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Mental Health

Frontal lobe lesion

11/13/2008

Question:

Dear Doctor:

After spending a period of time being completely over-medicated and having a severe memory crisis and other unpleasant symptoms, I was weaned off of Wellbutrin, Klonopin, Seroquel and Trazodone as well as switched to a different category of Ritalin. Now, I am down to Lamictal a@150 mg daily and Ritalin LA @20 mg daily. Most of the memory issues and nodding off/sudden fatigue (etc), disappeared immediately, although there would be occasional periods of (mild) forgetfulness... More recently (past 3 months or so), I feel as if my brain has flat-lined: My thinking has become more one-track and linear; I find it harder to make intellectual connections and don`t retain complex info; If I am told a phone number, I cannot retain it/forget it the minute that I hear it. Overall, I am less sharp.

I have been on the Ritalin and the Lamictal for almost a year: Although I am not in "crisis," the (consistent) brain haze has been for the past 3-4 months and only after repeatedly telling a psychiatrist; my PCP; and a therapist; did I get referred out for an evaluation. I was led to believe that I was getting a neurological work-up (with scans etc) and arrived only to meet with a neuropschytrist - only to take an IQ test of sorts.

I understand the purpose of it. I just felt ambushed. A positive result of this testing was that the neuropsychiatrist was so disturbed at my nonverbal resasoning results - particularly in the visual spatial realm- that he contacted my psychiatrist and said that a referral to a neurologist for further testing were in order. When I returned to him for a follow-up and explained that something weird was happening to me that day and that it was as if my brain froze... he said that my score was not consistent with what I had described and that the issues were probably long-standing. Yes, there has always been a difference between my nonverbal v. verbal. That said, many of the issues that I mentioned are not long-standing.

After this eval, I was finally given the referral for the neurologist who ok`d a brain scan: a lesion was found on my right frontal lobe. The neurologist was surprised to find the lesion but mentioned that there may be 2 separate issues at play because what I described cannot be totally attributed to the lesion. I have been scheduled for both a neurosurgical consultation and an EEG.

Can you please shed some light on this? In addition, what can I expect from the neurosurgical evaluation? Does this have anything to do with the meds - Lamictal for a mood disorder and Ritalin LA for ADHD? The mood disorder and the ADHD were diagnosed over a year ago and the mental flatlining has been for the past 3-4 months.

Thank you.

Answer:

Your clinical picture is very complex and I would not be able to shed further light on it given the information provided. You need to see a neurosurgeon to have the mass evaluated. I do not think it is in any way related to the medications you took. Good luck with this complex assessment.

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Response by:

Radu   Saveanu, MD Radu Saveanu, MD
Formerly:
Associate Professor
College of Medicine
The Ohio State University