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Neurology (Expert Forum)
What to do next
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
What to do next
by Jolene, Jul 20, 2000 12:00AM
Dear CCF Neuro,
I have had problems with vertigo and ataxia for almost four years now, constantly and slowly progressive. I have a down-beat nystagmus, positive Romberg, but passed the vestibular tests with the exception of the posturography and a failure at tilt suppression of post rotary nystagmus in the rotational chair. I have had autoimmune tests, lyme, and B12 and all were normal. I did have a slightly elevated ACE but no other indication of sarcoidosis. I have had three normal brain MRIs and a cervical MRI that indicated spondylosis but no other lesions. I have had a negative spinal tap. My vertigo is linear rather that spinning. I get a sensation of tilting, dropping or rocking which is worse when I walk but present to some degree at all times. I have a gait ataxia in addition to vertigo. I pass all the neuro tests with the exception of the Romberg and tandem walk. I am hyperreflexive but my neurologist thinks that is normal for me. Right now he is calling my problem cerebellar ataxia but is not really sure of the diagnosis. My question to you is what would you do now? Are there any tests that are indicated that haven't been done or that should be repeated? What are your thoughts?
Thank you for your time.
I have had problems with vertigo and ataxia for almost four years now, constantly and slowly progressive. I have a down-beat nystagmus, positive Romberg, but passed the vestibular tests with the exception of the posturography and a failure at tilt suppression of post rotary nystagmus in the rotational chair. I have had autoimmune tests, lyme, and B12 and all were normal. I did have a slightly elevated ACE but no other indication of sarcoidosis. I have had three normal brain MRIs and a cervical MRI that indicated spondylosis but no other lesions. I have had a negative spinal tap. My vertigo is linear rather that spinning. I get a sensation of tilting, dropping or rocking which is worse when I walk but present to some degree at all times. I have a gait ataxia in addition to vertigo. I pass all the neuro tests with the exception of the Romberg and tandem walk. I am hyperreflexive but my neurologist thinks that is normal for me. Right now he is calling my problem cerebellar ataxia but is not really sure of the diagnosis. My question to you is what would you do now? Are there any tests that are indicated that haven't been done or that should be repeated? What are your thoughts?
Thank you for your time.
Doctor's Answer
by CCF Neuro[P] MD, RPS, Jul 20, 2000 12:00AM
Dear Jolene:
Sorry to hear about all your problems. I guess the best thing thus far is that all your testing is essentially normal. I realize that the symptoms are terrible and your tired of having physicians looking at you thinking that your a psychological case. Every now and then we find patients with cerebellar problems (this can contribute to your vertigo problems) might be connected with a disorder of energy metabolism. More specifically a mitochondrial disorder. To test for this I would recommend that you have a lactate, pyruvate, ammonia,serum amino acid and urine organic acid analysis performed. I would tell you to fast, at least overnight before testing. Have the labs sent to particular places (lactate/pyruvate need to be processed within several minutes; organic acids should be sent to Kennedy-Krieger and to Dr. Richard Kelly; serum amino acids can be done at most places). The cerebellum is a very high energy demanding part of the brain and disorders of energy metabolism can be seen to give symptoms from only cerebellum dysfunction.
Let us know how things turn out.
Sincerely,
CCF Neuro MD
Sorry to hear about all your problems. I guess the best thing thus far is that all your testing is essentially normal. I realize that the symptoms are terrible and your tired of having physicians looking at you thinking that your a psychological case. Every now and then we find patients with cerebellar problems (this can contribute to your vertigo problems) might be connected with a disorder of energy metabolism. More specifically a mitochondrial disorder. To test for this I would recommend that you have a lactate, pyruvate, ammonia,serum amino acid and urine organic acid analysis performed. I would tell you to fast, at least overnight before testing. Have the labs sent to particular places (lactate/pyruvate need to be processed within several minutes; organic acids should be sent to Kennedy-Krieger and to Dr. Richard Kelly; serum amino acids can be done at most places). The cerebellum is a very high energy demanding part of the brain and disorders of energy metabolism can be seen to give symptoms from only cerebellum dysfunction.
Let us know how things turn out.
Sincerely,
CCF Neuro MD
Member Comments (2)
by Jolene, Jul 20, 2000 12:00AM
Forgot to say that I am a 46 year old female. My general health is good.
