Vertigo - pulsatile tinnitus - labyrinthine concussion

[jean001]

A little over 3 months ago I got up in the night to go to the bathroom and (we aren't sure if I fainted or felt and knocked myself out) but I hit the dresser and was unconscious for a while. I actually woke up back in in bed without knowing how I got back in bed and the room was spinning wildly. I was sweating, sick, nauseous, throwing up and couldn't walk. I finally made it to the bathroom and could see I had dried blood under my nose. The back right side of my head was so sore I couldn't touch it (hurt for months).  I blew my nose and it was full of blood clots. My husband rushed home and took me to the Urgent Care doctor (it was on a Saturday). I had a MRI and saw several specialist that week. The MRI came back with partially empty sella and a 5 mm pineal gland cyst. They said both were somewhat common and not the cause of my Vertigo.

I went and saw a Hearing and Balance doctor and at first he said it was BPPV. He's treated me for that a couple of times with the Epley Maneuver. He did a VEMP test and some others. The VEMP showed no response in the right ear at around one month. My hearing test was normal. The Epley did help so I know I knocked some crystals loose and they are floating around in my ears. At a little over a month I went in and I was having vertical nystagmus. He seemed concerned about that and ordered more test. He did a caloric test, VNG and some others. I also have had problems with my memory and feeling like I don't understand what someone is asking me. I had trouble thinking of names or words when trying to talk to someone. When I first when back to work everything looked like it was bouncing when I walked down the hall and I was seeing double vision when I looked at the computer (one dark line and one lighter above it). That started getting a little better at about 2 months or so.  He did the check to see if I had nystagmus at that time and I had it again in the right ear. I've had crystals in both each at different times.

So this last time he put me down as having a concussion, labyrinth concussion and BPPV. He also said I have "Meniere like symptoms" but not necessarily Meniere’s. My question is do you think it is Meniere's since I have no hearing loss? I also have pulsating tinnitus (not ringing) with a very distinct heart beat which I have read is not related to Meniere's. I really do not want it to be Meniere’s and he knows that.

Now I am having some dizziness still. Yesterday my head was killing me when I woke up from laying on it exactly where I had hit it when I fell and the pulse was extra loud in that ear. I have pulsating tinnitus when I get up in the morning if I have laid on my right ear all night. It last for a couple of hours and it is very loud at first and slowly fades to almost not being able to hear it during the day. I usually don't notice it too much any other time of the day unless I do something strenuous.

The other night I was riding a stationary bike and looking at my laptop at the same time. I was fine while on the bike riding but when I got finished and got off I suddenly couldn't walk straight like the floor was rolling under my feet. Something similar happened when I rode a bike outside. I know I didn't tilt so I don't think it had anything to do with BPPV on that occasion. It made me sick to my stomach. It was nothing like the normal Vertigo I've been experiencing. It was like my balance system was over stimulated or something. It worried me that something else is going on. The pulse in my ear is worrisome to me too. Do you think this is related to my concussion or something more?

[jean001]

Hi, the doctor I am seeing practices otology / neurotology and otolaryngology.  He has ordered a MRV/MRA. He said it most probably is from my head trauma/inner ear concussion but i may be starting to develop meniere's type changes in my ear. I hope it's just the concussion.

I really hope it just takes time and I get back to normal. You never know how good you had it until you can't do all the things you took for granted. If I do get back to normal I don't think I'll ever take them for granted again.

[Nancy T]

Did you tell your neurotologist about the pulsatile tinnitus? Have you had an MRA, to show possible blood-vessel problems that might be related to your symptoms?

Your case sounds complicated. Neurotologists (it sounds like you are seeing one) are the best specialists to figure these things out, but even they cannot always give you a definite diagnosis. I know little about it, but I think that "vestibular Meniere's" (meaning without hearing loss) is a term sometimes used.

What has your doc recommended besides the Epley in the way of treatment?

Good luck... I hope you improve soon and that the neurotologist can figure things out for you, or at least find helpful treatments.