Neurological Symptoms: Seeking the Right Specialist for Diagnosis

Symptom inquiry?

Hello Dr.
Lin: Recently, I have been experiencing many symptoms and have seen numerous doctors in various hospitals without finding the cause.
Could you please help explain my symptoms? 1.
I have sharp pain in the left back of my head accompanied by muscle spasms, dizziness, itchy ears, occasional pain, and nausea.
Recently, I have been experiencing increased vomiting when lying down.
2.
My eyes feel sore, and I also have pain in my neck, shoulders, and back, with occasional numbness in my left hand.
3.
I recently visited an endocrinologist due to swelling near the carotid artery on the left side of my neck, where an irregular image was detected, measuring approximately 1.5-1.6 cm in diameter.
The doctor suggested surgery for further examination to determine if it is benign or malignant.
However, regarding the first two issues, I was advised to see a neurologist or an otolaryngologist, as the thyroid issue should not cause those symptoms.
4.
These symptoms have persisted for two months, but the hand numbness has been intermittent for the past one to two years.
5.
Which specialty should I consult for these symptoms, and is a CT scan necessary? Please help clarify which department I should go to for further examination.
Thank you very much.

angela, 30~39 year old female. Ask Date: 2009/03/28

Dr. Lin Zijing reply Neurology

Your symptoms are quite broad and nonspecific, which may indicate the presence of two to three concurrent conditions or a transient episodic illness.
Here are some analyses based on your symptoms:
1.
Headache: The stabbing pain and spasms in the back of your head may be due to nerve compression in the upper cervical spine or tightness in nearby muscles.
However, the vomiting when lying down raises concerns about increased intracranial pressure (such as from a brain tumor), which necessitates further neurological examinations and fundoscopy for confirmation.
2.
Eye strain and pain, along with discomfort in the neck, shoulders, and back: These symptoms are more indicative of cervical spondylosis or shoulder-neck syndrome, often caused by prolonged poor posture or maintaining a fixed position for too long.
3.
Suspected thyroid tumor: Testing is necessary to confirm this.
A tumor causing hyperthyroidism can lead to symptoms such as increased heart rate, excessive sweating, weight loss, or tremors, but is less likely to cause the symptoms mentioned in points 1 and 2.
4.
Numbness in the hands: A neurological evaluation is needed to determine if further testing is required.
5.
The physician will arrange relevant examinations as necessary; a diagnosis does not solely rely on imaging studies.
Based on your condition, you may need to consult a neurologist, an endocrinologist (for thyroid issues), and a rehabilitation specialist.

Reply Date: 2009/03/28

More Info

Understanding neurological symptoms can be quite complex, especially when multiple symptoms are present and the underlying cause remains elusive. Based on the symptoms you've described, it seems that you are experiencing a range of issues that could potentially involve multiple systems, including neurological, musculoskeletal, and possibly endocrine (given your mention of thyroid issues).

1. Symptoms Overview:
- You mentioned experiencing sharp pain in the left posterior part of your head, muscle spasms, dizziness, ear itching, and occasional nausea. These symptoms could suggest a neurological issue, particularly if they are accompanied by changes in sensation or motor function.

- The pain and discomfort in your eyes, neck, shoulders, and back, along with left-hand numbness, could indicate a musculoskeletal issue or nerve involvement, possibly related to cervical spine problems or thoracic outlet syndrome.

- The swelling near the carotid artery and the irregular imaging findings raise concerns that should not be overlooked, as they may require further investigation to rule out any serious conditions.

2. Specialist Consultation:
- Given the complexity of your symptoms, it would be prudent to consult a neurologist first. Neurologists specialize in diagnosing and treating disorders of the nervous system, which includes the brain, spinal cord, and peripheral nerves. They can perform a thorough neurological examination and may recommend imaging studies such as MRI or CT scans to assess for any abnormalities in the brain or spinal cord.

- Additionally, an ear, nose, and throat (ENT) specialist may be beneficial, especially since you are experiencing ear-related symptoms and dizziness. They can evaluate for any vestibular disorders or other ear-related issues that might be contributing to your symptoms.

- Since you have mentioned thyroid issues, it may also be wise to continue working with an endocrinologist, especially if surgery is being considered for the irregularity found near your carotid artery. Thyroid dysfunction can sometimes contribute to neurological symptoms, so it’s essential to have a comprehensive approach.

3. Diagnostic Imaging:
- You asked whether a CT scan is necessary. Given your symptoms, a CT scan or MRI could provide valuable information about the structure of your brain and surrounding tissues. These imaging modalities can help identify any lesions, tumors, or other abnormalities that may be contributing to your symptoms.

- If the irregularity near the carotid artery is significant, your healthcare provider may recommend further imaging, such as a Doppler ultrasound, to assess blood flow and rule out vascular issues.

4. Next Steps:
- Document all your symptoms meticulously, including when they occur, their duration, and any factors that seem to exacerbate or alleviate them. This information will be invaluable to your healthcare providers.

- Seek a referral to a neurologist and possibly an ENT specialist. Given the interconnected nature of your symptoms, a multidisciplinary approach may be necessary to arrive at a comprehensive diagnosis and treatment plan.

- Be proactive in discussing your concerns about the irregularity found in your thyroid imaging with your endocrinologist. It’s essential to understand the implications of that finding and how it may relate to your overall health.

In conclusion, navigating complex symptoms can be challenging, but with the right specialists and a thorough evaluation, you can work towards understanding the underlying causes of your symptoms. Don’t hesitate to advocate for yourself and seek the necessary referrals to ensure a comprehensive assessment of your health.

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