Dr. Florilyn Joyce Chulsi Bentrez
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had an MRI done 2 months back that showed moderate supratentorial white mater disease, similar to the prior exam. Differential diagnosis includes demyelinating disease, vasculitis, and sequela from Lyme disease. There was no parenchymal atrophy. I am very concerned. The doctor does not have any earlier appointments available. What comes next? Other doctors (not specialists) have suggested to move up my appointment; but, there is nothing available. I know stressing is not a good idea, but, it is difficult not to. Recently, I had an allergy test done which shows I am allergic to mold and pollution from a cottonwood tree.
Kindly help.
Hello,
Welcome to icliniq.com.
The indication for the MRI was facial paresthesia. What is the distribution of the abnormal sensation in the face, is it just the right side or the left? Does it involve the forehead? So I can correlate with the results if the imaging findings are causing your symptoms or not. Do you have hypertension, diabetes or any medical condition? How is your memory? Subcortical white matter lesions may also be seen among people with long-standing hypertension or diabetes and may cause some cognitive impairment in the future if not controlled. A demyelinating disease is acute and usually would comprise bigger plaques in the MRI and would present as stroke-like symptoms which does not fit your profile. The imaging is always correlated to the clinical picture. Also, it would be better if I saw the MRI plates.
I hope this helps.
Patient's Query
Hello doctor,
Thank you for the reply.
It is the left side of my face. I have not noticed it on my forehead. But I have noticed a sensation in my scalp. I have headaches predominately in the forehead. I have not slept well for years. I have not been diagnosed with diabetes or hypertension. I have been diagnosed with a pinch nerve in my neck and arthritis of the neck. I have IBS and suffer from vitamin D deficiency. However, blood work shows only high calcium. My primary doctor advised he was going to keep check. There is a family history of diabetes, hypertension, and heart disease. I have MRI scans, but, I have no way of uploading them tonight. I am a bit more forgetful. I can still comprehend and retain information. However, it takes more time for me to do so.
Hello,
Welcome back to icliniq.com.
Please send me pictures of your MRI scan, especially the T2 and T2 flair sequences. Are your headaches pulsatile and one-sided? Does movement, light, and noise worsen your headache? If your answer is yes to the questions, it may be of migraine type. Chronic migraineurs can have white matter lesions on MRI too. but please monitor your blood pressure to know if we need medications to control blood pressure. I think the facial paresthesia is not due to the MRI lesions. It might be a peripheral nerve in etiology. I suggest you undergo a blood workup which includes:
Meanwhile, I suggest you take Pregabalin 75 mg once a day at night. It can cover facial paresthesia, pain, or headache, and for poor sleep. Side effects in some who take this would be sleepiness and dizziness. You can take Keltican (a combination of uridine monophosphate, vitamin B12, and folic acid) one capsule once a day for the nerve. If Pregabalin and Keltican are not tolerated, please notify me.
I hope you are satisfied with my answer. For further queries, you can consult me at icliniq.
Thank you.
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Neurology
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