Do I need a 2nd opinion?

[Vicky_1952_1952]

I've had repeated bouts of SUDDEN onset headache and vomiting. 1-2x wkly since Sept-02  Severe enough to be hosp 3x(dehydration)  PCP sent me to Gastro speciaist had endoscopy...all normal..PCP sent me to  Neurologist..had MRI, MRA, EEG Blood/urine ..all normal cept elevated liver enz. Other symptoms are ear fullness, hearing loss, balance difficulties. Neuro DX polyneurophathy from initail exam. Neuro did not personnally view MRI just read report(I asked) and his nurse called with "normal" results. 1.  Do I need 2nd opionion or just wait this out?  2.Does MRI always show tumors or Multiple Sclerosis?

[Ron3]

Hi Vicky,

I can't believe that your docs are not taking you more seriously.
Here is another condition which seems to resemble your symptoms.

Bye for now... Ron
----------------------------------------------------------------
SUDDEN DIZZINESS OR MENIERE'S
                               DISEASE

                          Gabe Mirkin, M.D.

If you develop dizziness that lasts for more than a few seconds, check with your doctor. it could be a stroke. Recurrent dizziness can be caused by temporary interruption of circulation to your brain, such as blocked neck arteries or an irregular
heart beat. It can be caused by a stroke, tumors on the hearing nerve or brain, drug reactions, a bang on the head, an infection in the inner ear or anything that interferes with nerve function such as lack of vitamin B12, diabetes, migraine, seizures/ or
infections such as herpes or chicken pox.

Dizziness lasting for a day or longer is usually due to nerve damage called neuritis and often gets better without treatment or a stroke which often does not get better and is associated with reduced vision. If your dizziness is caused by a stroke, you must check with a doctor immediately because shutting off the blood supply to a part of your brain called the cerebellum can cause progressive swelling and death if it is not treated immediately. Dizziness lasting for minutes or a few hours usually is due to
temporary obstruction of the blood supply to the brain called transient ischemic attacks, migraine or seizures. If it recurs, it is often due to Meniere's syndrome which includes reduced hearing, ringing in the ears and a feeling of pressure in the ears.

Dizziness lasting a few seconds is usually due to a debris in your balance apparatus in your inner ear, called benign positional vertigo and is cured by special rapid movements of the head (3,4). If you have Meniere's syndrome, you need rest and a
prescription for scopolamine. Antihistamines such as cyclizine or meclizine, tranquilizers such as Valium, anticonvulsants such as Dilantin, migraine medications such as Imitrex.
If your dizziness is severe enough, your doctor may give you a drug to damage your hearing nerve permanently.

1) NEJM September 3, 1998 Excellent review.

2) WPR Gibson, IK Arenberg. Pathophysiologic theories in the etiology of Meniere's disease. Otolaryngologic Clinics of North America 30: 6 (DEC 1997):961. A new theory suggests that a
narrowed duct becomes obstructed by debris that is cleared by a combination of the secretion of hydrophillic proteins within the sac and a hormone, saccin, that increases the volume of
endolymph within the cochlea. It is proposed that the sudden restoration of longitudinal flow initiates the attacks of vertigo.

3) E Mira, S Mauri. Paroxysmal positional vertigo. Italian Journal of Neurological Sciences 19: 3(JUN 1998):150-160. posterior semicircular canal (PSC-PPV) and horizontal semicircular canal PPV (HSC-PPV).

4)V Honrubia, RW Baloh, MR Harris, KM Jacobson. Paroxysmal positional vertigo syndrome. American Journal of Otology, 1999, Vol 20, Iss 4, pp 465-470

        Health Reports from The Dr. Gabe Mirkin Show and DrMirkin.com

Transcripts of segments of The Dr. Gabe Mirkin Show are provided as a service to listeners at no charge. Dr. Mirkin's opinions and the references cited are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provider.

[Ron3]

Hi Vicky,

You are making a better diagnosis than your doctor..
Inner ear infections or a condition called Benign Positional Vertigo can confuse the messages going to the brain.
When the messages from the eye do not agree with those being
received from the ear's balance system, nausea, vomiting and
falling over when the eyes are closed is often a result.

Since the tiny chamber where balance is controlled is supposed to have fluid in it (and it is tiny particles within this fluid
that cause the problem) they are often missed even with an MRI.
You might have to see and Ear Nose and Throat (ENT)specialist who
will make a diagnosis and try some head manipulation to
clear the debris from the balance fluid.

One sure sign of BPV is dizzyness wen lying down and simply rolling over in bed with the lights out.

Here is a report to read which will prove that I am not making anything up.

Take care.. Ron
--------------------------------------------------------
DIZZINESS WHEN CHANGING POSITION

                         Report #7072; 3/15/97

Some people feel dizzy and nauseous when they change positions. Exciting new research shows that many will have a condition called benign positional vertigo that can be cured by
surgery or special exercises.

If you feel dizzy or nausea when you change position, move from lying to sitting, turn when asleep or bending over, check with your doctor who will probably order tests for nerve damage: an MRI to look for a tumor, HbA1C for diabetes, Vitamin B12 for pernicious anemia, Lyme test, and so forth. He will also look for blocked arteries by measuring blood flow through the arteries in your neck and a electrocardiogram looking for irregular heart beats. The odds are overwhelming that the tests will be normal and you will have a condition called benign positional vertigo.

No medication is effective. Usually you will get better by yourself within six weeks. However, many people do not get better. The dizziness is caused by damage to the balance sensor in your middle ear. A recently described 15-minute office procedure called canalith repositioning procedure is effective. Special exercises taught by a trained physical therapist can also help to cure benign positional vertigo. The therapist will teach you how to move from sitting to lying on your stomach. Then she will have you turn your head toward one side until you feel
dizzy. Then roll over to the other side and sit up, tilting your head down and so forth.

I'm Dr. Gabe Mirkin on Fitness.

1) N Gordon. Benign paroxysmal positional vertigo. British Journal of Clinical Practice 50: 4 (JUN 1996): 208-210.

2) W Waespe. Benign positional vertigo and nystagmus of the horizontal semicircular canal. Schweizerische Medizinische Wochenschrift 127: 8 (FEB 22 1997): 287-295. Benign
paroxysmal vertigo and nystagmus are induced not only by the posterior but also by the horizontal semicircular canal.

Health Reports from The Dr. Gabe Mirkin Show and DrMirkin.com
Transcripts of segments of The Dr. Gabe Mirkin Show are provided as a service to listeners at no charge. Dr. Mirkin's opinions and the references cited are for information only, and are not
intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provider.

[JessicaM]

Do yourself a favor and get a second opinion, and if you are still unsatisfied, get a third opinion.  To make a long story short, I took my Mother to the Dr's office with clear signs of pneumonia,(chest pain, non-stop coughing, chills, severly dehydrated, low blood pressure and vomiting in front of the Doctor while being examined), and he sent her home with oral antibiotics and cough syrup and said she had a bronchial infection.  I left thinking, "oh, it's just a bronchial infection, thank god it's not pneumonia.'  Less than 24 hours later, she died...of pneumonia.  If you are uncomfortable with the diagnosis, be more assertive...and if your tests are still negative, at least you will have 'peace of mind'.  Good luck to you...

[CCF-Neuro-M.D.-JT]

1.A second opinion at a major academic center may be helpful, and should be considered as your symptoms appear to be quite dramatic, requiring 3 hospital admissions.
2.10% patients with MS have an initial normal MRI. But tumors are usually picked up on an MRI.

Inner ear/vestibular problems are certainly a possibility given your symptoms of hearing loss, ear fullness, and balance problems. This can be evaluated with a formal ENT exam and in a dizzy clinic such as the one we have here run by Dr.Oas. Atypical migraine is also a possiblity. The polyneuropathy in itself does not explain your symptoms. But there is a condition called acute intermittent porphyria which can manifest as GI, neurologic, and psychiatric symptoms.  It's a genetic defect affecting the liver's ability to make a component of blood, causing a buildup of certain chemicals in the body that somehow affects those systems I mentioned. You can get a polyneuropathy, abdominal pain with vomiting, and psychiatric changes as well as other symptoms. There's also a change in urine color. An attack can be triggered by certain medications such as estrogen, barbituates, and even alcohol. This can be diagnosed with blood and urine studies and treatment is usually supportive or in some cases with hematin and glucose.  Talk to your docs about this possibility as they have had the opportunity to examine you and review your clinical history in detail. Good luck.

[Vicky_1952_1952]

Mistake above - I dont have the results from the EEG yet.  I have another appointment on Jan 16 for an EMG (I think to obtain specifics on the nerve damage)  I want to emphasize that the Headaches and Vomiting are simultaneaous.   I realize one moment that I am naseated and the next moment I realize that I have a headache.  I tend to vomit for 1-2 days often while taking phenergan suppositories. My pcp tried 4 medications (since September) for migraines which I have had in the past.  The medications are Imitrex, sepapep, migrazone, amerge.  These headaches are not like migraines, not as painful, no sensitivity to light or noise, not on one side, more on the crown of my head.

[Vicky_1952_1952]

I didnt have enough space to explain my balance dificulties.  I am unable to walk heel to toe even two steps.  I am unable to stand on one foot with the other slightly lifted without falling over (either leg)  With eyes open it takes about 5-10 seconds.  With eyes closed it happens instantly.  Even with both feet solid when eyes are closed I fall over in 10-20 seconds.

IS THIS MORE LIKELY A MIDDLE EAR PROBLEM or NERVE PROBLEM IN MY FEET?

[Vicky_1952_1952]

I forgot to include some intermittant tremors of the lower right arm and right leg.