My 66-year-old father who is a retired school teacher was having a cold and cough for 10 days. One month back, he developed slurred speech and blurred vision, double vision, giddiness, imbalance, nasal intonation of voice, hypertension. Blood pressure was fluctuating. As per him, symptoms were more in the morning and improved gradually as the day passed by. There was no headache, vomiting, seizure, loss of control, bowel or bladder incontinences. CT of the brain done at first was reported as a left external capsular infarct.
An MRI done revealed prominent right cavernous sinus to correlate for significance there is age-related cerebral atrophy with white matter changes. Doctors first doubted MG then MS. Neostigmine test came negative. He was started on an antibiotic, a course of IV methylprednisolone, lipid-lowering agent, PPI and supportive. Blood parameters showed raised TC, RFT, uric acid, SGOT, SGPT. CSF analysis showed raised protein and TC. With treatment, a bit of improvement was seen but not substantial.
Ten years ago, he was diagnosed with retrobulbar neuritis. Doctors are more or less supposing it to be MS and gave a further course of prednisolone of 20 mg and Atorvastatin 20 mg tablets along with those for hypertension, cough and acidity and advised to take care about the blood pressure. There are no definitive answers or assurances. What should we do? Please help.
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Your father's symptoms are not typical of MG (myasthenia gravis). I would exclude MS (multiple sclerosis) due to his age and MRI (magnetic resonance imaging) findings although his past history of optic neuritis.
A stroke cannot be excluded although I would directly review his MRI for a more professional opinion. Are white matter changes enhanced by gadolinium?
Lambert-Eaton syndrome could mimic this clinical situation too.
I would recommend also checking any malignancies.
For this reason, it is necessary performing a chest X-ray study and an abdominal ultrasound coupled with tumoral antigens like CEA (carcinoembryonic antigen), CA (cancer antigen) 19.9 and PSA (prostate-specific antigen) levels.
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