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Forum Name: Neurology Topics

Question: "Dizziness", left side weakness


 some_knight - Wed Dec 02, 2009 11:56 am

Backstory
Three years ago I went to a doctor's appointment because I had been continually experiencing a weird sensation of "cloudiness" in my alertness: like losing that awareness of other around you; also, my head felt "lighter", but not fainting "lighter"; I also had some difficulty regarding watching motion of others (i.e. if a person was jumping repeatedly I was unable to maintain a crisp image of her face).
He tested my balance (told me to stand up, close my eyes and hold out my arms, palms up) which held up fine. He also tested my Plantar Reflex, which came out "unresponsive". The rest of the tests came out normal. Still, he scheduled a CT exam.
The scan found no growths or similar on the brain but found a "small retention pseudo-cyst in the maxillary" and a "light hypertrophy of the soft tissue of the rhino-pharynx wall", both with no "apparent pathological significance". The doctor had long conversations with me, said those results weren't a problem and attributed the feeling to stress.
The years after went uneventful, although I had that feeling from time to time, especially during weekends or on days that I overslept my 7 hours.
Now
Last week, it came back "full force" and I went to see a doctor. This doctor tested me similarly for balance, plantar and other reflexes with the same results. She then scheduled a contrast CT scan and some blood tests. However, after leaving the doctor's and before doing the CT scan new "symptoms" have appeared:
- my left leg "feels" weaker (I seem to have the same strength but different "control" over it, feels "heavy");
- my left hand "baby finger" also has the same feeling;
- the left side of my face also seems "weak", although I have the same expression-making ability on both sides;
- my neck is specially affected (left side too), still I am able to easily maintain posture;
- feeling of "fullness" of the head;
- rare pricking feeling on the back/top of my head;
All of these are not constant throughout the day, some don't even manifest on certain days. I consulted a ophthalmologist twice for my vision and he said it was fine.
Any ideas?
Should I go straight to a neurologist with my exams when they arrive?
Also, during my CT scan the neuroradiologist didn't administer any contrast, saying that "he didn't felt that it was justifiable"; is this a problem? Are there pathologies that need contrast to be visible during a CT scan and can the radiologist simply evaluate the need for contrast during a CT scan?
 Dr.M.Aroon kamath - Wed Jun 30, 2010 7:00 am

User avatar Hi,
What seems to be remarkable in your case is the presence of multiple seemingly "focal" symptoms, but a noticeable lack of focal signs.

The probable diagnosis is obscure, to say the least.

There is hardly any dispute regarding usage of contrast in "vascular CT" but, controversy does exist in respect of "non-vascular CT".

About your queries regarding contrast vs non-contrast CT scanning, i have provided a few references below, which may be useful to you.

One study observed thus: "Decisions regarding the use of contrast agents usually arise in the context of nonvascular CT. Although highly desirable in many situations, contrast enhancement is not absolutely required for nonvascular CT and may not add much to the emergency department evaluation in many situations. While the potential imaging benefits versus the risks of contrast-enhanced CT always should be discussed with a radiologist on a case-by-case basis".
( http://www.accessmedicine.com/content.aspx?aID=614948 )

Another study concluded thus: "it is reasonable not to give contrast if there is a low expectation of a lesion being present, and if the unenhanced scan is normal".
( http://www3.interscience.wiley.com/jour ... 1&SRETRY=0 )

Studies in the pediatric population also indicate similar findings such as in the adults.
One such study draws the following conclusion: "Unenhanced CT of developing brains has high sensitivity and specificity in the diagnosis of pathologic findings. The use of intravenous contrast material after unenhanced CT of the brain in children did not change the diagnosis frequently".
( http://radiology.rsna.org/content/244/3/838.full )

Protocols may vary from place to place and from one institution to another but, the decision whether to use contrast or not is
- either left up to the discretion of the imaging physician or
- in others, the treating clinician & radiologist may discuss and come to a consensus opinion.

Your radiologist obviously felt that contrast was not needed (in a rather acute setting), which it is entirely acceptable.

As some years have passed by since your first episode & you have a recurrence of symptoms, this time around, many clinicians & radiologists would possibly opt for a contrast CT.
Best wishes!

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