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Extreme fatigue, cognitive deficits, balance issues

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November 13th, 2010
My 16 yo son has been taking doxycycline for acne for 1 year. He gets classic migraines with aura, but 4 weeks ago started developing new migraine \"variant\" symptoms - blurred and double vision, eye crossing, lightheadedness, extreme fatigue, cognitive deficits, balance issues. Symptoms abate when prone, but increase with sitting and standing. Kid is an athlete and was in heavy duty training when symptoms started and increased. Stopped the doxycycline one week ago. Negative MRI. Does he need a lumbar puncture to rule out intracranial hypertenstion/pseudotumor - or a dilated eye exam first and then the lp? BP is slightly elevated - 144/88. Symptoms are increasing daily. Went to ER to "abort" migraine after 12.5 mg Axert did not work - had Depacoh (sp?) iv - some relief, but did not last. Had a normal dilated eye exam this summer.


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replied November 24th, 2010
Neurological Disorders Answer A17248

Hi,

Welcome to the forum. I am glad to help you out. A dilated eye examination should always be done prior to doing the lumbar puncture to rule out any papilledema as there's a small risk of herniation of the brainstem resulting in the coning and it can result in sudden death also. Brain MRI with gadolinium enhancement is the study of choice for all patients with Pseudotumor cerebri as it provides sensitive screening for hydrocephalus, intracerebral masses, meningeal infiltrative or inflammatory disease, and dural venous sinus thrombosis. These are the common ailments which need to be ruled out before thinking of pseudotumor cerebri.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care.


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