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Neurology (Expert Forum)
Loooonnnngggg term dizziness.
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Loooonnnngggg term dizziness.
by adrianxw, Jul 29, 2001 12:00AM
This history is that of my 41 year old wife. Before this matter, she was a normal, healthy, reasonably fit, sporty girl.
At the end of March last year, she came home one evening from a gymnastics class saying she felt "odd". A couple of days later she was complaining of weakness and extreme dizzyness, (difficulty walking or even sitting unaided). She had tingling sensations in her arms and legs and her skin was clammy, (the latter symptoms are possibly anxiety related as she was very frightened).
Our own doctor thought it was a sinus infection, gave her some anti-biotics and took some blood samples. All of which returned normal results. She was admitted into hospital where she was given some i.v. antibiotics, (I don't know why), more blood tests, (normal), and a CT scan which showed her sinuses to be clear. She was discharged and given some nasal sprays one decongestant and one for allergy.
Through April her condition remained very bad but slowly started to improve. An ENT specialist examined her and tested her hearing and reported all was normal. An orthopædic specialist thought the problem may be caused by misaligned cervical vertebrae and embarked on a lengthy course of manipulative treatment. Later in the year, he changed his mind and said he no longer believed the cause was orthopædic as all the vertebrae were aligned and the problem had not gone away or really improved. She has subsequently visited a physiotherapist and a chiropractor who seem to confirm this assessment.
At the beginning of December our own doctor took some more blood and ordered a very full series of tests, all again, were normal. She was examined by a neurologist who returned a completely normal report. An eye specialist found nothing. A second ENT specialist confirmed the hearing tests were normal but noted a "preponderence to the left" with the calorics test and recomended an MRI scan. This returned a normal report.
A third ENT specialist has said he cannot find anything, and was unable to duplicate the result of the previous calorics test.
She was referred to a physiotherapist for a course of "balance training" which she started but after 9 - 10 sessions the physio said he did not believe the problem was here and that continuing was not necessary. Partly in parallel, I tried, for 2 months, a program of Cawthorne exercises I got from Johns Hopkins University but she has not improved. We go to the local fitness centre three times a week where she does a very light routine with the various training machines, to keep her muscles from atrophying.
We have tried seasickness pills, (Marzine), but they had no effect.
Chewing food seems to make the problem worse, and she complains of "strange" feelings sometimes a little pain, but more often simply a sensation of pressure or tingling in her upper jaw stretching up her face towards her ears and below her eyes, sometimes above her eyes. I suspected temporo-mandibular disorders, and she was examined by an orthodontist. He felt this was unlikely, but agreed to make a small device resembling a boxers gum shield that she wears most of the time. He estimated noticable improvement after 4 weeks if this was the case, it has been more than this, and she is the same.
Her current state is that she feels constantly dizzy. The dizzyness is not altered by movement or position. When asked to describe the dizzyness, her reaction is, and has always been, to hold her hands out in front of her, palms facing down, and to move them in a circle about the size of a dinner plate at a rate of about 1Hz saying "it feels like everything is moving like this". She does not feel as if she is going to fall. She can basically look after herself at home now, but her condition is variable, she has a good few days then some bad ones, (but nothing like as bad as when she was first struck). She complains constantly of a terrible feeling of heavyness in her body. She fatigues easily. She has occasional memory lapses and concentration problems.
I don't know if this is related, but about the same time this problem started, she started getting a few slightly itchy red "blotches" for want of a better word, mostly on her hands, arms and legs although I have seen them occasionally in other places. They appear without warning, and disappear again after a few hours. She takes a very low dose, (half tablet every other day), of Zyrtec which seems to control this. She has always had pollen allergies.
Any ideas that I can try next? Thank you for taking the time to read this.
At the end of March last year, she came home one evening from a gymnastics class saying she felt "odd". A couple of days later she was complaining of weakness and extreme dizzyness, (difficulty walking or even sitting unaided). She had tingling sensations in her arms and legs and her skin was clammy, (the latter symptoms are possibly anxiety related as she was very frightened).
Our own doctor thought it was a sinus infection, gave her some anti-biotics and took some blood samples. All of which returned normal results. She was admitted into hospital where she was given some i.v. antibiotics, (I don't know why), more blood tests, (normal), and a CT scan which showed her sinuses to be clear. She was discharged and given some nasal sprays one decongestant and one for allergy.
Through April her condition remained very bad but slowly started to improve. An ENT specialist examined her and tested her hearing and reported all was normal. An orthopædic specialist thought the problem may be caused by misaligned cervical vertebrae and embarked on a lengthy course of manipulative treatment. Later in the year, he changed his mind and said he no longer believed the cause was orthopædic as all the vertebrae were aligned and the problem had not gone away or really improved. She has subsequently visited a physiotherapist and a chiropractor who seem to confirm this assessment.
At the beginning of December our own doctor took some more blood and ordered a very full series of tests, all again, were normal. She was examined by a neurologist who returned a completely normal report. An eye specialist found nothing. A second ENT specialist confirmed the hearing tests were normal but noted a "preponderence to the left" with the calorics test and recomended an MRI scan. This returned a normal report.
A third ENT specialist has said he cannot find anything, and was unable to duplicate the result of the previous calorics test.
She was referred to a physiotherapist for a course of "balance training" which she started but after 9 - 10 sessions the physio said he did not believe the problem was here and that continuing was not necessary. Partly in parallel, I tried, for 2 months, a program of Cawthorne exercises I got from Johns Hopkins University but she has not improved. We go to the local fitness centre three times a week where she does a very light routine with the various training machines, to keep her muscles from atrophying.
We have tried seasickness pills, (Marzine), but they had no effect.
Chewing food seems to make the problem worse, and she complains of "strange" feelings sometimes a little pain, but more often simply a sensation of pressure or tingling in her upper jaw stretching up her face towards her ears and below her eyes, sometimes above her eyes. I suspected temporo-mandibular disorders, and she was examined by an orthodontist. He felt this was unlikely, but agreed to make a small device resembling a boxers gum shield that she wears most of the time. He estimated noticable improvement after 4 weeks if this was the case, it has been more than this, and she is the same.
Her current state is that she feels constantly dizzy. The dizzyness is not altered by movement or position. When asked to describe the dizzyness, her reaction is, and has always been, to hold her hands out in front of her, palms facing down, and to move them in a circle about the size of a dinner plate at a rate of about 1Hz saying "it feels like everything is moving like this". She does not feel as if she is going to fall. She can basically look after herself at home now, but her condition is variable, she has a good few days then some bad ones, (but nothing like as bad as when she was first struck). She complains constantly of a terrible feeling of heavyness in her body. She fatigues easily. She has occasional memory lapses and concentration problems.
I don't know if this is related, but about the same time this problem started, she started getting a few slightly itchy red "blotches" for want of a better word, mostly on her hands, arms and legs although I have seen them occasionally in other places. They appear without warning, and disappear again after a few hours. She takes a very low dose, (half tablet every other day), of Zyrtec which seems to control this. She has always had pollen allergies.
Any ideas that I can try next? Thank you for taking the time to read this.
Doctor's Answer
by CCF-Neuro-M.D.-JT, Aug 14, 2001 12:00AM
Your wife sounds like she's been through a lot. Dizziness affects nearly 8 million people in this country and for half of these people, the causes are multifactorial. Your wife's case seems to be persistent and fortunately all of the testing thus far has been normal. Vestibular (inner ear) and psychiatric causes are most common. Possible medications include meclizine (for inner ear) or antidepressants.
But some other causes include problems with the neck like cervical muscle spasms, arthritic spine disease, and irritation of the nerves in the neck which may all cause symptoms of dysequilibrium or vertigo. In that case she could try relaxation techniques, massage, or light physical therapy.
If she has has a history of fainting or is near fainting, she may need a workup of her heart to make sure she doesn't have a rhythm problem or a tilt-table test to see if she's able to maintain adequate blood pressure in different positions.
If you've run out of ideas, we do have a special neuro-ENT doc here at the CLeveland CLinic named Dr. Oas who has a dizzy clinic. Best of luck to you and your wife.
But some other causes include problems with the neck like cervical muscle spasms, arthritic spine disease, and irritation of the nerves in the neck which may all cause symptoms of dysequilibrium or vertigo. In that case she could try relaxation techniques, massage, or light physical therapy.
If she has has a history of fainting or is near fainting, she may need a workup of her heart to make sure she doesn't have a rhythm problem or a tilt-table test to see if she's able to maintain adequate blood pressure in different positions.
If you've run out of ideas, we do have a special neuro-ENT doc here at the CLeveland CLinic named Dr. Oas who has a dizzy clinic. Best of luck to you and your wife.
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Something my little, (little?!), potted history has omitted is that a couple of months into the problem, she was prescribed a mild tranquilizer - (for the life of me I can't remember what it was right now, but I have records). Basically, she was given this to try to help her sleep more than anything, (the dizzyness was sufficient stop her sleeping , (anxiety I suspect), but even when she did sleep, it would sometimes wake her up).
Glad you're okay now.
The up and down swings in her condition do not appear synchronized with external factors. Earlier this year, for example, her father became ill and subsequently died, during the course of this episode, her condition ebbed and flowed in the same way it always seems to do, i.e., randomly. I have looked for patterns, but if there is one there, it has so far eluded us. It is simply n good days, m bad days where n and m are random. I believe there may be a longer term component. What I mean by that, is there are longer periods, (6 - 8 weeks), where her good days are really good and her bad days not so bad at all, followed by a period where her good days are average, and her bad days, incapacitating.
I've spent ages researching this, but I am really baffled.
We have noticed that some people are posting entire medical histories and requesting a diagnosis. We need to remind everyone that:
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Thanks to all of you for your help and consideration!
Ned Help International
If I posted "My wife has been dizzy for a year and a half" then the possibilities are endless, hence, I included as many of the salient points I considered useful, (you will note that my follow up messages in reply to others included details omitted from my original post - there are others).
You say you only wish to clarify existing diagnoses. In that case, what are people without a current diagnosis, with continuing debilitating symptoms, and a chain of doctors sending us from one to the next in a circle of gradually increasing size supposed to do?
The reason we posted the "reminder" is because your posting is VERY long.
We certainly understand what it's like to be frustrated by a lack of diagnosis and treatment and we sympathize greatly with your wife's medical dilema. Frustration over a lack of clear diagnosis is one of the main reasons we began Med Help International!
While we cannot offer a diagnosis online, we certainly CAN offer qualified suggestions for "next-steps", based on the information people provide. Med Help has done this for tens of thousands of people, during the past 7 years.
The doctors working with us are pulled in many directions every day and we are VERY grateful that they still manage to find time to offer their expertise in our forums.
Everything Med Help Int'l. has is offered free to all in need. All we ask is that our visitors be as brief and to-the-point as possible, when posting in our forums. This will help insure that our forums will be here for you.
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Med Help International
Patient "Doctor, my hand hurts"
Doctor "Hmmm, could be a nerve disorder"
Patient "The pain gets worse when I twist the nail stuck through my hand"
Doctor "Ah I think we have it licked now sir"
Silly I know, but think about it.
I was fishing for some topics to research. I discovered TMD's by chance after yet another careful rewording of my searches. I'd never heard of TMD's but, wrapped up in that label, was a whole range of non-life threatening conditions which matched the symptoms and which we could investigate, and, as it happened, more or less rule out. How many other areas are out there? The medical profession doesn't seem to be doing anything, someone else has too, and that someone is me.
I am sorry if you don't understand that.
I remember us discussing the MRI, before the results came back, we were almost hoping it would show something, (hopefully something non-life threatening of course), such that we would have SOMETHING to fight. But no. Another negative. Back to square one. Round the circuit again, (of course with the delights of waiting a few weeks between each station).
I don't know enough about what you have tried, but if the problem is vestibular, try searching the net for Cawthorne exercises - these are a self paced self help type thing. There are also planned vestibular rehab. programs, but most require someone to work with, (throwing balls to you while you stand on a wobbly board, (don't laugh - it's true!), and so forth), which if you live alone, may be a problem.
A couple of other net resources, look up the "Balance Disorder Institute", and browse the school of medicine at Johns Hopkins University, look for the "Center for hearing and balance". They have some useful stuff online which can help you get a better idea of what is wrong with you. By understanding some of the basics you will be better able to describe your condition to your doctor, (and with "dizzyness", description can be really difficult, but quite important, there are many different types).
I wish you all the best.
Owl Woman
As an update, I have been pursuing TMD as a cause and have recently discovered that I can temporarily alleviate her symptoms to a certain extent by manipulating her lower jaw at the same time as pressing on the pterygoid muscle on the same side, (difficult to acheive I assure you!). I have arranged ANOTHER session with the powers that be later this month.