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What causes spots on scalp?

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General & Family Physician
Practicing since : 2005
Answered : 2581 Questions
I have a 85 yr. old female pt., ambulatory, affect x 3, no mental delusions, no s/s of Alzheimer's. She has Bad recall, memory congruent with her age. MRI, CAT, and multiple x rays,(head and neck, spine), read two pinched nerves in the # ? part of her neck. She has a good med Hx with no major surgeries, and no complaints of an aberrant problems below her neck. She recently, (dyslexia), showed up with complaints of two saw-buck size spots on her scalp, she had no signs of rash or any discoloration, or any abnormal observable symptoms on these spots.. Her complaint was of a feeling of worms just under her scalp, just subdural, that also had the secondary complaint of pain associated in these two areas. They reportedly bothered her 50-75% of the day...? the assc pain required mild to moderate pain control, using mild scheduled narcotic antalgics' to get by, no seeking behavior at all. I have tried hit or miss therapy, from PT to meds, my journals pages are frayed.......I can do nothing to even come close to finding a cause. The only relief she gets is less than prescribed pain control. I could use two heads or more on this one. This GP is baffled, she is a person close to me friendship wise. I would really like to do something. I am really retired and have never seen the like after seeing everything.....? Ideas
Posted Wed, 19 Feb 2014 in General Health
Answered by Dr. Prasad 5 hours later
Brief Answer: Paraesthesia - unidentified reasons perhaps... Detailed Answer: Hi, I went through the details posted with diligence and I empathize with her symptoms. Accordingly I really appreciate your efforts to help her, it means a lot. Now, the two spots bothering her is most likely secondary from abnormal sensory perception. We call such sensory disturbance as paraesthesia secondary to abnormal neurotransmittor chemicals. The cause may or may not be identified; however if they are disturbing her a lot I would evaluate for metabolic functions such as hemogram, vitamin b12, vitamin D, calcium, magnesium, electrolytes, renal, liver and thyroid hormone check. But again only if these symptoms are worsening without medications. If the cause is unidentifiable or uncorrectable, I would treat her with pain modifying drugs like pregabalin. I have seen good success results with this medicine and similar other drugs. Her treating doctor will know about it. Hope this helps. Let me know if you need clarifications. Regards
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