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Neurology (Expert Forum)
Vertigo and Weakness
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Vertigo and Weakness
by MegB, Dec 04, 2005 12:00AM
I am a 28 year old female. Almost 3 years ago I had an episode of vertigo, imbalance (+Romberg) and Upper and lower Right extremity weakness resulting in daily falls, which lasted for 4-6 weeks. I had a normal MRI of brain w/ & w/o gad at that time. (blood tests Ruled out lyme, syphilis and variety of hormone imbalances.)
I had a similar set of symptoms 6 months later, vertigo, fatigue, weakness, especially in my right (dominant) hand with decrease of hand strength by 80% over my left hand. (Ruled out Lupus, RA, and variety of rheumatoid diseases, as well as active EBV/Parvo/Lyme infections. Normal sed. Rate, normal thyroid, slightly elevated CK, slightly low white count) Symptoms lasted about 4-6 weeks.
These symptoms returned this fall. I now have intermittent vertigo (including +Romberg and pronator drift, no dysmetria), Upper extremity weakness (mild thenar wasting), fatigue and severe neck pain for >8 weeks.
My reflexes are brisk (3+) with ankle clonus on left side. I have over the last 10 yrs experienced sciatic pain q 4-5 days (could explain the clonus.) I have occasional, short term parasthesias in hands, face, legs, as well as short episodes of tinnitus every day. My internist ordered an MRI of head and c-spine w/ and w/o Gad. I couldn't have the Gad due to insurance. Is a plain MRI adequate to assess my symptoms? I think my Dr. suspects cervical radiculopathy or a CNS issue? What else might she reasonably suspect?
I had a similar set of symptoms 6 months later, vertigo, fatigue, weakness, especially in my right (dominant) hand with decrease of hand strength by 80% over my left hand. (Ruled out Lupus, RA, and variety of rheumatoid diseases, as well as active EBV/Parvo/Lyme infections. Normal sed. Rate, normal thyroid, slightly elevated CK, slightly low white count) Symptoms lasted about 4-6 weeks.
These symptoms returned this fall. I now have intermittent vertigo (including +Romberg and pronator drift, no dysmetria), Upper extremity weakness (mild thenar wasting), fatigue and severe neck pain for >8 weeks.
My reflexes are brisk (3+) with ankle clonus on left side. I have over the last 10 yrs experienced sciatic pain q 4-5 days (could explain the clonus.) I have occasional, short term parasthesias in hands, face, legs, as well as short episodes of tinnitus every day. My internist ordered an MRI of head and c-spine w/ and w/o Gad. I couldn't have the Gad due to insurance. Is a plain MRI adequate to assess my symptoms? I think my Dr. suspects cervical radiculopathy or a CNS issue? What else might she reasonably suspect?
Doctor's Answer
by CCF-Neuro-M.D.-PW, Dec 08, 2005 12:00AM
Clonus is as a result of an upper motor neuron problem (if sustained more than 3-4 beats), and is not connected with a peripheral nerve problem like sciatica
Your symptoms would best localize to the cervical spine or lower brainstem, and the more common causes in your age group would include demyelinating disease (such as MS), masses or growths, a syrinx (hollow area in the spinal cord), or migraine. An MRI with and without Gad of the upper spinal cord and brain could evaluate for these, and a spinal tap could help evaluate for demyelinating disease. Tinnitus can be caused by vascular narrowings, so an MR angiogram can be done at the same time.
Good luck
Your symptoms would best localize to the cervical spine or lower brainstem, and the more common causes in your age group would include demyelinating disease (such as MS), masses or growths, a syrinx (hollow area in the spinal cord), or migraine. An MRI with and without Gad of the upper spinal cord and brain could evaluate for these, and a spinal tap could help evaluate for demyelinating disease. Tinnitus can be caused by vascular narrowings, so an MR angiogram can be done at the same time.
Good luck
Is it possible a bulging cervical disk could cause vertigo and/or other problems with proprioception? Or migraines which would cause vertigo?
The good news is that Alimta works great on the cancer but the bad news is that it makes her Very Dizzy and unstable on her feet.
The neurologist we visited with diagnosed her with Neuropathy -
Do you think thee might be some connection between Folic Acid / Vitamin B-12 and neuropathy and if so any suggesting to eliinate or reduce the dizziness??? I should also add that her dad developed Pernicious Anemia - and took vitamin B-12 injections from age 60 on.
Thank You!