Dizziness, numbness in feet, mild tremors

[Erik867]

Hi, I am a 23 year old male who is otherwise in great health. I work in an office most of the day with occassional site trips.

I began experiencing dizziness the first week of January 2009 (approximately 9 months ago). I do not get the typical vertigo feeling where the room spins or I feel like I'm spinning. Rather I feel like my head is very heavy and my legs also feel heavy, like if the ground was sucking me in. The dizziness is most prevalent when I stand up and am on my feet for over 5 minutes. The example that comes to mind is that I feel like when you get off a boat in choppy seas that although you're on ground, you still feel the ocean. Recently I have also experienced mild tremors in both of my hands and my right big toe. I also have had some numbness in my right foot and my left palm (hand). I also experienced a "white out" of my vision about 2 weeks ago, but for only 2 or 3 seconds, and sometimes I see a little lighter when I feel dizzy. I have not passed out except for on the tilt table test, which I will explain below.

I have had an ENG from the ENT and an auditory test, both normal. I have had a brain CT, a brain MRI without contrast, and an inner auditory canal (IAC) MRI with contrast all normal. I had a BEAR test at the Neurologist also normal. I had a stress test, ekg, and holter on my heart also normal. I've had my thyroids and copper checked out, also normal. However, my only positive test was the tilt table test, on which I passed out after 8 minutes. The neurologist says I have essential tremors, bbpv (positional vertigo), and orthostatic intolerance (autonomic dysfunction).  I am taking 12.5 mg of Antivert 3 times a day for 1 month and have not seen a significant change in my symptoms.

Sometimes I wonder if it's anxiety, I have had some family issues over the past few months. The symptoms get worse with stress. However, I am afraid it's something more serious like MS or some other disorder. Please let me know what you think. Thanks so much!

Erik

[Heiferly]

Hey Erik,

I'm sorry to hear about your symptoms; I don't think it's purely anxiety considering the results of your tilt table test.  However, from the sounds of it they didn't give you the full results of the test, so it's hard for me to tell you more.  "Positive" based on the fact that you did faint (vs. "negative" if the patient doesn't faint) is a very rudimentary way of interpreting tilt table tests and really misses the point when it comes to diagnosing dysautonomia and pinpointing the NATURE of the dysautonomia.  What is much more enlightening than whether or not a person fainted is what their EKG and blood pressure looked like throughout the stages of the test, and how this correlated to the symptoms experienced during the test--particularly since you did faint it would be nice to know what was going on with your heart and BP before and during the syncope.  (I'm guessing if the holter was indeed devoid of tachycardia or bradycardia and you had episodes of dizziness while wearing it, that the syncope during the tilt was probably purely a vasodepressor syncope, but I'm completely speculating.)

SO, you may want to ask for a copy of the test report to be sent/faxed to you or be made available for you to pick up (I always find the latter to be fastest by far).  Keep your eyes open for a post I'm going to make either later today or sometime tomorrow to the whole community regarding getting medical records, as I think it will be relevant to you but I don't want to be redundant and type the whole thing out again here.

In my opinion, the reason you haven't seen any change in your symptoms is because you had a positive tilt table test for orthostatic intolerance/dysautonomia (and those are even your doctor's words, not mine) and yet you are not on any treatment for it whatsoever.  Antivert is not treatment for OI/dysautonomia, it is treatment for vertigo/motion sickness.  Here's a list of dysautonomia medications, though this list includes meds for all different types of dysautonomia, so not all of them would be appropriate for any one of us:

http://www.medhelp.org/health_pages/Neurological-Disorders/Dysautonomia-Treatments/show/171?cid=196

(Pardon our dust, it's a work in progress.)

Incidentally, dysautonomia symptoms do generally worsen with stress, so that wouldn't be unusual to note that if you're having family issues that your symptoms would worsen.  

In regards to the tremors and numbness... Have you had EMG/nerve conduction studies?  Have they considered the possibility of peripheral neuropathy?  Neuropathy can sometimes go hand-in-hand with dysautonomia.

http://www.medhelp.org/medical-information/show/74/Peripheral-neuropathy
http://www.medhelp.org/medical-information/show/2287/Autonomic-neuropathy
http://www.medhelp.org/medical-information/show/3413/Sensorimotor-polyneuropathy

The dizziness and heaviness in your legs you describe are very much symptoms of orthostatic intolerance from the sounds of it.  (As you said, typical vertigo would be a spinning sensation.)  The "white out" was likely an episode of pre-syncope or almost fainting.  If you experience this again, the best thing to do is to lie down on the floor and elevate your feet to return proper blood flow to your head and your vision will restore and the symptoms should abate.  Don't stand up too quickly, but give your body some time to adjust before trying to get back up, and when you do, do so slowly and while keeping the muscles in your lower body contracted as much as possible to help squeeze blood up toward your head.  If you ever get this feeling in the shower, sit down and turn the water off right away, as it is more likely to faint in the shower where the heat expands your blood vessels.  

With your doctor's permission, a high-salt, high-fluid diet may be enough of a treatment plan for the OI to try at first, but definitely consult your doctor (and get those actual tilt results) before starting anything.  

[DizzyJ]

I was a nurse by profession and you give some of the best advice I've ever read. You are very accurate and explain things very well.

[Heiferly]

Thank you so much for the compliment!  I try my best.  

[Erik867]

Thank you so much for your comments and interest in helping me. I will definitely ask for a copy of the tilt table test and will investigate using these medications. I appreciate all your help, please let me know if you ever need me to help you with something.