Feeling imbalance for last 4 weeks

  I am in late 30s. I used to do hotyoga (Bikram) every week. In last Christmas, I went to India and I got sever cough which I could not control from anti-biotics. I keep taking anti-biotics by increasing the dose from 335mg to 625mg in India. Finally, I came back to US and start taking expotorant. I have to drink two bottles to finally get rid of the cough. After few days, in mnd Jan, I went to hot yoga again. This kind of yoga is very tough and they increase the temp to 110F. I did it after a month although I have  been doing regularly for last two years. That day I had headache after the Yoga and instead of taking pain killer I took some cold medicine(Actifed). Anyway, finally I took advil too the same day.

    Next day, when I wake up in the morning, I felt that I have difficulty walking specially when I move my head. I thought it will go away soon but it did not. I consulted my doctor and he said that your sinus is infected and you should be on anti-biotics so I again starts anti-biotics for one week but my symptoms remain almost same. Then I visited ENT specialist and they also told me that my ear is in good shape after doing all sorts of checks.

   Since mid of Jan, I have been experiencing this problem. Now it is very mid but all my reflexes are slow either I am typing, driving, holding whatever. I could sense the slowness. I talk to one guy who was physicist earlier and he said that due to sudden movement in your head your your inner ear bone is chipped and your brain is getting used to so it will take some time to recover.

  Can someone give me some clue what it can be. My health is in good shape and I feel perfectly normal. Lately, I am under stress due to my business otherwise I am very healthy. My wight is also normal. I really appreciate any help. I feel slowness in all parts of my body. I can walk and even run but feel little dizzy when I move my head.

  Please let me know your feedback. I hope I provided most of the information you were looking for. My insurance is really horrible so I am avoiding going to different specialist but if it is mandatory then I dont mind spending monety.

[JainMD]

Hi Ayush,
How are you feeling?
Your symptom of dizziness with head movement suggests that you might have vertigo.
You need to consult the ENT surgeon again to see for cause of vertigo and also whether it is physiologic vertigo or pathological vertigo and whether it is peripheral vertigo or central vertigo?
Vertigo is an illusion of movement, most commonly a sensation of spinning. Usually due to a disturbance in the vestibular system; abnormalities in the visual or somatosensory systems may also contribute to vertigo. Frequently accompanied by nausea, postural unsteadiness, and gait ataxia, and may be provoked or worsened by head movement.
Physiologic vertigo results from unfamiliar head movement (seasickness) or a mismatch between visual-propioceptive-vestibular system inputs (height vertigo, visual vertigo). True vertigo almost never occurs as a pre-syncopal symptom.
Pathologic vertigo may be caused by a peripheral (labyrinth or eighth nerve).
Distinguishing between these causes is the essential first step in diagnosis or central CNS lesion.
What is the direction of associated nystagmus? Does Visual fixation inhibits nystagmus or not? What is the severity of vertigo? What is the direction of spin? Where is the direction of fall? What is the duration of symptoms? Is there any Tinnitus and/or deafness? Are there any associated central abnormalities?
Common causes for peripheral vertigo would be Infection (labyrinthitis), Me´nie`re’s, neuronitis, ischemia, trauma, and toxin. The causes for central vertigo would be Vascular, demyelination, and neoplasm.
Keep me informed.
Bye.

[ayush123]

I certeainly dont have vertigo since he has done all the tests and they are negative. I never see things spinning. Currently, it is very light and it happens when I walk and I feel that my legs have very little problem. If I take sudden turn then it happens. Lately, I am under stress and my ear is very clean. Any other suggestion!! Anyway, thanks for your help.

Ayush.

[ayush123]

What is the direction of associated nystagmus? Does Visual fixation inhibits ?nystagmus . I feel only when I am walking or specially walking but looking somewhere else. As of now, it is almost disappeared so I heardly feel it.
or not? What is the severity of vertigo?
I never have spinning feeling. I can even walk with my eyes closed. Only only feeling was little slowness in my reflexes that includes my hands while tuyyping, my legs, and sometime I felt my mouth while speaking. It is very little now and may soon disappear.

What is the direction of spin? Where is the direction of fall? What is the duration of symptoms? Is there any Tinnitus and/or deafness? Are there any associated central abnormalities?
I have no spinning problem at all. It is just a senstation that my reflexes are not sharp enough. If I am still (sleeping, lying/working, etc.) I am perfectly all right. Once I walk or may be drive, I feel slowness in my reflexes specially walking and looking around or driving  little rough. Again, I am under stress and it can be associated with my nervous system due to my previous cough or excessive heat in Yoga class. I used to take pain killer (ibuprophane) after Yoga class since it was very hot and difficult. Now I completely stopped yoga since this problem.

[JainMD]

Hi Ayush,
Disorders of equilibrium result from diseases that affect central or peripheral vestibular pathways, the cerebellum, or sensory pathways involved in proprioception.
We have evaluated that you don’t have any pathology related to vestibular pathways as you have mentioned in your above post.
Your other symptom of feeling little slowness in your reflexes that includes your hands while typing, your legs, and sometime you feeling slowness while speaking could be an early sign of Ataxia.
Ataxia is in-coordination or clumsiness of movement that is not the result of muscular weakness. It is caused by vestibular, cerebellar, or sensory (propioceptive) disorders. Ataxia can affect eye movement, speech (producing dysarthria), individual limbs, the trunk, stance, or gait.
As you have mentioned you don’t have any vestibular problem, hence either it could be due to Cerebellar or sensory disorders.
Cerebellar ataxia is produced by lesions of the cerebellum or its afferent or efferent connections in the cerebellar peduncles, red nucleus, Pons, or spinal cord.
Cerebellar ataxia is commonly associated with hypotonia, which results in defective posture maintenance. In addition to hypotonia, cerebellar ataxia is associated with in-coordination of voluntary movements. Simple movements are delayed in onset, and their rates of acceleration and deceleration are decreased. The rate, rhythm, amplitude, and force of movements fluctuate, producing a jerky appearance.
You should be consulting a neurologist and get imaging study to evaluate Cerebellum in Toto.
Keep me posted.
Bye.

[ayush123]

Dear DrHain,

   As you mentioned that it may apear because of hypotonia which is because of improper posture. Since I did the extensive Yoga day before and I did it after a month. I think it might be because of that. Also, I am feeling better every week but I certainly have same symptoms but they are fading away. Do I have to worry too much or you think it will go by itself. Please suggest the right way to get rid of it ASAP. I am willing to go for MRI but it is quite expensive in US so I want to go when it is necessary. Also, please suggest what is the possible treatment to get rid of this disease. I am willing to go to neurologicst if it helps. You help is really appreciated. Thanks in advance for such a great help.

Aayush

[ayush123]

Also, Dr Jain,

  As of now I feel perfectly normal and nobody can detect that I have problem but it there and symptoms are very very light now but annoying. I need to get rid of it ASAP before it create more harm to me.

Ayush

[JainMD]

Hi,
Yes I think MRI is indeed necessary but since cost is a constraint then we can wait till overt symptoms develop.
I think a visit to a neurologist is indeed essential and should be taken up as early as possible and we can take a call from there on.
Keep me posted.
Bye.

[lud]

i am 74 yrs old i know at my age ishould have problems but i am sorry for the younger ones i read about with the problems that they have i think its in our genes i have a problem getting up and also have a unsteady gait very unbalanced when i get up legs hurt of a night mostley of a early morning when i get out of bed they do not bother me through the day i am in very good health i exersize every day ive had several mri's including my head and back it showed a normal amount of arthritis for a person my age i had my prostate removed 6 yrs agao robotic surgery got along fine out of hospital next day i had my gallblader (gallbladder) removed last dec. and got along fine with that had a stress test while in the hosp due to my unsteadyness they did the injection type checked out fine like i say im lucky to be in as good a shape that im in bp is normal take medication for high bp have essential tremor .. familar tremor i was born with it my brother also has it ive taken valium for meny years for it i take a half or sometimes a whole 5 mg tablet a day i have takrn 3 .......... 5 mg a day when i was working ... i wonder would this have a effect on my gait problem and unsteadyness ? i have fallen a few times no injuries from it i watch about going down steps i dont feel safe if there is no hand rail ....  thats about it i feel like im i very good shape for a person my age .... maybe it is due to my tremor i dont know ive had about ever test i know of run ...been to several neurologist.... any one out there who may have a segution i would appreciate hearing from you.....  thanks for this siti so we can share our thoughts ;;;;;;;;;;;; aaron r moon