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Could my fusion be causing hypotension/vertigo?
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Could my fusion be causing hypotension/vertigo?

I had a cervical fusion c4-5 in 2000 (car accident). Then a whiplash injury in 2003. I immediately developed severe muscle spasms b/t my shoulder blades which continues today.

For the past two years I have been experiencing episodes of postural hypotension. My docs have done multiple tests, in fact I am wearing an event monitor right now, but nothing ever shows up.  In December 2008 they did catch a blood pressure during an episode at 70/40. My normal is 100-110/70-80. My heart rate runs around 105.

They have done holter monitors, echo's, treadmill test, ekg's, tons of blood tests, mri, cat scans...all normal.

I do have Rheumatoid Arthritis.

Is it possible my fusion could be causing this?
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information

The autonomic nervous system is the part of the nervous system that controls blood pressure, heart rate, and other functions. It is not located in one specific part of the brain or other body part but is rather made up of several different components: a region in the brainstem, certain receptors located on blood vessels and in the heart, and small nerves in our skin, among other areas. Dysfunction of the autonomic nervous system due to whatever cause can lead to a variety of symptoms including but not limited to orthostasis (which means symptoms or signs resulting from assuming an upright posture), light-headedness with drops in blood pressure when sitting up or standing up (this is an example of orthostasis), syncope (passing out), constipation, diarrhea, sweating abnormalities etc. If there is a problem in the small nerve fibers, what is medically termed a small fiber neuropathy, in addition to these symptoms, burning/tingling in the feet and hands or mild sensory loss may also occur.

Normally, there are specific blood pressure and heart rate responses that an individual mounts in response to changes in posture. Often, these include a small drop in blood pressure and an increase in heart rate when one assumes a standing posture. In individuals with a problem somewhere within the autonomic nervous system, these responses are abnormal. Diagnosis of autonomic dysfunction includes a tilt table test and tests for peripheral neuropathy.

Treatment of autonomic dysfunction depends again on the cause. Causes of autonomic dysfunction include neuropathy, including large fiber and small fiber neuropathy due to diabetes, nutritional deficiencies, monoclonal proteinemias (conditions in which certain abnormal proteins are being produced), certain types of cancers can produce a paraneoplastic autonomic neuropathy etc. Certain types of parkinson's-type diseases such as a condition called multi-system atrophy can also lead to autonomic dysfunction (this usually occurs in people older than the age of 60).

When a cause is found, treatment of the underlying problem is obviously indicated. When there is not a specific cause to the dysautonomia, there are still methods that can be taken to prevent tachycardia from occurring during upright posture (postural orthostatic tachycardia) including certain medications and compression stockings.

Cervical disk disease can potentially cause some dizziness/vertigo, but would be highly unlikely to cause severe symptomatic orthostasis such as occurs in your case to my knowledge.

I recommend you continue evaluation for causes of autonomic dysfunction. Evaluation by a cardiologist in addition to a neurologist may be helpful.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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