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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What do confusion, dizziness, headaches and diminished cognitive and problem solving functions indicate?

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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3148 Questions

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Posted on Fri, 8 Jun 2018 in Brain and Spine
Question: To whom it may concern

I have been getting bouts of confusion,dizziness, headaches, pressure in my headand what I can only explain as brain fog ( during these episodes I find that my problem solving and my cognitive function is diminished). The episodes have been happening on and off for the lastyear in which I have had three mri,s a full cognitive function test full set of blood tests ie count,liver,kidney,cardiac panel,arthritis. Sleep apnea test. I have also had a cardiac stress test,24 hour holter monitor,5 day event monitor, echo cardio gram and these have not indicated a problem with my heart or a tumor or other brain defect.

Please can you give advise as to what this could be
doctor
Answered by Dr. Erion Spaho 1 hour later
Brief Answer:
Intracranial hypotension, low cobalamin, thyroid dysfunction.

Detailed Answer:
Hello and thanks for using HCM.

I have read your question and understand your concerns.

I need to ask you first if your symptoms are related to the body position.

For example, if the headache and the subsequent symptoms are worsened in upright position and improve after lying down intracranial hypotension is a possibility.

Besides the examinations you had, I think you should get evaluated about thyroid gland function and cobalamin blood levels that may be other conditions ( if found dysfunctional , that may explain your symptoms.

Hope you found the answer helpful.

Let me know if I can assist you further.

Take care.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Erion Spaho 49 minutes later
sorry I meant to confirm if anxiety can cause me to be doing a task and then I would finish it and not recall concluding it.
doctor
Answered by Dr. Erion Spaho 13 minutes later
Brief Answer:
Anxiety is a possibility.

Detailed Answer:
Hello again.

Yes, anxiety and stress disorder is a strong possibility that may cause such issues, but it remains a diagnosis of exclusion, in other words, other possible causes should be excluded first.

I recommend you to complete the examinations about before mentioned conditions first.

If they will be excluded, anxiety remains the culprit.

Hope this helps.

Greetings.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Erion Spaho 5 hours later
Regarding the symptoms of dizziness and and pressure I do feel it is relived by laying down however the last MRI I had was in October which did not show any thing. I have confirmed with my gp that the battery of blood tests also included vitamin B12 and a thyroid check.

Other than the EEG would you suggest any other test to rule out any underlying problem

In conclusion if you could reconfirm what you think the underlying problem is
doctor
Answered by Dr. Erion Spaho 6 hours later
Brief Answer:
Read below.

Detailed Answer:
Welcome back.

Since cobalamin and thyroid function were within normal ranges, these conditions are excluded.

If the MRI was done with gadolinium (i.v. contrast medium) and didn't show signs that may point towards intracranial hypotension ( meningeal thickening), this condition is unlikely the cause too.

However, symptoms regressing after laying down are suggestive of intracranial hypotension.

EEG is a tool to evaluate seizures that seem unlikely in your case.

In conclusion, since almost all other possible conditions seem to be excluded, anxiety remains the most likely condition that is causing your issues.

Take care.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Erion Spaho 3 hours later
Please be advised that all three of the MRI,s that I have had proformed were excluding contrast. Is it possible for an MRI without contrast to miss a potential problem

Would you recommend going for an additional MRI with contrast to exclude any potential problems

Please confirm if I have run out of responses
doctor
Answered by Dr. Erion Spaho 16 hours later
Brief Answer:
Read below.

Detailed Answer:
Welcome back.

Intracranial hypotension is suspected clinically ( your symptoms are suggestive ) and brain MRI with i.v. contrast is necessary to confirm or exclude the diagnosis.

So, I think you should discuss with your Neurologist about this possibility if he suspects that this condition may be a possible explanation for your symptoms you should have an MRI with contrast.

Hope this helps.

Regards.
Above answer was peer-reviewed by : Dr. Kampana
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