Medical Timeline

Early History

Childhood – Adolescence

  • Documented history of recurrent headaches beginning in early childhood

  • Significant infectious exposures in early life, including scarlet fever and varicella

  • Periods of geographic relocation during childhood

  • Onset of severe menstrual-related symptoms during adolescence

Young Adulthood

  • First pregnancy in mid-adolescence, followed by multiple pregnancies over a short time span

  • Gradual onset of persistent fatigue, pain, and systemic symptoms in early adulthood

Early Symptom Progression

Mid–Late Adulthood

  • Development of chronic neurologic symptoms, including sensory disturbances and weakness

  • Progressive headache syndromes, later characterized as chronic migraine

  • Increasing musculoskeletal pain involving spine and peripheral joints

  • Episodic dizziness, near-syncope, and autonomic-type symptoms

Initial evaluations focused on symptom management, with limited unifying diagnosis.

Endocrine Findings

2017–2018

  • Identification of pituitary adenoma with biochemical evidence of growth hormone excess

  • Elevated IGF-1 levels consistent with acromegaly

  • Surgical resection of pituitary adenoma

  • Postoperative imaging confirmed removal with stabilization of endocrine parameters

Despite successful surgical management, systemic and neurologic symptoms persisted.

Neurologic Diagnosis and Imaging

2017–Present

  • Brain MRI demonstrating periventricular and subcortical white matter changes

  • Progressive demyelinating lesions over time, radiographically consistent with multiple sclerosis

  • Interval development of new lesions on subsequent imaging

  • No consistent evidence of active enhancement on recent studies

  • Small, stable extra-axial lesion consistent with meningioma identified and monitored

Spinal imaging:

  • Cervical spine with postsurgical changes and degenerative disc disease

  • No clear demyelinating lesions within spinal cord

  • Thoracic and lumbar spine showing mild degenerative changes without acute compression

Pain and Neuropathy Evolution

Ongoing

  • Development of multiple neuralgic pain syndromes, including:

    • Trigeminal neuralgia

    • Occipital neuralgia

    • Peripheral neuropathic pain

  • Chronic unilateral lower-extremity weakness and sensory changes

  • Increasing reliance on neuropathic pain medications with partial relief

Pain has become progressively more constant, with significant morning exacerbation.

Autonomic and Cardiovascular Evaluation

2021

  • Tilt-table testing performed for syncope and near-syncope

  • Mild blood pressure drop noted without arrhythmia

  • Findings not diagnostic for classic neurocardiogenic syncope, but symptoms reproduced

Autonomic symptoms continue intermittently.

Recent Course

2023–2025

  • Imaging demonstrating progression of white matter disease without active enhancement

  • Worsening migraine frequency and cervical pain

  • Increasing functional limitation related to pain, fatigue, and leg weakness

  • Partial, temporary relief from corticosteroid therapy

  • Ongoing reassessment of medication regimens and supplements

Recent imaging shows no acute pulmonary pathology and stable non-neurologic findings.

Current Status

At present, the case is characterized by:

  • Multisystem involvement with overlapping neurologic, endocrine, autonomic, and pain features

  • Progressive symptom burden despite standard disease-specific management

  • Lack of a single unifying explanation for symptom severity and progression