Chronic Fatigue: When to Seek Neurological Evaluation

How to check..?

Hello doctor, I would like to ask about my symptoms.
Despite getting 6-7 hours of sleep each night without insomnia, I still feel extremely fatigued, drowsy, and have a foggy mind throughout the day.
Recently, a traditional Chinese medicine practitioner diagnosed me with Qi deficiency and insufficient blood flow to the brain, which seems similar to what doctors refer to as inadequate cerebral blood flow.
I would like to know if I can request a carotid and cerebral vascular ultrasound from a neurologist, and whether the doctor can arrange it, or if it must be paid out of pocket.
If the issue is indeed due to narrowed blood vessels causing insufficient cerebral blood flow, are there treatment options available? (Since my previous EEG was normal and doctors have indicated that they cannot determine any illness based on my symptoms, will they still arrange for the ultrasound?) (I am concerned about taking time off work and not wanting to go through the process for nothing.) After a major surgery, the patient's snoring has significantly decreased, but there may still be central sleep apnea.
I am currently unaware of any treatment options available for this condition (the more I use the ventilator, the more fatigued I feel).
Thank you.

Niming, 40~49 year old female. Ask Date: 2015/12/11

Dr. Gao Chunde reply Neurology

Cerebrovascular ultrasound will be performed under the National Health Insurance regulations, and physicians will use insurance coverage if there are indications such as stroke, transient ischemic attack symptoms, or suspected cerebrovascular abnormalities.
If the criteria are not met, the physician may discuss the option of a self-paid examination, which should be around NT$4,000.
If any issues are found, treatment options will be chosen based on the type and severity of the problems identified.

Reply Date: 2015/12/11

More Info

Chronic fatigue can be a complex and multifaceted issue, often requiring a thorough evaluation to determine its underlying causes. Given your symptoms of excessive daytime sleepiness, persistent fatigue despite adequate sleep, and a general feeling of mental fog, it is indeed prudent to consider a neurological evaluation.
Your description of symptoms aligns with several potential medical conditions, including sleep disorders, neurological issues, or even metabolic disorders. The fact that you have been diagnosed with "qi deficiency" and "blood not reaching the brain" by traditional Chinese medicine practitioners suggests that there may be a perceived imbalance in your body's energy systems. However, it is essential to approach this from a medical standpoint as well.

When it comes to seeking a neurological evaluation, you can certainly request a consultation with a neurologist. In many healthcare systems, a referral from your primary care physician may be necessary, but in some cases, you can directly approach a neurologist. If you have concerns about the cost of tests such as carotid Doppler ultrasound or other imaging studies, it is advisable to discuss these with your healthcare provider. They can guide you on whether these tests are necessary and if they can be covered by insurance or if they would need to be self-paid.

If your symptoms are indeed related to reduced cerebral blood flow due to vascular issues, there are treatment options available. These may include lifestyle modifications, medications to improve blood flow, or interventions to address any underlying vascular conditions. For example, if there is significant stenosis (narrowing) in the carotid arteries, surgical options such as carotid endarterectomy or stenting may be considered.

Regarding your concerns about central sleep apnea and the use of a CPAP machine, it is not uncommon for patients to feel fatigued when using these devices, especially if they are not properly adjusted or if the patient is not fully compliant with their use. It may be beneficial to follow up with a sleep specialist who can assess your sleep patterns and the effectiveness of your current treatment. They can also explore alternative therapies or adjustments to your CPAP settings to enhance your comfort and efficacy of treatment.

In summary, given your ongoing symptoms of fatigue and sleepiness, it is advisable to seek a neurological evaluation. You can request specific tests such as a Doppler ultrasound of the neck vessels, and your neurologist can help determine the necessity of these tests based on your clinical presentation. If vascular issues are identified, there are several treatment avenues to explore. Additionally, addressing any potential sleep disorders with a specialist can significantly improve your quality of life. Always communicate openly with your healthcare providers about your symptoms and concerns to ensure a comprehensive approach to your health.

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