Ask a doctor on the topic of Neurology

I'm desperate, I urgently need help!!

March 2, 2012 | 30,00 EUR | answered by Christian Welsch

Hello,
my name is Florian, I am 27 years old and have been suffering from an unexplained illness for several years!
Symptoms include:
• It started with severe eye burning and impaired vision
Over the course of weeks and months, headache, fatigue, weakness, and occasional nausea developed.

In the following years, further symptoms developed such as:
• Decreased consciousness
• Confusion and dizziness
• Chronic headaches
• Body spasms, especially in the calf muscles
• Heavy sweating (underarms), strong acidic odor
• Inner restlessness / nervousness
• Sensory disturbances such as tingling and twitching in arms, legs and back
• Hypertension: 150/110/75
• Tremor, memory gaps
• Sleep disorder
• Nausea and vomiting

Since all previous serological examinations did not provide any evidence of an organic disease, my general practitioner now suspects a depressive episode. I have been in psychotherapeutic treatment for about 1 year, unfortunately without any success! Now my general practitioner has referred me to the Infectiology Institute in Frankfurt.

Findings:
• Hypertriglyceridemia (Triglycerides 318 mg/dl)
• Past EBV infection
• HSV-IgG positive
• HSV-IgM negative
• CRP 0.5 as well as blood counts within normal range

I saw a neurologist, who ordered an MRI of the skull to rule out meningitis. Again, no evidence was found to explain my symptoms.

Therefore, my questions are:
1. Can a chronic inflammatory disease of the central nervous system be completely ruled out based on normal blood values and MRI images?
2. Can every chronic meningitis or encephalitis be detected in magnetic resonance imaging?
3. What further examinations (especially in the neurological field) would be useful to rule out the mentioned diseases?

Christian Welsch

Dear inquirer,

I consider meningitis or encephalitis to be ruled out with negative inflammatory markers in the blood (CRP!) and a normal MRI. Virus markers for herpes and EBV only indicate that you have had contact with these viruses at some point in your life, which is common at 27 years of age.

Regarding neurological conditions, a lumbar puncture may still be considered, but I believe it may be excessive in your case.

I assume that your general practitioner has also ruled out endocrine disorders (thyroid? diabetes?) as well as any deficiencies in your body. Overall, you exhibit numerous symptoms that, in my opinion, do not fit an organic disease profile, suggesting a psychosomatic or even psychiatric cause. Patients in the psychosomatic realm often desperately search for something organic, finding it difficult to accept that there may be nothing there.

Discuss with your general practitioner what further steps would be advisable.

Get well soon,
C. Welsch