics are not given in the introductory statement.

At your age my interest would be to perform a detailed history to see if any these problems (and perhaps a few that you've not noticed as readily) started any greater than 1 year ago. I'd be interested in knowing who else you've seen for this evolving picture and if anyone had been contacted in the beginning what their initial thoughts were at that time vs. how things have evolved since then.

I would then, perform a detailed neurological and physical examination to document both the motor, sensory, cranial nerve, and autonomic functions and see which problem predominates and how much of a relative decline has taken place over the course of these symptoms. I would also rule out the possibility of what is referred to as a PARANEOPLASTIC DISEASE process which refers to an occult tumor or CANCER that could be tucked away somewhere in the body which has not been apparent and could be causing these remote effects.

If you've not gotten any imaging studies of the brain then, I would very much like to get an MRI of the brain with gadolinium contrast to rule out the presence of a tumor or other mass lesion which could also explain the pressure about the eyes.

The features you relate can be thought of as parkinsonisms as well as neurodegenerative symptoms that can be seen in DEMYELINATING DISORDERS such as MS and even though you would be generally considered much older than the typical patient to have MS at this time....I should just tell you about a 73 year old who came off of an airplane after a flight, tumbled down some stairs and landed up in the hospital. When we got her and thought she'd had a stroke or something similar and did the entire workup we discovered the most unusual and reportable finding that she had just presented MS for the first time at her age! Quite extraordinary it was to say the least.

That is not to say that is what I think you have but your symptoms of slow progression involving just one half of the body certainly do lend themselves to that type of thought process.

In conclusion, I would clearly have a neurologist perform a detailed examination and history of the problem followed by appropriate laboratory analyses and an MRI with gadolinium contrast. Whether or not I would go to a PET scan given what you've described I don't know at this point. I think the MRI will definitely show us something such as right cerebral or cortical degeneration or enlargement of the right ventricles of the brain which could be another possible cause of problems which is referred to as a hydrocephalus that could be obstructive if only one side of the body is affected.

If I've provided useful and helpful information to your questions and satisfaction could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 20 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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