Neurological Symptoms: Seeking Answers for Oral and Brain Issues

Q: Neurological Symptoms: Seeking Answers for Oral and Brain Issues

Hello： The 24-hour urine test you mentioned may be for measuring cortisol levels. <br>Elevated cortisol levels are associated with adrenal tumors, pituitary tumors, or ectopic ACTH-producing tumors. <br>Conditions such as pregnancy, estrogen therapy, and severe stress can also st

Brain issues

Hello Doctor, I have previously detailed my symptoms #146754.
Now I have some questions to ask.
I had a brain MRI done before, which showed no abnormalities.
However, during a brainstem function test, it was found that the function values on the left side of the brainstem were not very good, with an index of 42, which is right on the borderline between normal and abnormal.
The doctor mentioned that this nerve controls cranial nerves 9, 10, and 12, which affects the abnormal taste sensation and numbness in my tongue.
I also asked if the mild burning pain and swelling in my oral mucosa are related to this nerve, and the doctor confirmed that they are.
She believes the values are not ideal and that functional degeneration is affecting my symptoms.
The doctor mentioned that the nerve would slowly repair itself, but the process would be very slow, and advised me to take B vitamins.
I also asked if all my oral symptoms could be related to temporomandibular joint issues or trigeminal nerve problems.
The doctor reviewed the MRI report and said it didn't seem likely.
She prescribed me medication to take once before bed for three months (1 tablet of Rifampicin and 1 tablet of Zanaflex) to see how it goes.
I asked the doctor if I have autonomic nervous system dysfunction, and she said there is a bit of combined nerve function degeneration.
When I asked if it is definitely a nerve issue, she said it might be.
I will return for a follow-up in September.
I also visited a rheumatology and immunology specialist, who listened to my concerns and thought it should be a nerve issue.
She advised me to take one more tablet of Rifampicin and B12 twice daily for three weeks.
I have already been taking them for two weeks and feel a slight reduction in symptoms, but I cannot completely alleviate or eliminate this discomfort.
Is there really no way to resolve my discomfort, or should I seek help from another specialty?
Now I have another issue.
My blood test report from May 28 showed that my prolactin level is elevated at 36.120 (normal range: 5.18–26.53), and my thyroid levels are problematic, with a very low value of 0.058 (normal range: 0.35–4.94).
Additionally, some blood test results indicated that I am not ovulating.
Could the irregular and scant menstrual periods over the past few months be causing these abnormal values? I went to a metabolic clinic (where I had the blood tests done at another hospital, and the doctor wrote a referral letter) and was advised to go to a larger hospital.
The doctor suggested repeating the blood tests.
On the day of the report, the doctor noted discrepancies between the results from the outside lab and the ones from the hospital.
The doctor requested another MRI of my head with contrast.
I told her that I had already done that at this hospital, but she said the previous one was focused on stroke indicators and did not provide the necessary information.
I also asked a neurologist about my pituitary gland, and she confirmed that there were no abnormalities.
I relayed this information to the metabolic specialist, who said he needed to check for different issues.
He also asked if I have underarm hair, and I mentioned that I do, but I had shaved my breasts in mid-June, and it seems that hair has not grown back since then.
Is there something wrong? The doctor also requested a 24-hour urine sample for testing.
I am unsure why the metabolic specialist wants me to undergo further testing.
Given my situation, what could be the underlying problem? I have an examination scheduled for the 11th, and I am very worried and scared while waiting for the results, which I will receive on the 15th.
Additionally, I had a neck ultrasound in mid-January, which showed no abnormalities or tumors in the thyroid.
Do I need to have another examination?
Thank you.
Initially, I only mentioned discomfort in my oral symptoms, but now it seems there might be an issue with my brain as well.
What exactly is wrong with me? Could the temporomandibular joint be inflamed and related to the nerves? If the discomfort is located in the posterior molar region, could it affect the abnormal sensations in my mouth? I had two molars extracted from my upper left jaw within the last six months, and I wonder if this could be causing discomfort due to adjustment or changes in occlusion, as I often bite the inside of my cheek.
I also feel that my alveolar bone is swollen and pressing against the oral mucosa.
Is this truly a nerve issue? I am really confused and do not know how to recover.
I am at a loss as to which specialist could help me.
I feel very desperate; it has been over six months, and the daily discomfort is becoming unbearable.
Is it possible that my oral mucosa has issues, even though the dentist has checked and found nothing wrong? Please help me analyze whether there might be something growing in my brain that necessitates another scan.
I have also had a CT scan of my head and neck with contrast, which showed no abnormalities, except for a lymph node in my chin that was not specified as large, and there was mention of a bone tumor that was discovered three years ago.
The doctor confirmed that this could not be the cause of my oral symptoms, as it would have presented earlier.
Since I have already undergone a CT scan and MRI of my head, is it still possible to rule out the presence of something abnormal in my head, neck, or oral cavity? Please, compassionate doctor, help me.
What suggestions can you provide for further evaluation or testing? Thank you for your kindness.
I apologize if I have repeated any questions; I appreciate your understanding.
Thank you.

Miss Lin, 40~49 year old female. Ask Date: 2019/07/08

Dr. Jiang Junyi reply Neurology

Hello: The 24-hour urine test you mentioned may be for measuring cortisol levels.
Elevated cortisol levels are associated with adrenal tumors, pituitary tumors, or ectopic ACTH-producing tumors.
Conditions such as pregnancy, estrogen therapy, and severe stress can also stimulate increased cortisol secretion.
Low cortisol levels may indicate systemic adrenal insufficiency or defects in the metabolic pathways of cortisol biosynthesis.
Regarding the brain imaging issue you mentioned, due to the limited resolution of imaging, it seems unnecessary to repeat the examination in a short period.
As for your concern about repeated tests, as long as you are at the same hospital, you can regularly monitor and track changes in the values.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Hospital cares about you.

Reply Date: 2019/07/08

More Info

It sounds like you are going through a very challenging time with your health, and I understand how distressing it can be when symptoms persist without a clear diagnosis. Based on the information you've provided, it seems that you have been experiencing a range of neurological and oral symptoms, including burning sensations in the oral mucosa, altered taste, and discomfort in the area where teeth have been extracted. Additionally, you have undergone multiple imaging studies and blood tests, which have not revealed any significant abnormalities.

From a medical perspective, the symptoms you describe could potentially be linked to several underlying issues. Given that you have already had a thorough evaluation, including MRI and CT scans of the head and neck, it is reassuring that no significant structural abnormalities were found. However, the persistent nature of your symptoms suggests that there may be other factors at play.

1. Neurological Considerations: The involvement of cranial nerves, particularly those that control taste and sensation in the oral cavity, could explain some of your symptoms. The fact that your doctor mentioned a potential degeneration of the cranial nerve function (specifically cranial nerves IX, X, and XII) could indeed be contributing to your altered taste and oral discomfort. Neuropathic pain, which can arise from nerve damage or irritation, may also manifest as burning sensations or tingling in the oral cavity.

2. Oral Health Factors: The extraction of teeth can lead to changes in the bite and oral environment, which might contribute to discomfort or pain in the surrounding tissues. If the bite is altered, it can lead to issues such as temporomandibular joint (TMJ) dysfunction, which can cause pain and discomfort in the jaw and surrounding areas. Additionally, if you are inadvertently biting your cheek or gums due to changes in your bite, this could lead to further irritation and discomfort.

3. Systemic Factors: Your elevated prolactin levels and low thyroid hormone levels could indicate an endocrine issue that may be contributing to your overall symptoms. Hormonal imbalances can affect various bodily functions, including metabolism and nerve function. It is essential to follow up with your endocrinologist regarding these findings, as they may provide insight into your symptoms and overall health.

4. Autoimmune or Inflammatory Conditions: Given that you have seen a rheumatologist, it might be worthwhile to explore the possibility of an autoimmune condition that could be affecting both your oral and neurological health. Conditions like Sjögren's syndrome can lead to dry mouth and oral discomfort, while also having neurological manifestations.

5. Psychological Factors: Chronic pain and discomfort can lead to significant stress and anxiety, which can exacerbate symptoms and create a cycle of discomfort. It may be beneficial to consider psychological support or counseling to help manage the emotional toll of your symptoms.

In terms of next steps, it may be helpful to:
- Consult a Neurologist: Since you have already seen multiple specialists, a neurologist may provide further insights into the neurological aspects of your symptoms. They may suggest additional tests or treatments that could help alleviate your discomfort.

- Follow Up with an Endocrinologist: Given your hormonal imbalances, it is crucial to address these issues with an endocrinologist who can provide a comprehensive evaluation and management plan.

- Consider a TMJ Specialist: If you suspect that your symptoms may be related to TMJ dysfunction, a dentist or oral surgeon specializing in this area could assess your bite and jaw function.

- Explore Pain Management Options: If your symptoms are primarily neuropathic in nature, a pain management specialist may offer treatments such as medications or therapies that can help alleviate your discomfort.

- Keep a Symptom Diary: Documenting your symptoms, triggers, and any changes can help your healthcare providers better understand your condition and tailor their approach to your needs.

It is essential to continue advocating for your health and seeking answers. While it may feel overwhelming, remember that you are not alone in this journey, and there are healthcare professionals who are dedicated to helping you find relief and understanding.

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