Neurological Issues: Exploring Oral Symptoms and MRI Findings

Brain issues

Hello Doctor, I have been experiencing some discomfort in my oral cavity for over five months.
I have consulted with specialists in oral and maxillofacial surgery, dentistry, otolaryngology, neurology, and rheumatology, but so far, none have been able to provide a complete diagnosis or treatment.
The only possibility I feel might be related to neurology.
The neurologist performed a head MRI, which showed no obvious tumors, and conducted some brainstem function tests, indicating that my left brainstem function index is right at the borderline between normal and abnormal at 42.
This is said to be related to the control of cranial nerves 9, 10, and 12, which affects all my oral symptoms, including abnormal taste sensations on my tongue, numbness, burning pain in the oral mucosa, slight swelling of the oral mucosa, and discomfort in my gums.
The doctors have suggested that this is a neurological issue combined with brainstem function degeneration.
They mentioned that the nerves might recover, but it will take time.
Currently, I can only manage the symptoms with medication to alleviate discomfort.

Could you please advise if there are other possible causes for the oral symptoms I described? I am unsure which specialty to consult next.
Additionally, I have been experiencing irregular menstrual cycles since giving birth eight months ago, with very light flow, so I visited a gynecologist.
The doctor informed me that I am not ovulating and that my endometrial lining is thinner than normal.
I was prescribed hormonal medication.
During this time, I also visited an endocrinologist due to previous abnormal thyroid levels and some recent concerning blood test results.
The endocrinologist referred me to a larger hospital for further evaluation.
I mentioned to the doctor that I had previously undergone a brain MRI, but they said they could not assess the pituitary gland area and advised me to have blood tests done before determining the next steps.

I reiterated my issues during a follow-up with the neurologist, who confirmed that the MRI showed no abnormalities in the pituitary gland.
However, during my recent visit to the endocrinologist, they indicated that my blood test results were inconsistent with previous findings and recommended another MRI with contrast.
I expressed my concerns about the neurologist's assessment regarding the pituitary gland, and I am confused about why the endocrinologist is suggesting further testing.
If there were indeed a pituitary tumor, what would be the typical management approach? What causes pituitary tumors to develop?
I would appreciate it if you could review my initial blood test results and provide your analysis.
Thank you.
[Link to blood test results]
Could you help me understand the likelihood of having a pituitary tumor? Is it possible to clearly identify any tumors in the brain with an MRI without contrast? I also had a CT scan in May with contrast, which did not reveal any significant abnormalities, except for a 1.6 cm osteoma in the frontal sinus.
Initially, the doctor suspected it might be pressing on nerves and causing my oral symptoms, but this osteoma has been present for three years and has not changed in size.
When I inquired with my original doctor, they deemed it unlikely that the osteoma was the cause of my symptoms, as they would have likely appeared three years ago.

Given that I have already undergone a CT scan, what is the likelihood of having a brain tumor? Additionally, with both MRI and CT scans having been performed with contrast, can we rule out the possibility of tumors in the head, oral cavity, jaw, temporal bone, and sinuses?
Thank you for taking the time to read this lengthy message.
I appreciate your help.

Miss Lin, 40~49 year old female. Ask Date: 2019/06/27

Dr. Zhang Junwei reply Neurosurgery

To be honest, what you said is too complicated, and it's difficult to answer these questions online.
I recommend discussing this with a neurosurgery outpatient clinic and a physician.

Reply Date: 2019/06/27

More Info

Hello,
Thank you for sharing your detailed medical history and symptoms. It sounds like you have been through a challenging journey with your health, and I understand how concerning it can be when symptoms persist without a clear diagnosis. Based on the information you've provided, let's explore the potential neurological issues related to your oral symptoms and the findings from your MRI.

From what you've described, your symptoms include a burning sensation in the oral mucosa, abnormal taste sensations, and discomfort in the gums, particularly after dental extractions. These symptoms, combined with the MRI findings indicating a borderline function of the left brainstem, suggest that there may be a neurological component to your condition. The cranial nerves that control sensations in the mouth and tongue (specifically cranial nerves IX, X, and XII) could be affected, leading to the symptoms you're experiencing.

It's important to note that while your MRI did not show any tumors or significant abnormalities, it is still possible for subtle changes or functional issues to exist that may not be easily detectable through imaging. The fact that your neurologist mentioned the possibility of nerve function degradation aligns with your symptoms. Nerve regeneration can be a slow process, and while some improvement may occur over time, complete resolution of symptoms is not guaranteed.

Regarding your menstrual irregularities and hormonal issues, these could be interconnected. Hormonal imbalances can affect various bodily functions, including the nervous system. The fact that you recently gave birth may also contribute to changes in your hormonal levels, which could explain the irregularities you're experiencing. The recommendation to see an endocrinologist or a specialist in metabolic disorders is wise, as they can help assess your hormonal levels and determine if there are underlying issues that need to be addressed.

As for the concerns about a pituitary tumor, it's important to understand that these tumors can sometimes be functional (producing hormones) or non-functional. If there were a tumor, it could potentially affect hormone levels, leading to symptoms like irregular menstruation. However, your previous imaging studies have not indicated any abnormalities in that area, which is reassuring. MRI scans with contrast are typically more sensitive in detecting small lesions, but if your previous scans were clear, the likelihood of a significant issue is reduced.

In terms of further investigations, it may be beneficial to follow your endocrinologist's advice regarding additional blood tests and possibly another MRI with contrast. This could provide more clarity on your hormonal status and any potential issues with the pituitary gland. Additionally, if your symptoms persist or worsen, seeking a second opinion from a neurologist or a specialist in oral medicine may provide further insights.

To summarize, your symptoms appear to be multifactorial, involving both neurological and hormonal components. While your imaging studies have not revealed any significant abnormalities, continued monitoring and further evaluations are essential. It’s crucial to maintain open communication with your healthcare providers and advocate for your health, ensuring that all aspects of your symptoms are thoroughly investigated.

I hope this information helps clarify your situation and provides some guidance on the next steps. Please take care, and I wish you the best in finding answers and relief from your symptoms.

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