I believe he has Subdural hematoma.
1
Question:
How much time before the headaches started did you start using oil paintings, and did you test for food allergies and sensitivities, or molds in your house?
Diagnosis:
Some sort of general toxification of the brain. Either caused by brain toxic chemicals in the oil paintings, or by food allergies and damaged gut function and digestion, or by molds in the house. The Brain toxification was also sped up and intensified by the fact that he leads a sedetary life without a lot of exercise and fresh air. The toxic air in Tokyo as well intensified the toxification increasing his symptoms. (And in case there are molds in his house all the time he spent painting also increased the toxification). Everything led to toxification and inflammation of the brain and its deterioration. Hard to put one name on the illness. Partly it has a bit of Autism, a bit of Dementia and a bit of Parkinsons. I would call it intense Brain toxification and inflammation.
How much time before the headaches started did you start using oil paintings, and did you test for food allergies and sensitivities, or molds in your house?
Diagnosis:
Some sort of general toxification of the brain. Either caused by brain toxic chemicals in the oil paintings, or by food allergies and damaged gut function and digestion, or by molds in the house. The Brain toxification was also sped up and intensified by the fact that he leads a sedetary life without a lot of exercise and fresh air. The toxic air in Tokyo as well intensified the toxification increasing his symptoms. (And in case there are molds in his house all the time he spent painting also increased the toxification). Everything led to toxification and inflammation of the brain and its deterioration. Hard to put one name on the illness. Partly it has a bit of Autism, a bit of Dementia and a bit of Parkinsons. I would call it intense Brain toxification and inflammation.
Oil based paints causing headaches
Question: any history of preceding trauma: "minor trauma " including fall or twist, stretch or even sneeze preceding the onset of headaches.
Diagnosis: frontotemporal brain sagging syndrome.
Diagnosis: frontotemporal brain sagging syndrome.
Parasitic infection from raw fish eaten in Japan.
Have you been bitten by a tick while out painting ?
I believe he has Lyme disease.
I believe he has Lyme disease.
I thought about some chemical poisoning from the paints, but then again, I'm just a doctor of teeth and I see wacky patients but I can't diagnose something like this. Had I known about the accident I would have ventured some vertebral artery damage, never a fistula. This is great skullduggery. Very intriguing.
Do you have water/fluid rushing out from your left nostril when you bend forward? Is it clear fluid?
1
Cadmium poisoning
Did you eat sea food in Japan?
What do you clean your brushes with?
"Tell me more about your paintings". He may have exposure to lead and/or other solvents. He did have something indolent and/or chronic that became worse because of an insult. An arteriovenous malformation and/or obstruction temporarily cutting off supply to areas of the brain is possible. Another question would be "do you hear voices, smell things, or see things differently?" I wish I could have seen this case sooner!
WOW, what a terrific, sus[penseful story. But. what the procedures that were done to correct this condition? Please explain.
Thanks
Thanks
Do any of the newer paint contain lead or any heavy metals
Diagnosis heavy metal toxicosis
Diagnosis heavy metal toxicosis
Usually only white and some blues, rarely some reds.
1
"When you switch between paint brushes, do you hold the extra in your mouth?" He's been ingesting small amounts of toxic oil paints as he works.
Two questions:
1. is the headache relieved by lying down, worse when standing up?
2. do you have pulsatile tinnitus?
1. is the headache relieved by lying down, worse when standing up?
2. do you have pulsatile tinnitus?
Meningeal Irritation caused by the inhalation of volatile organic compounds. He switches from painting with acrylic to oil. He used turpenoids to thin his paint and hence his symptoms.
1
"Did you have extra-marital relationships?"
(neurosyphilis)
(neurosyphilis)
I think that he has a fungal meningitis ...acrylic type paints are known to cultivate fungal species.
Hence the question should be if he still stores the acrylic paintings ....these maybe source of the fungi
Hence the question should be if he still stores the acrylic paintings ....these maybe source of the fungi
Do you drink coffee?
Waldenstrom's macroglobulinemia
Do you have jaw pain while chewing food? (Giant cell arteritis)
In the event the answer has not been published because the correct diagnosis has not been named, I feel I must exhaust all possibilities. ;)
Question: Do you have to touch things to know where they are? OR, is it impossible for you to read now?
Diagnosis: Balint's Syndrome. His change of painting style (and how he sees things) would be an indicator of this. A possible cause would be some kind of neurodegenerative disease, such as Alzheimer's.
Question: Do you have to touch things to know where they are? OR, is it impossible for you to read now?
Diagnosis: Balint's Syndrome. His change of painting style (and how he sees things) would be an indicator of this. A possible cause would be some kind of neurodegenerative disease, such as Alzheimer's.
1
Do you have history of thyroid problem?
Hashimoto Encephalopathy
Hashimoto Encephalopathy
Toxic encephalopathy from use of solvents used to clean brushes.
Fungal infection in the brain
3
Hypertrophic pachymeningitis.
Joint pain or rash?
Possible cerebral vasculitis related to systemic lupus erythematosis.
Possible cerebral vasculitis related to systemic lupus erythematosis.
Question - "Do the oil paints contain any lead?"
Diagnosis: Chiari malformation type I. His head MRI noted that he had low-lying cerebellar tonsils, which is a clear indication of this disease. Normally, Chiari presents in childhood, as it is a congenital condition. However, some patients who have the condition are completely asymptomatic. This patient probably had this condition his whole life, and never showed symptoms until ingestion of lead led to encephalopathy (brain swelling). When his brain swelled, the portion of his cerebellum that was herniating through the foramen magnum became compressed and presented with sever occipital headaches.
Diagnosis: Chiari malformation type I. His head MRI noted that he had low-lying cerebellar tonsils, which is a clear indication of this disease. Normally, Chiari presents in childhood, as it is a congenital condition. However, some patients who have the condition are completely asymptomatic. This patient probably had this condition his whole life, and never showed symptoms until ingestion of lead led to encephalopathy (brain swelling). When his brain swelled, the portion of his cerebellum that was herniating through the foramen magnum became compressed and presented with sever occipital headaches.
5
Chiari Malformation-Type O, presenting with ataxia, cerebellar signs and headache.
Question: Did your father (with history of dementia) have headaches also?
Diagnosis: CADASIL - Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy
*This is a tough case. There are so many clues, but figuring out which clues are significant, or not, is the tricky part. There are a few possible diagnoses that fit better than others, but actually there are a surprising number of possibilities. I can't wait to find out if the fact that he is a painter is a red herring or not.
Diagnosis: CADASIL - Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy
*This is a tough case. There are so many clues, but figuring out which clues are significant, or not, is the tricky part. There are a few possible diagnoses that fit better than others, but actually there are a surprising number of possibilities. I can't wait to find out if the fact that he is a painter is a red herring or not.
The question asked, Did you have a line placed in your neck, that is was there a venous catheter placed in your neck.
The diagnosis is Internal Jugular Vein Thrombosis
The diagnosis is Internal Jugular Vein Thrombosis
Question: Do you paint in a well ventilated space - especially now that you are using oil paints and thinners for oil paints?
Sounds like exposure to the chemicals in either the paints or the thinners (eg, toluene or similar).
Sounds like exposure to the chemicals in either the paints or the thinners (eg, toluene or similar).
1
I think he has mercury poisoning. I think the Dr asked for his oil paint and tested it for heavy metals.
Chemical poisoning resulting from the switch to oil paint.
4
A stroke. How is your heart health?
I think maybe lead poisoning. Smith asked him about the paints he used.
Creutzfeldt-Jakob Disease.
Would be completely obvious from MRIs.
Can it be heavy metal (cadmium, etc) poisoning from the oil paints?
Surya poisoning from lead based paint
Q: Have you ever experienced any joint pain or been diagnosed with Rheumatoid Arthritis?
Could possibly be Rheumatoid Meningitis/nodules given his response to the steroids
Could possibly be Rheumatoid Meningitis/nodules given his response to the steroids
Lead poisoning. As to the question, the doctor could have asked the patient if he had ever absently or deliberately put his paint brushes in his mouth.
2
Chronic cyanide poisoning, with indolent delayed symptomology.
Question: Have you been on immunosuppressive drugs? (immunosuppression can lead to this diagnosis)
Diagnosis: PML - Progressive Multifocal Leukoencephalopathy (caused by JC Virus)
This would explain the clumsiness, personality changes, trouble speaking, visual changes etc.
Diagnosis: PML - Progressive Multifocal Leukoencephalopathy (caused by JC Virus)
This would explain the clumsiness, personality changes, trouble speaking, visual changes etc.
Question: What type of dementia did your father have?
Diagnosis: Dementia. Several of his symptoms fit with Alzheimer's. I'm not so sure about the headaches as a symptom, but it could be that the Alzheimer's is making him forgetful enough that he is making mistakes with his medication and/or supplement dosing that is leading to headaches. ie. not taking his medicine on a regular basis, taking too much, not enough etc. Or, maybe there is a separate cause of the headaches, in addition to the Alzheimer's diagnosis.
Diagnosis: Dementia. Several of his symptoms fit with Alzheimer's. I'm not so sure about the headaches as a symptom, but it could be that the Alzheimer's is making him forgetful enough that he is making mistakes with his medication and/or supplement dosing that is leading to headaches. ie. not taking his medicine on a regular basis, taking too much, not enough etc. Or, maybe there is a separate cause of the headaches, in addition to the Alzheimer's diagnosis.
Did you eat sushi in Japan? Fluke worm (parasitic infection of the brain)
I'm wondering if he has Cysticercosis. Did he come from somewhere in the developing world where pig farming techniques are not up to sanitary standards?
I think the consultant's question was, "Do you use solvents such as turpentine or turpentine for your oil painting in an unventilated area?" I think that breathing the solvents caused an increased concentration do these solvents in the frontal and ethmoid sinuses, which connect with the meninges. The solvents caused ulceration of the meninges, which led to a cerebrospinal fluid leak. This was compounded by capillary oozing, which was promoted by anti-coagulation with Coumadin. I'm not sure why the meninges became affected in a more widespread way, but I would guess that this was an inflammatory process. The patient's poor performance on finger to nose test is consistent with chronic turpentine exposure, which is also occurring.
3
Bleeding escaping from thin vessels in the whitened area of MRI ...
What do you use to clean your paint brushes?
What do you use to clean your paint brushes?
1
CNS Vasculitis affecting vessels around the cerebellum and occipital lobe
Ask about Past Medical History and Family History of Autoimmune Disease
Ask about Past Medical History and Family History of Autoimmune Disease
Maybe PACNS. But I don't know of a question that would lead to diagnosis.
1
What types of paints do you use? Sounds like Hg poisoning.
1
CSF leak.
Neurologist asked about runny nose. Asking about CSF rhinorrhea
Neurologist asked about runny nose. Asking about CSF rhinorrhea
1
Acute Radiation Syndrome
As an artist - I wonder what materials he was painting with - the fumes of many thinners, glues and adhesives have negatively affected the behavior of several people of my acquaintance with symptoms that lasted for years, but that eventually cleared up after they ceased to use certain materials.
2
Intracranial hypotension
Q: How long have you had the persistent cough?
You have Leptomeningeal tuberculosis.
You have Leptomeningeal tuberculosis.
2
Lyme desease. He spends too much time outside. We can see it in his paints.
2
CSF leak secondary to an injury.
1
Has the patient ever been exposed to people with tuberculosis?
Maybe psychological/neurological and cardiac symptoms stemming from hyponatremia. Underlying endocrine cause like over-production of ADH (stemming from pulmonary illness, given his recent cough)?
Maybe psychological/neurological and cardiac symptoms stemming from hyponatremia. Underlying endocrine cause like over-production of ADH (stemming from pulmonary illness, given his recent cough)?
Neurosyphillis, I saw an art exhibit at the Prado that showed an artist's before and after paintings that exhibited the same type of paintings.
Maybe he asked if his studio is ventilated. Chronic solvent induced encephalopathy? Because of the timing of the oil painting.
Leptomeningeal lymphoma
Do you have a burning sensation when you drink alcohol?
Do you have a burning sensation when you drink alcohol?
Are you using lead based paints ?
Possible lead poisoning.
Possible lead poisoning.
1
The question: does the onset of your headache coincide with oil painting?
Diagnosis: neurotoxicity due to toxic chemicals in oil paint, especially in the darker hues he was using (cadmium --see the bright undertones in example of recent painnting. As well as other chemicals, such as mercury, lead & cobalt sulfides, or chemicals in toxic solvent (OMS or turpentine).
Diagnosis: neurotoxicity due to toxic chemicals in oil paint, especially in the darker hues he was using (cadmium --see the bright undertones in example of recent painnting. As well as other chemicals, such as mercury, lead & cobalt sulfides, or chemicals in toxic solvent (OMS or turpentine).
What is the name of the dietary supplement taken orally, but not specifically named in the list?
Thr question: did the onset of your headaches coincide with painting with oil? (Given oil paints' highly chemical composition)
What have you eaten in Japan?
Parasites
Parasites
Interesting story, but nobody mentioned base rate frequency of symptoms appearing in other cases involving poisonings involving heavy metals, aromatic solvents, and the like.
The painting done by the patient appear to be done with artists' paint brushes, which do not have the surface area to release significant quantities of aromatics into the air. Spray ccan and air brushes release much more solvent. Years go, toluene-based model airplane cement was far more common, but well-publicized abuses by people using model cement to get high led to significant restrictions on their sales and distribution. Moreover, casual exposure to those chemicals would have had a much higher frequency of published reports than appears to be the case here. Acrylic paints also release volatile chemicals, so it's probably something else. Again I would look at the base rate for all incidents of people who were exposed to those chemicals, and work from there. It could well be that none of those chemicals are implicated in this patient's symptoms.
The painting done by the patient appear to be done with artists' paint brushes, which do not have the surface area to release significant quantities of aromatics into the air. Spray ccan and air brushes release much more solvent. Years go, toluene-based model airplane cement was far more common, but well-publicized abuses by people using model cement to get high led to significant restrictions on their sales and distribution. Moreover, casual exposure to those chemicals would have had a much higher frequency of published reports than appears to be the case here. Acrylic paints also release volatile chemicals, so it's probably something else. Again I would look at the base rate for all incidents of people who were exposed to those chemicals, and work from there. It could well be that none of those chemicals are implicated in this patient's symptoms.
2
Primary angitis of the central nervous system. (PACNS)
Patients present with headaches that progress to other stroke like symptoms. MRI highlights leptomeninges and SF fluid shows elevated protein. Angiography helps in the diagnosis but a biopsy is generally required.
Patients present with headaches that progress to other stroke like symptoms. MRI highlights leptomeninges and SF fluid shows elevated protein. Angiography helps in the diagnosis but a biopsy is generally required.
2
I am no doctor.
Dr. Sanders: thanks for letting me learn so much about such mysterious and not so mysterious diseases, their symptoms and resulting diagnosis
If nothing else, Dr. Sanders, I am learning to take medical Q&A with an attendant physician seriously. I should prepare myself better before visiting a doctor - to ensure that I tell him or her everything I know about any symptoms or other issues I have.
Just to let you know, recently I had a fainting spell - a repeat to the day two years later. My neurologist who is well known in the world - asked me probing questions. He complimented me on my thorough answers. It led to a quick diagnosis and resulted in no medication at all.
So, many thanks, Dr. Sanders. for allowing me to be a better patient
Dr. Sanders: thanks for letting me learn so much about such mysterious and not so mysterious diseases, their symptoms and resulting diagnosis
If nothing else, Dr. Sanders, I am learning to take medical Q&A with an attendant physician seriously. I should prepare myself better before visiting a doctor - to ensure that I tell him or her everything I know about any symptoms or other issues I have.
Just to let you know, recently I had a fainting spell - a repeat to the day two years later. My neurologist who is well known in the world - asked me probing questions. He complimented me on my thorough answers. It led to a quick diagnosis and resulted in no medication at all.
So, many thanks, Dr. Sanders. for allowing me to be a better patient
6
Do you do your painting in an enclosed space?
Hypertrophic pachymeningitis
Hypertrophic pachymeningitis
1
He asked about pulsatile tinnitus (dural AVF).
1
Question - do you hold paintbrushes in your mouth? The vermilion pigment (in the picture) may contain mercury sulphide and the patient may be suffering from mercury toxicity.
Q: Did your father have Alzheimer's Disease or Frontotemporal Lobar Degeneration?
Dx: Cerebral Amyloid Angiopathy (CAA)
Dx: Cerebral Amyloid Angiopathy (CAA)
1
I am not 100% sure it is caused by paint solvent toxicity. While it does account for most of the s/sx, I think a key question to r/o this cause would be how long has he been painting. Typically, acute exposure (recent change in paints) would present with immediate sx; however, our pt has noticed the sx have been getting progressively worse over the last year.
At this point, I would favor neurosarcoidosis as the dx. Neurosarcoid can have vision changes such as sharp discs (as noted in the CN exam). CNS involvement would explain h/a, confusion, and possibly the meningeal "irritation". CSF protein was elevated and cytology was negative, all supportive of this dx.
The short course of steroids that improved his condition is the first line treatment (prednisone). Serum ACE was WNL, which suggests it may not be systemic sarcoidosis. B12 and A1c were normal, which r/o those pathologies as causes for the neuropathy (which was attributed to stroke anyway).
In any case, I will be curious to see the answer.
At this point, I would favor neurosarcoidosis as the dx. Neurosarcoid can have vision changes such as sharp discs (as noted in the CN exam). CNS involvement would explain h/a, confusion, and possibly the meningeal "irritation". CSF protein was elevated and cytology was negative, all supportive of this dx.
The short course of steroids that improved his condition is the first line treatment (prednisone). Serum ACE was WNL, which suggests it may not be systemic sarcoidosis. B12 and A1c were normal, which r/o those pathologies as causes for the neuropathy (which was attributed to stroke anyway).
In any case, I will be curious to see the answer.
1
Possible Dx: Paget's disease of bone.
The question : Did you notice any change in your hat size?
The question : Did you notice any change in your hat size?
1
Hypertrophic pachymeningitis? Rheumatologist or idiopathic?
1
The doctor should ask: What type of solvent are you using with the oil paint?
Possibly chronic solvent encephalopathy which can cause headaches, memory loss, and neurobehavioral changes.
Return to acrylic paints which can be dissolved with water and symptoms should clear.
Possibly chronic solvent encephalopathy which can cause headaches, memory loss, and neurobehavioral changes.
Return to acrylic paints which can be dissolved with water and symptoms should clear.
VZV vasculopathy. Ever have zoster infection?
Any urinary symptoms? Normopressure hydrocephalus can mimic toxic cerebellar ataxia.
1
Nasal CSF leak from solvent exposure causing pachymeningitis.
Ask if his nose has been running a lot.
Ask if his nose has been running a lot.
2
Question: Are you of Japanese descent? (ophthamologic and cardiac involvement are more common in Japanese than in other races)
Diagnosis: Neurosarcoidosis.
Diagnosis: Neurosarcoidosis.
acute cerebellar ataxia caused by neurotoxic effects of metals/solvents used in painting
Cavernous sinus thrombosis
The question was "What do you use to clean your brushes?"
Turpentine, most commonly used to clean oil paints, or similar solvents, can have effects on the brain causing the symptoms that the patient experienced.
Turpentine, most commonly used to clean oil paints, or similar solvents, can have effects on the brain causing the symptoms that the patient experienced.
Vascular dementia
csf leak, possibly due to a spontaneous defect of the dura allowing leakage through the cribriform plate, causing intracranial hypotension. This would account for the persistent cough that was reported by the neurologist, from CSF draining back into the nasopharynx and down to the larynx.
csf leak, possibly due to a spontaneous defect of the dura allowing leakage through the cribriform plate, causing intracranial hypotension.
Question - does the patient lick his point brush?
Diagnosis - Lead poisoning.
Was patient anemic?
On the LP, did they measure the opening pressure?
Diagnosis - Lead poisoning.
Was patient anemic?
On the LP, did they measure the opening pressure?
For the next doctor question: What are your paints from, and how do you use them? Paints traditionally used heavy metals and other toxins. US-produced paints may no longer do so, but are imports tested??? Oral/respiratory contact with any paints sounds risky.
Do you ever put your paintbrush in your mouth? He had switched from acrylics to oils at retirement, raising his risk of neurotoxicity from mercury and/or lead in the oil paints.
Japanese encephalitis because, why not
Solvents like oderless terp!
Do you wet your pants often and cannot control it?
Dx: Normal pressure hydrocephalus according to my humble knowledge.
Dx: Normal pressure hydrocephalus according to my humble knowledge.
1
I believe the issue is related to the fact that he switched to oil paints from acrylics. He is experiencing neurotoxicity from the paints, perhaps lead poisoning.
Do you drink unpasteurized milk?
TB meningitis
TB meningitis
I suspect there is something in the oil paints that is causing his problem. Mercury poisoning could produce his symptoms and I would wonder whether any of his oil paints contain mercury.
I'm thinking it is due to the oil paints, possibly the solvent being used in the closed space. It is causing the inflammation and headaches. He should change brands, work outside and possibly return to acrylics.
Lead poisoning
Wegener's granulomatosis or Idiopathic Hypertrophic Cranial Pachymeningitis? The response to corticotherapy is intriguing me.
Also I was wondering as well if there is no CSF leak through a fistula like spinal or thoracomeningeal fistula, explaining the venous congestion and intracranial hypotension.
Also I was wondering as well if there is no CSF leak through a fistula like spinal or thoracomeningeal fistula, explaining the venous congestion and intracranial hypotension.
Did he have blood with his cough?
Answer: Wegener's granulomatosis
Answer: Wegener's granulomatosis
2
Dr. Smith asked: Did you eat snails when you were in Japan?
His diagnosis: Angiostrongyliasis
His diagnosis: Angiostrongyliasis
1
Cadmium poisoning.
Was he submitted to any thoracic or spinal surgery? It could be a thoracomeningeal fistula or rupture of dura mater.
Do you have a burning sensation when you drink alcohol?
dx : Leptomeningeal lymphoma
dx : Leptomeningeal lymphoma
Did the headaches start when you switched from acrylic to oil paints?
Sounds like some kind of poisoning from the oil paints, possibly lead and/or mercury poisoning.
Sounds like some kind of poisoning from the oil paints, possibly lead and/or mercury poisoning.
Migraine due to oil paint and solvent toxicity?
Q: did the headache started shortly after you changed paint?
Diagnosis: lead poisoning by paint
Diagnosis: lead poisoning by paint
Normal pressure hydrocephalus.
Had the patient ever played football or other contact sport?
Could it be CTE?
Could it be CTE?
The question was do the headaches quickly resolve with lying down.
The diagnosis is frontotemporal brain sagging syndrome mimicking frontotemporal dementia due to spontaneous intracranial hypotension. It's usually from a CSF leak in the spine.
The diagnosis is frontotemporal brain sagging syndrome mimicking frontotemporal dementia due to spontaneous intracranial hypotension. It's usually from a CSF leak in the spine.
Neurotoxicity from solvents, especially turpentine.
Intracranial hypotension, ideopathic. Possibly from a spontaneous CSF leak.
Question: does the headache get better lying down.
Try treating with a blood patch.
Question: does the headache get better lying down.
Try treating with a blood patch.
Do you use toluene as a solvent?
Do you lick your paintbrushes?
Lead toxicity
Lead toxicity
Question: Do you eat a lot of carrots?
Diagnosis: Pseudotumor cerebri
Diagnosis: Pseudotumor cerebri
The diagnosis was: Chiari Malformation Type 1
The question was: Do the headaches worsen upon sneezing, coughing or any other Valsalva maneuver?
The question was: Do the headaches worsen upon sneezing, coughing or any other Valsalva maneuver?
1
Good guess! It was mentioned that his pain was worse when bending over and pain is worse in the back of his head.
I think it has to do with the change in paints. I think some of the paint he is using has lead in it. His symptoms seem to match up with lead poisoning effects. I also gave a thought to poisoning from the thinners he might be using with the paint or to clean his brushes and hands but his symptoms don't seem to line up with any of the thinners he might be using such as white spirits or turpentine.
The patient has symptoms of a Chiari Malformation Type 1.
1
I feel that he might be unconsciously putting his paint brush in his mouth and thus ingesting too much lead.
Question: has he been smelling the paints? Or working in smaller area where may get vapors?
Diagnosis: mercury poisoning
Diagnosis: mercury poisoning
"What kind of paint do you use?"
I'm an amateur painter, and I clearly remember a teacher telling an oil painting class that extended exposure to oil paints causes psychosis.
I'm an amateur painter, and I clearly remember a teacher telling an oil painting class that extended exposure to oil paints causes psychosis.
Question: Have you noticed any changes in the coloring of you nails?
Leptomeningeal carcinomatosis secondary to acral melanoma
R/o with meningeal biopsy
Leptomeningeal carcinomatosis secondary to acral melanoma
R/o with meningeal biopsy
Dx: Lewy Body Disease
Question: Does the patient move or speak when he is asleep/does the patient act out dreams while he is asleep?
Question: Does the patient move or speak when he is asleep/does the patient act out dreams while he is asleep?
I believe the question is when he switched from acrylics to oils what additional cleaning agents and mixing agents did he start using. Acrylics are often applied mixed with water and the brushes cleaned with water and detergent. But many artists who use oils then use dangerous solvents in both the mixing of paint and cleaning of brushes. Turps, varnishes, even orderless solvents can wreak havoc on the brain. I have experienced many of the symptoms first hand....dizzyness, missing steps, headaches, blurred vision. I finally started using walnut oil to mix paints and brushes and soapy water. Symptoms disappeared quickly.
I'm only a layman, but it smells like mercury poisoning from the pigments (Mad Hatter's disease). This was frequent in the past because most oil paint pigments involve toxic heavy metals.
Do you have elevated anti-thyroid antibodies? Hashimoto encephalopathy
Did you obtain cadmium paints or eat rice from Toyama Prefecture while you were in Japan? Also, did you lose your sense of smell? If so, cadmium poisoning. (Cadmium can produce inflammatory cytokines.)
Difficulty swallowing? MS or ALS
Have you recently had a virus? Acute cerebellar ataxia
Or Cerebellar cognitive affective syndrome / Cerebellovestibular syndrome
Did you obtain cadmium paints or eat rice from Toyama Prefecture while you were in Japan? Also, did you lose your sense of smell? If so, cadmium poisoning. (Cadmium can produce inflammatory cytokines.)
Difficulty swallowing? MS or ALS
Have you recently had a virus? Acute cerebellar ataxia
Or Cerebellar cognitive affective syndrome / Cerebellovestibular syndrome
Question: do you use red or yellow paints much?
Dx: chronic mercury poisoning
Dx: chronic mercury poisoning
Does your mouth feel dry? Sjogren's syndrome.
Lead poisoning from use of oil paint. Or solvent induced encephalopathy.
Mercury toxicity
Tell me about your non prescribed supplements.
One increased the potency of the beta blocker leading to cerebral venous stasis.
One increased the potency of the beta blocker leading to cerebral venous stasis.
Chronic Solvent-induced encephalopathy or neurotoxicity. Doctor asked, "Did you note a foul odor before onset of symptoms, or noticed a loss of smell?"
Q. Do you stretch your own canvases? Do you use rabbit skin glue or another substance?!?
IANAD, but I would say the problem points to the occipital lobe.
Occipital Neuralgia?
Question, do you see double?
Occipital Neuralgia?
Question, do you see double?
4
He switched to oil paints from water colors which can have high levels of iodine and other volatile agents and pigments may contain Hg which in high concentrations as well as Hg can cause neurotoxicity therefore my question would be about exposure to these agents and how close his studio is to his bedroom and if it is in the house.
7
Do you recall being bitten by a tick?
Systemic symptoms of Lyme - cardiac block, HA, leptomeningeal thickening etc.
Systemic symptoms of Lyme - cardiac block, HA, leptomeningeal thickening etc.
11
Chronic toxic encephalopathy or Danish Painter's Syndrome from exposure to solvents in paint or cleaners. Question: Do you have any exposure to paints or solvents either from inhalation or from dermal contact? (Could also be ingested I suppose if the patient has a habit from the days of using acrylic paints or placing the brushes in his mouth)
15
I think solvent exposure with the new paints. I would ask about his new paints and what uses to clean the brushes
4
Was the lumbar puncture particularly difficult? (Due to low CSF volume/pressure) Dx: Spontaneous CSF leak causing intracranial hypotension
2
Q: From where do you get your oil-based paints and your dietary supplements?
Test: Blood lead test.
Dx: Lead poisoning
Oil-based paints manufactured abroad may contain high levels of lead. Dietary supplements can contain anything, as they are completely unregulated.
Test: Blood lead test.
Dx: Lead poisoning
Oil-based paints manufactured abroad may contain high levels of lead. Dietary supplements can contain anything, as they are completely unregulated.
16
Specific questioning as to whether the patient uses paint containing mercury could also suggest mercury poisoning, or 'mad hatter syndrome'
4
Question: what sort of oil paints do you use?
Diagnosis: lead poisoning
Diagnosis: lead poisoning
2
Question: What solvent do you clean your paintbrushes with?
Answer: toluene toxicity resulting in dysdiadochokinesia
Answer: toluene toxicity resulting in dysdiadochokinesia
13
Cobalt toxicity
1
I forgot to add the question doc might have asked if suspecting brain AVM: he may have asked- does anything improve your symptoms or make them worse? Or, he may have asked about a family history of AVM.
1
Q: Did your symptoms begin after switching to painting in oil?
Diagnosis: Aseptic meningitis caused by heavy metal exposure in paint
Diagnosis: Aseptic meningitis caused by heavy metal exposure in paint
11
Question: What is the source of your dietary supplements and what is the one that is not identified?
Possibly contaminants or incorrect doses in the supplements.
Possibly contaminants or incorrect doses in the supplements.
1
Or interference with his prescription meds.
Frontotemporal brain sagging syndrome
I would ask onset and duration of dysarthria, dysphagia and unsteady gait, and if tinnitus (ear ringing) to rule out another condition
I would ask onset and duration of dysarthria, dysphagia and unsteady gait, and if tinnitus (ear ringing) to rule out another condition
4
Primary diffuse leptomeningeal gliomatosis (PDLG)
4
Question: When you paint with oil paint are the windows open or closed? How do you clean your paint brushes?
Diagnosis: Encephalitis or neuroleptic malignant syndrome from inhaling paint fumes and those fumes getting into and staying in his body's fatty tissues.
Diagnosis: Encephalitis or neuroleptic malignant syndrome from inhaling paint fumes and those fumes getting into and staying in his body's fatty tissues.
5
Q: can you see things that other people can't see?
Dx: Lewy body dementia
Dx: Lewy body dementia
Have you had any recent falls (from a ladder while painting)? Closed head injury from a fall the painter did not think was significant at the time.
1
Have you changed the materials you use to clean your brushes/thin your paint now that you are using oil paints? Diagnosis: Chronic solvent induced encephalopathy.
8
Do you lick your brushes while painting.....
4
"Do you use a lot of cadmium yellows and greens?"
10
Q= What products do you use to clean your brushes?
Dx= Solvent neurotoxicity.
Dx= Solvent neurotoxicity.
1
adult onset hydrocephalus
the question the doctor asked was about incontinence, frequency , urgency of urination and loss of bladder control.
the question the doctor asked was about incontinence, frequency , urgency of urination and loss of bladder control.
2
Brain AVM
Also, I am now noticing that he was already having zig zag pattern spacial (or visual?) issues when doing his original style of painting (as evident in the zig zag line of the dirt path in painting pictured at top.)
The doc may have asked if there was a particular area of his head that most often was the source of his pain. The physician may have also asked if patient had ever had a seizure, or hallucinations?
Perhaps the painters switch to oils and the highly toxic turpentine caused the headaches and the brain irregularities.
6
Lead poisoning
2
Primary angiitis of cns ;)
Lewy body dementia
He asked which solvents he was using and how. May be from solvent exposure after switching to oil- Chronic solvent-induced encephalopathy
7
When did you retire? The answere may help correlate the headaches to increased exposure to paint/paint Thinner fumes which has led to toxicity.
3
Diagnosis: Intracranial hypotension secondary to dural arteriovenous fistula
Question: Do you have a pulsatile sound in your ears?
Question: Do you have a pulsatile sound in your ears?
2
Seems likelt to be related to the change in painting materials.
3
Sarcoidosis caused by toxic inhalants, likely turpentine/paint fumes.
2
Chiari malformation - the doctor asked if the pain worsened with coughing or valsalva
The question: do you put your brush in your mouth? The diagnosis: toluene and/or other aromatic chemical poisoning
6
Any trauma to the back of the head prior to the onset of the headaches?
Dural AVF involving the venous sinus of the foramen magnum. The abnormal movement with the finger to finger test is consistent with a cerebellar injury or hypoperfusion from arterial steal.
Dural AVF involving the venous sinus of the foramen magnum. The abnormal movement with the finger to finger test is consistent with a cerebellar injury or hypoperfusion from arterial steal.
1
Diagnosis: Oil-based paint poisoning
Question: Did the onset of symptoms coincide with the change to using oil paint?
Question: Did the onset of symptoms coincide with the change to using oil paint?
5
When he switched to oil paints from Acrylic I bet the solvents he used, paint thinner and turpentine, may have caused his problems.
3
Binswanger's Disease
1
Toxic encephalopathy. The doctor asked how and where the painter was working with and cleaning his tools.
2
Have you changed the type of paints or materials you work with?
Lead poisoning
Lead poisoning
7
When and where will we ordinary and curious readers who don't offer a diagnosis learn what the correct diagnosis is?
23
There is a followup article on Friday, with the title amended with "solved"
1
Tomorrow. Here at this website.
1
Tomorrow afternoon.
Question: Have you had any infections this year that you treated?
Diagnosis: Encephalitis
Diagnosis: Encephalitis
Occipital neuralgia
What's the posture of your head and neck when you paint? Or what's the position of your head when you paint?
What's the posture of your head and neck when you paint? Or what's the position of your head when you paint?
1
DAVF
tinnitus
CSF leak
Supine relief of headache
tinnitus
CSF leak
Supine relief of headache
1
After looking around the Internet a bit more, I think the symptoms (confusion, brain damage, headaches) could possibly be caused due to turpentine exposure.
4
I would say it could be chemical poisoning from the paint.
1
Because he is a painter and has recently increased the time devoted to painting and has changed to Oil Paints, I think that his problem is due to heavy metal poisoning. His early painting suggests a lot of cadmium, some manganese, lead and because of his age he probably uses paint thinner rather than some of the less toxic solutions. His work space is probably not ventilated well and he may not clean his hands before eating or may not wear gloves or masks to protect himself.
3
What kind of paint was he using? Did he try to take a break from painting to see if the symptoms subsided?
1
Hypertrophic pachymeningitis caused by Neurosyphilis. The question: Have you ever had Syphilis?
2
Question: Have you spent time around birds or bird droppings?
Diagnosis: Fungal Meningitis
Diagnosis: Fungal Meningitis
2
Yes! And he may have been exposed while working on painting a scene outdoors.
I would be amazed if this hadn't been asked and ruled out by a previous physician, but I would ask about history of head injury. A recent concussion or history of traumatic brain injury (possibly CTE) could account for many of the patients symptoms.
Lead poisoning (is he using a lead based white paint? Does he lick the paintbrush tip?)
2
Qn: Any personal or family history of autoimmune disease?
Dx: autoimmune encephalitis
Dx: autoimmune encephalitis
Color change of painting due to cataracts. Monet's paintings had the same reddish hue when he developed cataracts but went back to normal once he had the cataracts removed. Headache from long term paint thinner exposure after the change of medium? Doctor: Where do you keep you paint thinner?
2
Dr. Smith might have asked whether the patient had rhinorrhea or otorrhea indicating possible sites for a CSF leakage? The findings seem consistent with spontaneous intracranial hypotension with secondary hypertrophic pachymeningitis due to a CSF leak.
Poisoning from his new type of paints. Probably lead poisoning.
Qn: are the symptoms precipitated by physical exertion, hyperventilation or crying?
Dx: moya moya
Dx: moya moya
Qn: Did the neurologic deficits last for less than 24 hours? (Suggestive of TIA)
Dx: Moya Moya
Dx: Moya Moya
Sussac Syndrome
Few questions:
What types of solvents is he using with his oil painting? (R/O aseptic meningitis)
Colonoscopy history? (Malignancy as risk factor for central venous thrombosis)
How long as he been taking prepafenone? (R/O aseptic meningitis)
What types of solvents is he using with his oil painting? (R/O aseptic meningitis)
Colonoscopy history? (Malignancy as risk factor for central venous thrombosis)
How long as he been taking prepafenone? (R/O aseptic meningitis)
1
Qn: was the decline in function stepwise?
Dx: Vascular dementia
Dx: Vascular dementia
1
CSF leak
Or
DAV fistula
If he has tinnitus
Or
DAV fistula
If he has tinnitus
1
Dural arterivenous fistula
The doctor questioned the patient if he has tinnitus
The doctor questioned the patient if he has tinnitus
1
He asked the patient if he had tinnitus, suggestive of dural AV fistula
5
Does the patient say words differently than he used to?
cerebellar cognitive affective syndrome
cerebellar cognitive affective syndrome
Moyamoya disease!
To edit my comment above, the question asked would be "are you headaches worse in the morning when you wake up?"
Diagnosis: Intracranial hypotension from spontaneous CSF leak
Question: Do the headaches get worse when the patient stands up?
Question: Do the headaches get worse when the patient stands up?
1