Discussions By Condition: I cannot get a diagnosis.

Progressive Problems with Language/Thought

Posted In: I cannot get a diagnosis. 15 Replies
  • Posted By: researchedout
  • December 2, 2008
  • 07:34 AM

Over the past year I've been experiencing issues with (what might be) coordination, language and thought. Except for the purposes of excluding possible causes, I am no closer to an answer despite having visited two neurologists and a psychiatrist.

For some background, I'm a caucasian male in my late twenties and live in the southeastern United States (but I was in South Korea for five months in 2007). I have bachelor's and master's in computer science and work at an information security company.

What follows is a brief history of the problems I've been experiencing.

Around October 2007, I noticed an increased frequency of mistakes while typing and some speech issues (jumbling words together more often; pronunciation issues). I discussed my concern with my coworkers and ultimately dismissed them as "getting older." Around December 2007, my speech issues worsened (which is troublesome, as I speak publicly a number of times each year).

In January 2008, I visited my primary care physician to discuss my concerns; he ordered some simple blood tests. The results were normal and he recommended seeing a neurologist. My problems with speech waxed and waned (mostly absent in February and March) and I delayed seeing the neurologist.

Between May and July 2008, my symptoms started to increase in frequency. In addition, besides frequent typing mistakes, composing ideas into sentences became more difficult. I finally visited the neurologist, who ordered an MRI; it came back clean. The neurologist concluded that the symptoms were caused by anxiety and prescribed a SSRI.

In August 2008 (after taking the SSRI for a few weeks) the problems I was having temporarily went away. I thought the neurologist was right: perhaps I was simply anxious. However, at the end of August they returned, with the addition of frequent mistakes when reading. Given the amount of text I consume on a daily basis, this problem considerably complicates my work.

In October 2008 I stopped taking the SSRI and saw another neurologist. He ordered an EEG and some blood work (a thyroid panel and a vitamin B12 test); the results of both were normal. The neurologist recommended seeing a psychiatrist, to which I agreed.

In November 2008 I visited the psychiatrist. At initial interview he found nothing specific and recommended neuropsychological tests; I am waiting to hear back from his office regarding scheduling. Finally, in the last week, my vision has been off (e.g., a dark afterimage of text appears directly below its image on the TV or a white wall looks as it would if I had just stared at a bright light).

In the weeks preceding the appointment with the psychiatrist, I began to document insights I had in regards to the problems I experienced with reading, speaking, or writing. What follows is pair of bulleted lists that attempt to summarize the problems.

Reading
-Inserting (from later in the sentence or the surrounding body of text) or omitting words; reversing the order of adjacent words.
-Reading one word for another (e.g., reading buses as businesses or processor as professor).
-Misunderstanding words with different meanings that are spelled the same.

Speaking/Writing
-Mispronouncing words by omitting parts of the word, substituting or transposing letters in the word.
-Problems recalling the desired word (e.g., uneventful, dental floss).
-Misspelling words with a phonetical equivalent (e.g., "that's nothing knew").

It's important to note that these symptoms do not present consistently (right now, as during most evenings, I'm feeling sharp albeit not asymptomatic). I usually wake up each morning fairly clear and then it's downhill until the evening (although things in general have gotten worse over time). The day of the week does not seem to affect this cycle.

Any insights that might lead me in the right direction would be greatly appreciated.

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15 Replies:

  • Hi I don't know if this link will help but it may - or at least set you on the right lines:http://alzonline.phhp.ufl.edu/en/reading/memory/guide_ch6.phpIf I were you I'd do a bit of online research - they call doctors general practitioners because that's exactly what they do 'practice' on people and not always very well. Good luck:)
    maggiemay 68 Replies
    • December 2, 2008
    • 11:45 AM
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  • Just an observation. You don't seem to have these problems in your writing.
    aquila 1263 Replies
    • December 2, 2008
    • 05:22 PM
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  • Just an observation. You don't seem to have these problems in your writing.I spent over an hour proofreading and correcting what I wrote before posting; I'm not sloppy.
    researchedout 3 Replies
    • December 2, 2008
    • 06:48 PM
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  • Do you have any emotional/ behavior symptoms? Some aphasia can have psychiatric causes. Do you have any other medical conditions such as diabetes or epilepsy (although acquired epileptic aphasia tends to produce abnormal EEGs)?One of the tests they should do is an MRI. An EEG may not show any significant abnormalities, when an MRI and CT may be able to give you a better idea of the health of the Broca and Wernicke areas of the brain (which produce and interpret language respectively) and rule out a brain tumor or damage caused by stroke.How are you with repetition? When you are experiencing your speech problems, if someone asks you to repeat something they say, even if it's complex, can you do so? How is your auditory verbal comprehension?
    Anonymous 42789 Replies
    • December 2, 2008
    • 07:39 PM
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  • Some aphasia can have psychiatric links, so it actually does make sense to have been referred to a psychiatrist. Do you have any other medical conditions such as diabetes or epilepsy (although acquired epileptic aphasia tends to produce abnormal EEGs)?One of the tests they should do is an MRI. An EEG may not show any significant abnormalities, when an MRI and CT may be able to give you a better idea of the health of the Broca and Wernicke areas of the brain (which produce and interpret language respectively) and rule out a brain tumor or damage caused by stroke.How are you with repetition? When you are experiencing your speech problems, if someone asks you to repeat something they say, even if it’s complex, can you do so? How is your auditory verbal comprehension?
    OnceBlue 6 Replies
    • December 2, 2008
    • 08:19 PM
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  • Some aphasia can have psychiatric links, so it actually does make sense to have been referred to a psychiatrist. Do you have any other medical conditions such as diabetes or epilepsy (although acquired epileptic aphasia tends to produce abnormal EEGs)? To my knowledge, I do not have any other medical conditions such as diabetes or epilepsy. One of the tests they should do is an MRI. An EEG may not show any significant abnormalities, when an MRI and CT may be able to give you a better idea of the health of the Broca and Wernicke areas of the brain (which produce and interpret language respectively) and rule out a brain tumor or damage caused by stroke. As I mentioned, I was given an MRI in July 2008; it was normal. How are you with repetition? When you are experiencing your speech problems, if someone asks you to repeat something they say, even if it’s complex, can you do so? I do not remember having any problems with repetition when experiencing speech problems, but I may not have tried (I tend to get quiet during those times). How is your auditory verbal comprehension? I have experienced problems understanding what others are saying. I'll hear the sentence (and get all the words), but for whatever reason will not understand its meaning. The last time this happened was when my boss asked me a question during a meeting and I did not understand. He asked me if I was OK and one of my coworkers was nice enough to respond (and I did understand the response) "oh, he's just tired."
    researchedout 3 Replies
    • December 2, 2008
    • 10:59 PM
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  • If you don't mind, is it possible for you to provide some general typed content and please refrain from correcting or proofing it in any manner. I will primarily point out that persons with true aphasias are incapable of "proofing" to correct semantic or descriptive errors in language. This, in of itself, would suggest an alternative process may be at work. Realize that the area of the brain that is involved with semantics and iconic representations of word associations, etc. does not demonstrate remitting/relapsing signs or symptoms. Word insertion or word & letter reversal is actually more associated with disorders excacerbated by stress. As a brief example, persons with clinical depression demonstrate severe memory problems on occasion and fear develops that something pathological may be responsible, ie Alzheimer's etc. What actually occurs in such cases is that attendance to salient stimuli is being interrupted by the features of the depression like rumination and flight of ideas to the extent that the brain is not able to properly process and store the information. Therefore, retrieval is either distorted or altogether impossible. It is actually coined as pseudo-dementia because while some of the features are observed in actual dementia, it is not caused by a neurodegenerative process, but merely inattendance and distraction. The fact that the SSRI provided temporary relief would suggest that your problem is not related to any type of neurodegeneration and because of your age, I would suggest the possibility to be highly remote. While there are many disorders such as semantic aphasia or primary progressive aphasia with features of dysgraphia that can produce symptoms somewhat similar to those you describe, it is not capable of remittance because neurological tissues do not regenerate. In other words, it's sort of a one-way street with the problem only growing worse with time. Incidentally, an MRI would not differentiate something like SA or PPA and more sophisticated imaging such as functional MRI or PET scans would be necessary but even then, inconclusive in many cases. Visual disturbances such as phantom images are actually quite common in persons with anxiety disorder and other circumstances where stress is elevated. Distortion of colors, receptivity to light, auras and other disturbances are all common features of stress-related visual disturbances. I would not think a psychiatrist would be of greatest benefit at this point, but rather a neuropsychologist who can perform a wide range of neuropsychological tests to determine whether the symptoms are truly representative of a neurological disorder or if they are alternatively associated with anxiety, depression or other disorder. This would also not be associated with the kind of obtunded features of glucose intolerance, thyroid dysfunction or similar disorder. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • December 3, 2008
    • 00:18 AM
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  • If you don't mind, is it possible for you to provide some general typed content and please refrain from correcting or proofing it in any manner. Sure; I will attempt to refrain from any s typing issues in this reply. If you need a proofed version for to disambiguate my reply, let me know. Note that I have a havit of wording thigns just right, so you'd probably you will probably see partially formed senrtences (the s above is was originally conaidered supposed to be "spelling"); I normally correct these or wrewrite them as I go.I will primarily point out that persons with true aphasias are incapable of "proofing" to correct semantic or descriptive errors in language. This, in of itself, would suggest an alternative process may be at work. That's That would be a good thing, right?Realize that the area of the brain that is involved with semantics and iconic representations of word associations, etc. does not demonstrate remitting/relapsing signs or symptoms. Word insertion or word & letter reversal is actually more associated with disorders excacerbated by stress. I would think that I'm fairly resitant to stress (I completed two dewgres at a tough school and graduated top of my class), I do have a but I would think I wouldn't discount that I have a demanding job.As a brief example, persons with clinical depression demonstrate severe memory problems on occasion and fear develops that something pathological may be responsible, ie Alzheimer's etc. Well, my I would agrgue that my memory hasn't really been affected. I'm usually very particular, and there are small things I know I shouldn't nomrlaly forget (e.g., wondeting why I went to the fridge after I've opened the door, or closest lane to the exit to get back to ma apartment), but it's otherwise fine.What actually occurs in such cases is that attendance to salient stimuli is being interrupted by the features of the depression like rumination and flight of ideas to the extent that the brain is not able to properly process and store the information. Therefore, retrieval is either distorted or altogether impossible. It is actually coined as pseudo-dementia because while some of the features are observed in actual dementia, it is not caused by a neurodegenerative process, but merely inattendance and distraction. I think it wrings true when you kmention "flgith of ideas." I have a thoughtm, but it turns into multiple thoghts, and I find myself picking the "wrong one." It That it extends beyond language, but I usually catch myself before I speak/decidew what to do.The fact that the SSRI provided temporary relief would suggest that your problem is not related to any type of neurodegeneration and because of your age, I would suggest the possibility to be highly remote. While there are many disorders such as semantic aphasia or primary progressive aphasia with features of dysgraphia that can produce symptoms somewhat similar to those you describe, it is not capable of remittance because neurological tissues do not regenerate. In other words, it's sort of a one-way street with the problem only growing worse with time. Incidentally, an MRI would not differentiate something like SA or PPA and more sophisticated imaging such as functional MRI or PET scans would be necessary but even then, inconclusive in many cases.I've read that SA or PPA are difficult to identify with di imaging tests (usually the diagnosis is clin due to symptoms), and I understand that it's usually very rare. in someone with my age. Visual disturbances such as phantom images are actually quite common in persons with anxiety disorder and other circumstances where stress is elevated. Distortion of colors, receptivity to light, auras and other disturbances are all common features of stress-related visual disturbances. It just seems very odd that stress would manifest itself now. Why I've worked very hard un up until this point with very reaction to it? And wou why would it present itself over the course of a hyear?I would not think a psychiatrist would be of greatest benefit at this point, but rather a neuropsychologist who can perform a wide range of neuropsychological tests to determine whether the symptoms are truly representative of a neurological disorder or if they are alternatively associated with anxiety, depression or other disorder. Noted. However, would dep it be depression if I don't feel "depressed?" I've felt down before (a long time ago, when I was in my teens), and I wouldn't don't think it' s sim a similar feeling.This would also not be associated with the kind of obtunded features of glucose intolerance, thyroid dysfunction or similar disorder. Well, the thryoid panel was normal, and I don't have any of the physiologial symptoms assiocatedi with something like diabetes or adrenal insufficiency. Best regards, J Cottle, MD Thanks for your time; I really appreciate it. I hope my response provides some of the insight you're looking for.
    researchedout 3 Replies
    • December 3, 2008
    • 02:31 AM
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  • Hmmm. very interesting. I was going to say "aphasia" until Dr. Cottle's discourse. Did you suffer any injury to your head when you were a child? Perhaps you may want a speech evaluation by a speech therapist. Your insurance may even cover it. What about food sensitivity? Have you gone organic and eliminated all artificial ingredients? Eliminate sugar, too...no espartine or artificial sweeteners; withdraw from coffee gently. Check for toxin exposure, which would be hard to evaluate, pesticides, carbon monoxide, mold, etc. Do you smoke? Pot? Any innoculations, meds? How's your hearing? Checked out by an othalmologist??? This is interesting:http://en.wikipedia.org/wiki/Aphasia Also, I think you do need a medical diagnosis or one from the speech pathologist. It would afford you protection at work under the American's with Disabilities Act so the boss would know that you are really okay but have a processing disorder.
    Monsterlove 2921 Replies
    • December 3, 2008
    • 03:47 AM
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  • sounds like aluminum toxicity
    Stephenhero 1 Replies
    • December 3, 2008
    • 03:28 PM
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  • I can identify with what the original poster has described. I experience the same type of problems and have a job that's quite similar to yours (high intensity, upper level mgmt, stress, etc.). I too feel like I handle stress well (I actually enjoy the pressure). I experience the same symptoms maybe once a week, but it feels like it's an all day or several hour experience until I'm able to snap out of it. I too am very particular about the wording, formatting, etc. of written communication - it takes me quite a while to craft each masterpiece I send out. To one of the poster's points, I proof read the heck out of things and able to find the mistakes, so I don't think what I have is true aphasia either.This has been happening for 2-3 years now and here are some patterns I've noticed:1) Fatigue - it generally happens when I'm tired (more mental fatigue than physical). I joke at work that I peak during Tues-Thurs. I notice it on Mondays if I've had a long weekend and on Fridays if the work week has been particularly brutal (long days, lot of brain power needed, etc.) and I'm feeling run down. Due to this, I usually take steps to schedule most of the more important mtgs I'm in during Tues-Thurs.2) Anxiety - I experience panic attacks. I don't use medication for this as I feel like it dulls my senses, but have instead trained myself to spot it as they happen and calm myself down. This can be particularly challenging when publicly speaking. Sometimes it feels like you hear the words coming out of your mouth, but they aren't making sense (kind of like you're talking over the thoughts you're formulating in your head). Then, when you feel like you're not making sense, your flow of dialogue becomes a disaster. What I do in these cases is make sure I'm extremely well prepared (e.g. I make "cheat sheets" for every meeting), if I feel this happening I pause (a cough or something to that effect), take a deep breath, focus on my "cheat sheet" (I make sure this is bulleted and key items bolded in a way that I can easily find the item I was just talking about), say "excuse me", and then continue. Caffeinated bevarages can sometimes trigger the anxiety so if I have a presentation or very imporant mtg, I don't drink any coffee prior.3) Dehydration - I find if I don't drink enough water this happens. I drink extra water on "off days".4) Alcohol - if I drink more than 2 drinks at night, I'm impaired the next day. I've cut out drinking completely during the week.Unfortunately, stress does contribute to items #1 and #2. I can usually tell that I'm having one of those days (i.e. it doesn't come on suddenly) and plan accordingly via extra preparation, rescheduling lower priority mtgs/tasks, not drinking coffee or other caffeinated beverages, doing some deep breathing, drinking LOTS OF WATER (this is an important one, it always helps), etc.I've also found exercising to be very helpful. Bit of a ramble here...hope it helps.
    Anonymous 42789 Replies
    • December 3, 2008
    • 08:12 PM
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  • I sympathatize as I have that same problem too but for myself it's a symptom of another issue I have (neurological issue).. you dont thou have the same underlying problem causing it as I do. In the issue I have the Aphasia or whatever one wishes to call it.. may be being caused by lack of blood or oxygen to the cells at times. I get the issue as remiting and relapsing too. Sometimes im able to work things out so I understand and then can recorrect but other times I cant (and at such times I wont be posting). I can forgot and stop understanding very simple things like big gaps in my mind.. things can like just "drop out" of my memory at times eg I forgot what a door was!! so hence was trapped somewhere as i didnt know know what a door was and didnt know one could open it. Another time I knew i was looking for something called "a toaster" to cook my bread in.. but i forgot what a toaster looked like, so i couldnt cook my bread that morning. I was looking at the objects on my cupboard.. trying to work out what the bread went into to cook it. Other times.. ive been unable to speak..as i cant work out how to formulate sentences and put words together to do so. These issues aint stress related and can happen to me at any time..but heaps worst if im tired (mentally exhausted). Some times due to word loss.. I'll make up words so i can get across what im saying.. I know i had to do this at this site the other day and made up the word "Multisymptomic" (or something like that) :o ... cause i couldnt remember the word symptomatic at the time, I ended up using the same made up word with a medical friend who just laughed when I told him about my word loss and so i had to ask for the correct word (as it just wouldnt come to me.. even 6 hrs later.. i didnt realise i had the correct word but had altered it by adding something to front.. all i knew was word was wrong cause i had to make it up). (hopefully most here miss the things i insert to replace my word less.. i also correct my posts LOTS due to completely wrong words ending up in wrong places). I dont know if you also have recognition issue with faces too. Ive found that goes hand in hand when im having bad issues with the other comprehension stuff. Once I couldnt recognise my brother-in-law when he came to my door - Facial agnosia. It took 10 mins of talking to this person I knew I knew.. but didnt know who the person was, before I finally "knew" him.............
    taniaaust1 2267 Replies
    • December 5, 2008
    • 03:31 AM
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  • part of a symptom list from conditon i have.. which you dont have but your comprehension issues seem similar.. so maybe the same part of the brain is suffering damage or lack of blood flow ??? maybe you have some of these other issues going on too which you didnt mention. "COGNITIVE & NEUROLOGICAL DYSFUNCTIONSProblems with memory including; difficulty making and consolidating new memories (particularly short-term memories), difficulty recalling formed memories and difficulties with visual recall and with immediate and delayed verbal recall are common. Short-term memory problems may lead to people forgetting where they are or what they are doing, this can be so severe that patients are unable to finish a sentence. Facial agnosia may also occur (not being able to recognise faces, even those of close friends and family)Multi-tasking problems, an inability to learn to perform new tasks, forgetting how to perform routine tasks and a difficulty with simultaneous processing. There can be a difficulty with following step-by-step instructions, recipes or performing any tasks which require a series of separate actions. Sequencing dysfunction can also occur; inability to look words up in a dictionary, to look up phone numbers in a phone book or to organise files etc. Patients may also need extra sensory cues to complete tasks (for example, the patient may need to be able to see what they are doing to be able to complete a task where formerly the task could be completed using touch alone eg. turning on a light or operating the controls in a car)Cognitive slowing (tasks can take much longer than usual)Impairment of concentration; maintaining a reasonable level of concentration on a task for even a short period of time may become extremely difficult, or impossible. There is a need for mental micro-rests.Difficulty with visual and aural comprehension; difficulty following oral or written directions, trouble distinguishing figure from ground and speech comprehension difficulties. Greater difficulty with auditory comprehension than visual is common. Word, letter and short term ordering problems, for example; transposition - reversal of letters or numbers, words or sentences when speaking or writing (pseudodyslexia)Inability to locate the words for writing (Agraphia). Handwriting may also change completely with the onset of illness, may be deformed in a way consistent with brain damage (this may wax and wane with the severity of the illness)Problems with reading (Alexia) or word blindness; patient can still read but what is read is not comprehended and cannot be compared with known information already stored. If reading is still possible, text may have to read many times before it can be comprehended.Difficulty or an inability to understand speech (Wernicke's Aphasia); words are heard clearly, they are not garbled, but they make no sense. It is a loss of the ability to interpret normal language. When the input is aural, there seems to be a loss of the initial orienting information. The person is actively listening, but the information simply does not register at all or must be repeated several times before it registers.Increased need for visual cues in understanding speech; visual or multisensoral cues are an important compensatory tool. (for example, a patient may not be able to understand the same conversation with the same person on the telephone that they understood perfectly well when conducted face-to-face). In speaking, important elements are often left out of the sentence such as the verb or subject, sometimes the syntax is askew. At times speech makes no sense and/or does not relate to the question asked. Sometimes speech comprehension is delayed which can result in long pauses, interruptions, mistiming of responses and apparent non sequiturs. Patients themselves may or not be aware of these problems with their speech. Incorrect word selection (paraphasia) is common, such as using the wrong word from the right category or using a word that sounds similar to the correct word but has a different meaning. Commonly used words become hard to retrieve. These problems combined may result in a significant loss of communicative ability. There can also be a difficulty pronouncing words intelligibly (Dysarthria) or a complete inability to express language (Broca's Aphasia).Dyscalculia; (loss of arithmetic skills) an inability or difficulty to do simple additions and other calculations, to count money, add up columns etc (irrespective of the quality of former mathematical abilities) is common. There may also be a difficulty or confusion with following timetables or keeping scheduled appointments.
    taniaaust1 2267 Replies
    • December 5, 2008
    • 03:45 AM
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  • Loss of verbal and performance intelligence quotient (IQ) A loss the ability to block out extraneous and unwanted information and noise; patients lose of the ability to distinguish noise from required information and tend to shut down all intake after minimal prolongation of the information signal. For example, a person may not be able to understand speech when there is more than one person speaking, more than one conversation taking place, or when there is a TV or radio on in the background. (This receptive shutdown has alarming connotations for making memories and can also at times create real danger to the patient) An exaggerated response to even small amounts of additional input or stimulus (light, noise, movement, vibration) is common, causing incoming messages to become scrambled or blurred resulting in distorted signals and odd sensations (ie. low level seizure activity). Even very low levels of light or noise etc. can also causean exacerbation of other symptoms, or of the severity of the illness generally. Polyneuropathy; a neurological problem that occurs when many peripheral nerves throughout the body malfunction simultaneously. Many polyneuropathies have both motor and sensory involvement and some have autonomic dysfunction. Hyperreflexia; overactive or overresponsive reflexes eg. twitching or spastic tendencies as well as the lessening or loss of control ordinarily exerted by higher brain centres of lower neural pathways (disinhibition). Perceptual and sensory dysfunctions eg, spatial instability and disorientation. There may be a loss of co-ordination or clumsiness - difficulty in judging distance, placement and relative velocity (caused by proprioception dysfunctions, proprioception being the perception of stimuli relating to your own position, posture, equilibrium, or internal condition) Extension or quick rotation of the neck can cause dizziness (also due to proprioception dysfunctions) Altered time perception (losing time), feeling 'spaced out' or 'cloudy' or not quite real somehow Disorders of colour perception - recognising colours but forgetting what they mean, (Seeing the red light at an intersection, knowing it is red, but not recognising that red means ‘stop,’ for example) Abstract reasoning dysfunction; difficulty organising, integrating, and evaluating information to form conclusions or make decisions (some patients find it almost impossible to make decisions) Stroke-like episodes Short periods of amnesia may occur which may be associated with disorientation where the patient momentarily does not know where or who she is which may cause considerable anxiety. Some patients lose large parts of the day but this is infrequent. In most cases the patient can be brought out of the amnesiac attack with cues In severe illness patients can become unconscious, comatose for up to 23, 24 hours a day (the brain becomes unable to maintain wakefulness). There can be a difficulty in maintaining full consciousness for more than a few seconds, minutes, or half-hour periods at a time. Volitional problems; difficulty starting or stopping tasks, or switching from one task to another (a neurological dysfunction where the body does not respond appropriately, or quickly, or without difficulty, to the minds commands; is related to sleep paralysis. This is a central dysfunction and may be similar to that seen in Parkinsonianism) A feeling of agitated exhaustion is common (neurological in origin) Emotional symptoms include: mood swings (emotional lability) – crying easily, excessive irritability etc or intense emotions such as rage, terror, overwhelming grief, anxiety, depression and guilt. Sometimes there can be an emotional flattening or situations may be erroneously interpreted as novel (due to prefrontal cortex dysfunction). Disinhibition may occur to varying levels. Anxiety and panic attacks may occur, often not tied to environmental triggers. "
    taniaaust1 2267 Replies
    • December 5, 2008
    • 03:46 AM
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  • Hi there- did you ever end up receiving a diagnosis? I am experiencing similar issues, but have not been able to figure out what's going on. Would be very helpful to hear how this ended up for you.
    Anonymous 1 Replies Flag this Response
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