#MRI? Unremarkable

[mossistyping]

Hmmm I am a mystery I am unknowable

[smoov-criminal]

[ID: a cycle meme showing a yellow male emoji facepalming. around him is a four point cycle with arrows between each point. the top one says "i go to the doctor" and the next ones, moving clockwise, read "they order some testing" "the test comes back normal" and "my symptoms get worse" the next arrow points towards the first point, completing the cycle. /end ID]

The undiagnosed chronic illness cycle

[appleicecream]

i had a brain mri last year because i've been experiencing stroke-like symptoms for almost a year now, and when i got contacted with the results, my doctor said there was a DOT on my brain scan. she said it was "unremarkable," but i really feel like maybe that should have been looked into more. Given my symptoms. 😐

[caystar13star]

Kinda need to vent to people who will hopefully understand. I had an MRI a week ago (not the point- I’m comparatively ok and the mri was “unremarkable”). So while I was sitting there trying not to die from claustrophobia, I started writing a fic in my head. I made great progress, told myself I would either go home and write it or get on my google docs and dictate it on my way home.

Problem- I left the MRI with the beginnings of a migraine, which led to going home and googling can MRIs give you migraines or am I dying? (They can in fact prompt migraines if you were leaning towards having one, and weeks of anxiety and lack of sleep led me straight into a migraine).

Now, it’s been a week and I have no earthly idea what that amazing story was that I wrote in my head. It’s possible that it was the MavHondo fic I finished and posted, but I don’t actually feel like that was it? It might have been.

Either way, I am dealing with writers hide and seek (not exactly writer’s block, but more where the fuck did my writing go?)

Anyway, maybe I’ll find it…

[knifegremliin]

oh btw fun little fact. i don't normally share my medical info but!

last month i had an mri of my hip and pelvis done and it was unremarkable. except.

in the words of the test result findings: "there is a small focus of apparent metallic artifact anterior to the right piriformis muscle, of uncertain etiology, presumably a metallic surgical clip"

i have never had surgery in my life.

[jcsmicasereports]

Spontaneous Disappearance of an Arachnoid Cyst after appearance of chronic subdural hematoma by M.Hammoud in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Background: Arachnoid cysts are benign extra axial lesions, most commonly located in the fronto temporal region and account for 1% of all intracranial masses. They may remain stable or they may grow in size over time. Reports of spontaneous disappearance of arachnoid cysts are rare.

Case Report: We report the case of a 1-year-old boy with a middle fossa arachnoid cyst revealed by convulsive seizures, managed with anti epileptic drugs, 13 months later, the patient had one seizure episode, the cranial computed tomography Scan showed nearly total disappearance of the arachnoid cyst and the appearance of subdural hematoma. No surgical intervention was performed. Follow-up CT scans 1 month after admission, showed total disappearance of both the arachnoid cyst and the subdural hematoma.

Keywords

Arachnoid Cyst, Subdural hematoma, Spontaneous Resolution

Introduction

Arachnoid cysts are rare benign congenital extra axial lesions, which consist of collection of cerebrospinal fluid (CSF) surrounded by normal arachnoid membrane.

They account for approximately 1% of all intracranial space-occupying lesions, with a higher prevalence in the first 2 decades of life [1].

Most arachnoid cysts are quiescent and remain asymptomatic throughout life. 
They are incidentally detected on CT or magnetic resonance images [2]. 
The cyst may progress, stabilize, or spontaneously regress [3,4].

Spontaneous regression of an AC has been rarely reported in the literature [5,6].

In our knowledge, this is the second reported case of spontaneous disappearance of cerebral arachnoid cyst in less than 2 year [7].

Case report

A 1-year-old boy was admitted to pediatric emergency department for two episodes of non-febrile generalized seizure. On clinical exam, there was no focal neurological abnormality, cranial nerve deficit or papilledema. His head circumference was normal.

Brain magnetic resonance MR imaging showed a well defined, no enhancing, extra-axial cystic lesion in the right frontotemporal region, between the tabula interna and the insula. The lesion is isointense to CSF on T1 and T2 weighted images (Figure 1). This fluid collection suppresses completely with FLAIR and shows no restriction on DWI. The diagnosis of a right frontotemporal arachnoid cyst was made.

We decided not to operate the patient; he was putted under antiepileptic drug,

At 2-months follow-up, the patient was doing well and was seizure-free.

13months later, the patient was presented with another seizure episode; there was no cranial trauma. The neurological examination was unremarkable.

Unexpectedly, the brain CT scan showed a subtotal resolution of the arachnoid cyst with a subdural hematoma on the same side.

We decided to observe the patient without surgical intervention.

At 1-month follow-up, the CT scan control showed total disappearance of both the arachnoid cyst and the subdural hematoma.

Discussion

First described by Bright in 1831 [8]. ACs are benign cystic lesions, which consist of CSF collections between the two layers of arachnoid membrane, by definition three criteria are required for a lesion to be considered an AC: 1/ it must be enveloped by an arachnoid membrane, 2/ it must contain arachnoid mater cells, and 3/ it must contain CSF [9].

They can be congenital or acquired after surgical trauma, infection, or hemorrhage [10].

In most cases, ACs are asymptomatic, the diagnosis is an incidental finding. When they are symptomatic, they are resulting of the direct compression of surrounding structures, ACs are relatively rare. The reported incidence accounts for only 1% of intracranial space- occupying lesions [11].

On CT, ACs manifest as extra-axial cysts with the density of CSF, it does not enhance after injection. MRI signals are similar to CSF in T1- and T2-weighted imaging with no enhancement on gadolinium.

Diffusion-weighted MRI has proved to be very useful for differential diagnosis that includes other cystic lesions [12].

Arachnoid cysts may remain stable or they may grow in size over time, in rare cases ACs may resolve spontaneously [7]. AC disappearance is a rare phenomenon that can occur spontaneously or after an inciting event.

The mechanism of spontaneous disappearance of ACs has not been described in the literature. Probably Communication between an AC and the subarachnoid space may be direct transport through the cyst wall or it may be a valve-like mechanism [13].

Although, the cyst wall rupture and CSF flow perturbation theories seem to be the most applicable pathophysiological mechanisms in triggered AC resolution(18).

Rupture of arachnoid cyst associated to subdural or intracystic effusion or bleeding is a rare complication. It occurs mostly after a head injury [14].

In this case, there was no history of head trauma, the cyst resolved spontaneously with the appearance of a subdural hematoma SDH. In the literature, there are only 11 cases reported in the literature of spontaneous SDH complicating an arachnoid cyst [15,16].

The management modality of asymptomatic ACs is not clear. However, surgical treatment is suitable for large or symptomatic ACs [17].

SDH associated with ACs spontaneously or due to traumas should be treated in an individual-based manner that is specific to each case, either conservatively or surgically [17,18].

In our case report, based on the clinical assessment no intervention was required.

Conclusion

The present case and the few reported cases of spontaneous disappearance of ACs suggest a more conservative approach in patients without asymptomatic ACs. Thus, we report highlight the interest of regular follow up of patients with known ACs.

[unrivalling]

Tentatively positive-ish news. MD said that he thinks my wrist issue is tendonitis. Which is kind of a relief because I didn’t know tendonitis could hurt this much or limit my mobility. Have an MRI next week to check for sure but it sounds like the treatment in the mean time will be the same (immobilize the wrist). My irrational health anxiety is still going brr but the doctor treating it as fairly unremarkable was reassuring to me.

Still sucks because it will take a Long Time To Heal. But it’s better than a tear for sure.

[axolotlmermaid]

MRI was clear, I am officially "medically unremarkable", which is nice.

Still on meds to keep me alive, buts it's good to know nothing other than my mutated genes are currently trying to kill me.

[fred-the-dinosaur]

Adding tips: (I had three in the last week and I'm notably claustrophobic but I survived bitch). These mainly apply if you are slightly claustrophobic.

Ask for a pillow under your legs if you are uncomfortable lying flat. It's hard to be calm if your entire body is tense.

Don't open your eyes at all. What you can't see isn't there. Focus on the air moving past you and know* you are in a big open space. Fill that space with the most distracting things you can imagine.

Ask for the little mirror that means if you open your eyes all you see is your feet. I sometimes get the urge to open my eyes even through I know I'll panic. Knowing all I'll see is a cheap funhouse effect really helps prevent that for some reason.

It helps me to be the one to say 'go' when I'm ready, so I feel like I'm in control. It depends on the tech, but most will ask if you're ready before they put you inside. You're in charge here.

Once you have panicked, it's hard to put it back in the bottle. This means two things. Be proactive about soothing yourself. If you start getting nervy, ask for a moment to calm yourself BEFORE it spirals. It might feel embarrassing but it's easier to pull yourself back from the brink than haul yourself back up from over it. If I panic while I'm going in, I make them pull me out, pause, then I can always take going back in. YMMV.

Second thing is hopefully it will go unremarkably and you'll never need another one again, but whatever happens you need to convince your body this was an ok experience after the fact. Get out of there, get your results, then: play Tetris (or similar absorbing time sensitive puzzling game), and have someone tell you how brave and calm you were (regardless) and give yourself a happy treat (ice-cream, biscuit, pringles, whatever)

In all likelihood this will be true, most of my MRIs have been perfectly pleasant experiences. But the important thing is to reinforce this, and to do so regardless of how true it might be. Our brains and bodies hang on to fear, we gotta flush that out. Give yourself the reward for being a big brave [redacted] even though it wasn't bad at all in the end

Hi! I'm getting my first MRI (for my brain, with contrast) and I am TERRIFIED! It sounds like you've had a few - any reassurance or advice? (No pressure to respond - you probably get lots of these!)

It’s definitely a weird sensation and I understand the fear, but I actually don’t mind them. Some labs offer things like music or aromatherapy to keep people calm (some people find the machine extremely claustrophobic and they are aware of this) so check with your radiology department to see if you can bring in your own playlist if you think that’d help.

For my first MRI with the contrast they let me bring my childhood teddy bear and once I was situated in the tube, the lab tech placed him in my hands outside the machine so I could hold onto him, as well as the panic button that they give you so they can pull you out if you suddenly realize, yeah, actually, you’re claustrophobic and about to freak the fuck out.

I’m someone who panics in enclosed spaces, but the MRI was actually okay. I knew I wasn’t trapped because my feet were outside the machine and I just closed my eyes and made up fanfic in my head for forty five minutes 😅.

The drum spinning can be loud. So if you’re noise sensitive, ask about ear plugs.

I don’t usually bother with the earplugs and sometimes just talk to the lab tech over the intercom if they’re feeling chatty. They know I’m an MCAS risk with the dye so they tend to chatter more with me than other people, I think. My first ever episode of MCAS anaphylaxis happened inside of a CT machine from the contrast dye (different dye from the MRI dye). So they know my PTSD from being in big whirly machines is through the roof and do what they can to help. If you’re extremely anxious let them know. They’re used to it.

Afterwards, don’t be surprised if you’re dizzy or experience vertigo. I felt like I’d been on a very fast spinning ride when they pulled me out.

The tech explained this was the MRI affecting my inner ear and it’d go away pretty quick. I think it took an hour for me to stop tripping over my own feet, so if possible I’d suggest having someone there to drive you home/take a cab if you can.

Other than that, just try to make sure you’re well rested beforehand and give yourself something to look forward to after. I usually go to the bookstore or grab a new comic, but getting your favorite coffee or another little treat is a good idea too.

I hope your scan is uneventful and whatever reasons you’re doing in for resolves soon. Best of luck!

[myrawjcsmicasereports]

 Prolapsed Endometrioid Adenomyoma Associated with Post-Coital Bleeding by Krina Kathawadia, Sharmi Das, Ayman Aboda in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

This case reports an atypical presentation of Uterine Adenomyosis.   Adenomyosis is typically a diffuse, infiltrative disease of the endometrium and myometrium, which arises as a benign non-localized neoplasm of endometrial glands, stroma, and smooth muscle that almost always remains closely intimated to the uterine wall.  Very rarely is it found to extend into the uterine cavity or, as in this case, develop into an Adenomyomatous polyp that passes through the cervix and into the vagina.  More typically, these features are found with uterine leiomyomata.  Both conditions are most often benign and are treated definitively by surgical excision.  The distinction is important given the rarity of the finding reported by this case and because of the implications of differential effect given the specific progressive clinical nature associated with each condition.

Keywords: Adenomyoma, adenomyosis, vaginal bleeding, post-coital bleeding, endometrioid adenomyoma, uterine neoplasms, endometriosis.

Case Presentation

A 42-year-old woman presented to Gynaecology Outpatients with a history of vaginal bleeding for several months, associated with an awareness of an intermittent vaginal mass.  The mass could be reduced digitally and was most apparent following coughing or accessory strain.  She reported a long history of heavy and irregular menstrual bleeding, often with clotting.  She also experienced urinary stress incontinence.

Past obstetric history included four children, three born vaginally and one by caesarean section.  She had declined cervical screening for more than five years.  Inspection of the external genitalia and vulva was unremarkable.  Speculum examination revealed a 3 x 3 cm mass extending into the upper vagina from the external cervical os.  The mass was smooth and non-ulcerated but bled with touch.  Transvaginal pelvic ultrasound demonstrated a bulky uterus with an endometrial thickness of 5.3 mm and a uniformly enlarged cervix measuring 3.4 x 3.7 x 3.9 cm.  An MRI was performed that confirmed a solid-cystic mass-like structure at the level of the cervix measuring 34 x 30 x 44 mm.  Myometrial distortion suggested possible fibroid change, although no large fibroids were identified.  The features did not suggest a malignant change.

Differential diagnoses included prolapsed uterine myoma, cervical fibroid, or possible cervical carcinoma.  After discussing immediate treatment options, a hysteroscopic examination was performed following dilatation of the cervix and curettage of the uterine cavity.   Multiple small submucosal fibroids distorted the cavity.   A pedunculated, polypoidal lesion arising close to the internal os was excised and was found on histopathological examination to be an endometrioid-type adenomyoma measuring 55mm in size.  Endometrial cuttings showed late proliferative changes with sparse fragments of Adenomyomatous change.  The patient recovered well post-operatively and has since been booked for a hysterectomy with bilateral salpingectomy.

Discussion

Uterine leiomyoma, more commonly known as fibroids, and adenomyosis are two common but distinct gynaecological conditions that may significantly impact women's health (1-3), often presenting with pain, abnormal vaginal bleeding and, more rarely, polyps (4,5).  These conditions share overlapping symptoms and clinical features but are inherently different in their pathophysiology, disease progression and clinical management (6, 7, 8, 9)

Uterine leiomyomas are benign smooth muscle tumours that typically originate from the myometrium of the uterine wall.  They are the most common benign pelvic tumours in women, affecting approximately 20-50% of women of reproductive age and occurring in up to 70% of women by age 50 (10).  Leiomyomas can range from tiny and virtually undetectable to large masses that distort and enlarge the uterus.  Symptoms vary widely, with many women being asymptomatic.  However, symptoms typically include heavy and prolonged menstrual periods, abnormal bleeding between periods, pelvic pain and pressure, urinary frequency and coital discomfort. (11)  Fibroids can affect reproductive health, causing infertility and abnormal pregnancy outcomes such as recurrent miscarriage and obstetric haemorrhage. (11) They may occasionally promote the growth of endometrial polyps or may present as a polypoidal or pedunculated intrauterine mass.  The aetiology of leiomyomas is not entirely understood but is believed to involve an interplay of genetic, environmental and hormonal factors, particularly estrogen and progesterone (11,12).

Adenomyosis, on the other hand, occurs when endometrial tissue, which typically lines the uterus, exists within and grows into the muscular wall of the uterus (myometrium) (13, 14, 15).  This condition is commonly found in middle-aged women and those with children.  Although it can be asymptomatic, adenomyosis often presents with heavy or prolonged menstrual bleeding, severe menstrual cramps, and chronic pelvic pain.  The exact cause of adenomyosis is unclear, but it is believed to be associated with various hormonal changes, including those induced by childbirth and menopause (5) While adenomyosis can lead to significant discomfort, it is typically not considered a risk factor for other health complications, although it may be coexistent with pelvic endometriosis (16, 17).  In rare cases, adenomyosis may contribute to the formation of polyps and lead to irregular bleeding (18).  Typically, they contain haemorrhagic cystic spaces, which are unusual in other polyps such as leiomyomas or malignancies (19). The characteristic sonographic features of polypoid adenomyomas include heterogeneous or homogeneous echogenicity relative to the myometrium, a smooth surface, a poorly defined margin with the underlying myometrium, haemorrhagic foci, and usually, associated adenomyosis in the myometrium (20).  When ultrasound evaluation demonstrates a soft tissue mass in the vagina prolapsed from the uterine cavity with a visible connecting stalk, it is termed the broccoli sign (21,22)

Uterine leiomyomas and adenomyosis can cause abnormal vaginal bleeding, typically heavier and longer than normal menstrual bleeding.  However, the bleeding associated with leiomyomas is usually due to the increased surface area of the uterine lining, while in adenomyosis, bleeding results from the disruption of the muscular wall of the uterus (23, 24).  In both cases, the bleeding may be severe enough to cause anaemia and disrupt a woman's perceived quality of life (25).

Regarding management, treatment for adenomyosis and leiomyomas can range from watchful waiting to medical therapy (e.g., hormonal treatments) and surgical interventions such as minimally invasive, local resection, or hysterectomy (8,11,14).  In both cases though more rarely for the latter, medical management using hormonal treatments to control or mitigate the menstrual cycle may effectively reduce provocateurs for growth, leading to regression or diminution of size and consequent reduction of symptomatic effect (8,11,14).

Conclusion

This case report presents a unique manifestation of uterine adenomyosis, typically a diffuse disease, uniquely presenting as an Adenomyomatous polyp protruding into the vagina.  This rare presentation mirrors features commonly associated with uterine leiomyomata.  Both adenomyosis and leiomyoma are benign gynaecological conditions causing similar symptoms, such as abnormal vaginal bleeding, but each carries distinct clinical implications.  Accurate diagnosis and treatment, typically surgical excision, and ongoing effective medical management, are crucial.  Knowledge of the clinical and sonographic appearance of polypoid adenomyomas may facilitate diagnosis and help distinguish these tumours from other uterine polyps.  This report advocates the need for heightened clinical awareness and comprehensive differential diagnostic criteria when managing abnormal vaginal bleeding, particularly when associated with evidence of an expansive polypoidal growth.

[nathank77]

10/8/24

9:42 a.m

Something weird about my MRI report is it doesn't mention global volume loss. I called to see if it would mention it, since my cat scan did from last year... but my mri from last year didn't mention it and the place I went to this year has no comparison.

They said it would mention it... any issues it would pick up would be mentioned....

How could that be? When I was leaving, I saw an image of the back of my brain and my brain looked to take up the whole space of my skull. It almost looked too full.

I'm wondering if cbd is helping my white and gray matter volume expand?? Or what?

The place that did my CT scan and my mri last year was the same place with multiple comparisons.... but the place i went to this time has no comparison... so I mean the place i went last year mentioned global volume loss but only in the ct scan, I think they said that the mri and CT was unremarkably similar.

If it's true that I don't have global volume loss anymore, then cbd actually regenerated my white and gray matter. I'm trying to get my results sent to some radiologist for comparison... bc I've only been on a high dose of cbd since April and tbh it would be absolutely astounding if the dose of cbd actually regenerated my white and gray matter.. that and time... cause I haven't been smoking weed.

My brain looked big in that back view image. It didn't look like what i imagine global volume loss to look like at all..

Also in that nightmare I had, I know the person to my left and the arms behind me were hallucinations.. which made it all the more scary bc I can't control my auditory hallucinations... they don't stop. They do sometimes but they never truly stop...and if I were to suffer from visual hallucinations, I know they wouldn't stop and id have no control over what I see or how often I saw things that weren't real. When I saw the hands in a cross behind me, I ran into my bed and closed my eyes. And then I actually woke up in real life, thinking it was real.

[chronicallyillphoenix]

Got a lumbar epidural this morning because my new pain doctor thinks that my MRI results are bullshit because we know for a fact i have congenital lumbar stenosis on my L4-L5, and the most recent lumbar mri said everything was "unremarkable" so my doctor is just going off the assumption that the radiologist didnt actual do a good job reading it because they were swamped, which according to my doctor is normal for the company i used and is why he hates using them. He said that doing the lumbar epidural will help both my back pain and the pain in my legs that happens after walking for 5-15+ minutes straight, even tho at pt we think the problem is focused in the ankles itself. But whatever i guess we shall see if the injection helps or not

The doctor said it can take up to a week to start working and that itll be a little sore at first and christ he was right. It hurts to both sit and stand and it hurts more than usual to walk and its annoying as fuck. I am hoping it ends up working by the end if the week, i am going to hopefully go on a walk every day this week (minus tonight because they told me not to) and see if the leg problem gets any better or not

If it doesnt i am going to be annoyed because i didnt even want to try anymore injections im tired of them because they either dont help, or if they do, they only last like 12 days max

We shall see i guess

[thoughtsonchronicpain]

8/23/23 (early afternoon)

So apparently it's not arthritis???? My PCP just called and was like, "the MRI report says your back is unremarkable and calling what is there arthritis is scary." And I was like, "Yuh, I am scared."

Plus the second physiatrist (who told me it's arthritis) also misled me about what two different medications she prescribed me do: She told me she was prescribing me a muscle relaxer when it's actually a treatment for chronic pain in small doses and a treatment for depression in higher doses, and she told me she was prescribing me steroid patches when they are in fact not steroidal.

Literally what on earth is the point of these fancy out of network Fifth Avenue doctors when they're misleading me!?

I'm getting whipped around and no one can actually tell me what's going on.

[cosmique-o]

My back aches terribly hours ago but I find as I'm lugging around my bookstacks that I have a Dover Thrift Edition of G.K. Chesterton's Favorite Father Brown Stories. From Wick of Peedee Wah (that's how it goes, yeah?):

Father Brown is a fictional Roman Catholic priest and amateur detective. He features in 53 short stories by English author G. K. Chesterton, published between 1910 and 1936... Father Brown is a short, plain Roman Catholic priest, with shapeless clothes, a large umbrella, and an uncanny insight into human behaviour. His unremarkable, seemingly naïve appearance hides an unexpectedly sharp intelligence and keen powers of observation.

OK, so - it doesn't sound life-changing. Especially in 2023 (or am I saying that as some all encompassing cope for collective inadequacies?). I sure do talk about things in the context of 2023 a lot - usually in a joking, possibly sarcastic manner - a part of me thinks it is because - let's be honest - 2023 is one of the worst numbers ever discovered, or invented, or... Uh, found? Is found different than discovered? You bet your butt it does, and it is a sad state of affairs to see things so.

I have a vague memory bubble up with almost caustic vigor and boiling chaos. I think about a little festival held in Hamtramck years ago, and my very drunk 50-year-old friend insisting to dance with my roommate ("That's what you do... and she's like a fuckin' daughter to me! It's like a daddy daughter dance to music. That's what people do.") Getting all pushy and violently unaware of his state, the utter foolishness and desperation, my roommate seeing this (with her boyfriend next to her - who in all fairness should have just tipped my buddy on the shoulder or something and he would have just fell over and asleep - no fight neccesary. I am glad they're no longer together). My friend was so apologetic, in a 3D way - I felt a bit bad for him - he is a slave to many things. He was molested young, made an enormous amount of money and his ex-wife simply obliterated his entire stash, she took him for everything through the courts as he slipped into terminal obesity, terrible habits and, supposedly, a brain that is so "unique and damaged and overstressed" from, uh, drinking Milkwaukee's Best and smoking huge joints all day. He says the doctors want to pay him out big time, but he rattled off some garbage apocrypha about, jeez - I dunno - I know he said MRI machines will mess up your testicle(s) and sperm production. And that they're just too dang clausterphobic.

He is a great friend - I genuinely love the guy. I feel bad about insisting that he make drastic life changes over the years. I'm not sure he needs to, or it would help. He's had a rough life. He's got his beers and gigantic joints and a curmudgeon girlfriend... and two sons. And a granddaughter, who he has seen once. Son #1 distracted him with the baby while Son #2 ransacked $80k (eighty-thousand) in rare coins. They are both tremendous gambling addicts and I told him he needs to go nuclear. Sadly - to use that term a bit too much, SADLY! - he will just rattle off nonsense about karma, paying it forward, the Universe settling all its books eventually and realizing he needs to square things up and.... sadly... consider getting his adult grown thief sons in court. He should lock his door. He let's so many people in, and they steal from him and act unsavory and basically that entire - let's say, five block radius? - it is a veritable circus, a semi-ajar if not low-key open-air drug market that leans heavily towards pharmaceuticals. Genetic freakshow oddities go around to senile doctors and they see which one is far gone enough to simply ask "So what would you like?" or "Here, take these Oxycodoes, some deaf guy left them here and I don't know what the hell do to with them."

I tell him, take three, put on your favorite comedy and order some gratuitous food. Don't be lazy. Write down your abstracted, far-out inquiries - ask questions. Answer them later. Note takers have a natural aversion to reading their own notes later - myself included. I have a good fifty notebooks over the past 15 (fifteen) years. Woof. I have no clue if they're "good," but they must certainly be interesting. And I'd love it for others to find them interesting. That'd be really terrific and helpful. Well, let's just say terrific for now.

One more thing. A question - why do men hate each other? Not even in the Joe Rogan alpha-monkey shpiel. Why do they bring out the worst in each other? Why do they all seem jealous of me? I don't mean that narcissisticly. They just have this angry face of regret and longing when I am dominating the conversation or simply just doing my own thing. I think they're afraid of a lot of things. I fear nothing. I just really don't want to die - and I have that feeling I'll outlive everyone I know that deserved it. The types who tried, and put effort into learning how their bodies work. What diet is for them. How much exercise a day.

And then their genes give them a heart attack before their first grey hair grows in. Yeah. Their genes. Must be, right? Yeah?

[oakfern]

my MRI results came back in!!! looks like i don't have a brain tumor. also my sinuses are "unremarkable"

[jcsmicasereports]

In Hindsight, A Deafening Diagnosis by Ecler Jaqua in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Dizziness is a common presentation to the outpatient, primary care physician. Its persistence, associated with hearing changes, should prompt further evaluation for more rare diagnoses such as an acoustic neuroma. Although not malignant, timely management of an acoustic neuroma is essential to prevent chronic facial paresthesia, pain, or taste disturbance, and more rarely death.

CASE PRESENTATION

This is a sample text. You can click on it to edit it inline or open the element options to access additional options for this element.

A 34-year-old female presents to the primary care physician with a 2-week history of fatigue, generalized headache, intermittent right-sided tinnitus, and dizziness that started abruptly after a dental procedure. Tinnitus is high-pitched and most often noted in the morning. The dizziness occurs mainly when changing from a supine to seated position. She has no pertinent medical history, engages in regular cardiovascular exercise but is plagued with an addiction to coffee, approximately 3 cups a day. She denies taking any medications or over-the-counter supplements.

Physical exam, including vital signs and orthostatic blood pressure measurement, is unremarkable. Differential diagnoses included benign positional vertigo and caffeine-induced headache. Plan was to obtain an audiogram, keep a headache diary, decrease caffeine consumption, and improve hydration on days of exercise.

While awaiting the audiogram, the patient presented again to her primary care physician for worsening fatigue and self-diagnosed anxiety, in addition to her stable dizziness, tinnitus, and headache. Physical exam was, once again, unremarkable. Differential diagnoses were expanded to include anemia, thyroid disorder, and vestibular migraine. Plan was to trial sumatriptan and begin laboratory evaluation for her fatigue and hair loss. Labs were unremarkable for anemia, electrolyte or vitamin imbalance, and thyroid disorder.

Almost one year later, the patient returns with persistent symptoms of fatigue, anxiety, tinnitus, dizziness, and intermittent headaches. She reports that her symptoms were overwhelming and affected all aspects of her life, not relieved with the sumatriptan. Physical exam, once again, was unremarkable. Differential diagnoses were again expanded to include Meniere’s disease, intracranial mass, and somatization disorder. Plan was to obtain the previously ordered audiogram, non-urgent magnetic resonance imaging (MRI) of her brain, and consultations with Psychology for coping techniques and Otolaryngology for her tinnitus and dizziness.

THE DIAGNOSIS

The audiogram was notable for asymmetric hearing loss (Fig 1) and subsequent imaging with MRI Brain confirmed the diagnoses of a 5mm intracanalicular tumor, suggestive of acoustic neuroma (Fig 2). The patient was offered proton therapy but elected for definitive, surgical intervention with Neurosurgery. She underwent translabyrinthine resection of the intracanalicular acoustic neuroma. Her postoperative course was complicated by facial weakness but resolved after one year. Follow-up imaging confirmed complete tumor resection and she continues to do well two years after surgery, without recurrence of the acoustic neuroma.

THE DISCUSSION

Headaches, dizziness, and tinnitus are challenging concerns because the differential diagnoses are quite broad. In this case, since the patient presents often, the symptoms were more likely to be acute and the more common diagnoses of benign paroxysmal positional vertigo, vestibular migraine, and caffeine-induced headache were considered. As the symptoms became more persistent, the clinician correctly broadened the differential diagnoses list and requested the appropriate imaging and specialty follow-up.

This patient’s diagnosis, a right-sided acoustic neuroma, was delayed by poor follow-up and procrastination in obtaining the audiogram.  Fortunately, the acoustic neuroma is a slow-growing, benign tumor that develops from schwannoma cells along the branches of cranial nerve VIII, the vestibulocochlear nerve.1 Acoustic neuroma is also known as vestibular neuroma or schwannoma, most commonly affecting individuals between 65 and 74 years old with a prevalence of 1 in 100,000.2,3,4 The most common risk factor is having a history of neurofibromatosis type 2 or exposure to high-dose radiation.5 Increased prevalence, over the last several years, has been attributed to advanced imaging technology.3 Although it is a slow-growing tumor, its growth can compresses the facial and trigeminal nerves causing facial paresthesia, pain, and taste disturbance.6 Rarely, the tumor can compress the brainstem and cause death.6,7 It can be monitored for growth or treated with radiation and/or surgery.

THE TAKEAWAY

Unfortunately, the etiology of patients’ concerns cannot always be determined. But, it should be the responsibility of the primary care physician to evaluate potentially life-threatening conditions for persistent symptoms. This case demonstrates balancing the common with the uncommon differential diagnoses and illustrates the patient’s role in adherence to the treatment plan. Although headaches, dizziness, and tinnitus are non-specific symptoms, the persistence of them should warrant further investigation with more advanced imaging and specialty consultation.