Unresolved Questions

Purpose of This Page

This page outlines key unresolved clinical questions that remain following years of evaluation and management across multiple specialties. These questions are presented to support pattern recognition, interdisciplinary perspective, and thoughtful discussion, rather than to seek diagnosis or treatment recommendations.

Neurologic Disease Correlation

  • How well does the current burden and distribution of demyelinating disease correlate with the severity, laterality, and progression of neurologic symptoms?

  • Could progression without active enhancement account for worsening symptoms in the absence of acute inflammatory findings?

  • Are there aspects of central nervous system involvement that may not be fully reflected on conventional imaging?

Central vs Peripheral Pain Mechanisms

  • To what extent might central pain processing or central sensitization be contributing to persistent and severe neuropathic pain?

  • Could overlapping central and peripheral pain mechanisms better explain the multiplicity of neuralgias and widespread pain?

  • Would additional characterization of pain mechanisms meaningfully clarify symptom drivers?

Autonomic Contribution

  • Could autonomic dysfunction be amplifying neurologic, pain, or fatigue-related symptoms?

  • How should prior tilt-table findings with symptom reproduction but nondiagnostic results be interpreted in the broader clinical context?

  • Are central autonomic network considerations relevant in this case?

Intracranial Lesions and Symptom Interaction

  • Could skull base or cranial nerve–adjacent lesions, including the stable lesion in the right Meckel’s cave, contribute to focal craniofacial pain syndromes?

  • How should multiple stable intracranial lesions be contextualized alongside demyelinating disease and chronic neuropathic symptoms?

Endocrine and Long-Term Effects

  • Are there potential long-term neurologic or musculoskeletal effects of prior growth hormone excess despite successful surgical treatment?

  • Could historical endocrine pathology contribute to ongoing symptom vulnerability or interaction with neurologic disease?

Disease Interaction and Multisystem Complexity

  • To what extent might the interaction of neurologic, endocrine, autonomic, and musculoskeletal conditions contribute to symptom severity beyond what would be expected from each condition in isolation?

  • Are there unifying frameworks that may help explain symptom amplification across systems?

Clinical Framing

  • Are current symptoms best understood as the result of parallel disease processes, or is there evidence of synergistic interaction among conditions?

  • What conceptual models may be most helpful in guiding future evaluation and discussion?

Invitation for Perspective

Which of the unresolved questions on this page stand out to you as most relevant or worth prioritizing?

Any brief perspective—whether confirming, reframing, or deprioritizing a question—is welcome.

Responses may be brief and informal. No ongoing correspondence is expected.

Closing Note

These questions are presented to support collaborative, high-level clinical review and are not intended to suggest specific diagnoses or management strategies. The goal is to better understand mechanisms, interactions, and areas of uncertainty that may inform ongoing care discussions.