loosing your balance and falling

[supermum_ms]

Hey Guys and Dolls,

I have a rather patheticly problematic thing that comes on, when ever I'm in an episode, i'm in one now. I dont know when its going to happen, or why it happens but like the title, I keep loosing my balance and falling over. My cane doesn't help at all, and i gave my walker to my mother-in-law because I wasn't ready to go there yet, she's hitting 80 and so needs it, i'm still not ready!

So far i've not caused my self any damage, a few bumps on my noggin, bruises and gee the garden looks really different when you get up close, like up your nose lol. I seem to keep going over until i either find something to grab or the ground, which ever comes first. I still fall backwards if i close my eyes, i end up on my butt and the stopping suddenly has me falling forward but I've added to it. I think it might be connected to that and the tilting to the left thing i've got when i'm in motion, i dont walk straight I always veir to the left.

I can sort of get it to make sense when it happens whilst i'm moving but when i'm just standing still and i start going over, its harder to work out or be proactive. Its like my brain is temperarily confused of where up right really is, even though i am up, my brain isnt recognising it. It could be for a split second, I dont really know how it works but what I do know is that I just start falling and I dont always know I am until i'm down. Sometimes my brain starts recognising i'm falling, when i get to a certain angle I think its more muscle memory than brain memory that kicks in when something is trying to save me. When I just fall like a tree in the woods, there is nothing to warn, nothing!

It seems to have no ryme or reason, no pattern, lol last night i was standing next to dh and i started falling, i'd already wobbled around to his back before i could grab on to something. It just happened to be his T.shirt, he hadn't realised I was falling, he just thought id walked off, once i grabbed him he reacted. I dont get why i'm silent, no sound at all comes out of me, no ahhhh, no ohhh, no umphs, no screach, no sqweal, no scream, simply  no sound at all, and i dont understand that.

Does anyone understand the why's of any of this?

Cheers...........JJ



  

[sllowe]

Super-M

This is an excellent web resource for vestibular disorders (VEDA):
http://www.vestibular.org/vestibular-disorders.php

-Shell

[crwriter]

Hmmm - Interesting.  I was just thinking about falls I have had down stairs.  It's almost as if I put my left leg out and it expects that there is floor extended outward from the stair.  It's happened three times, so it repeated.  I find I must keep my eyes on my feet when I go down stairs, and since I fell from pretty high up, I am afraid I will cause damage.  I'll say one thing - my bones must be great.  Oh - and I've proven to myself that when I flap my arms, I cannot fly.  (a bit of humor)

[JemmAus]

I've got all my scans on disk, but despite figuring out how to copy them once, (three years ago) I've not been able to remember how to again, otherwise I'd show you mine.

I did, however, find this pic, which has an arrow pointing to a cerebellar lesion in almost the exact same spot as mine.

http://www.unitedspinal.org/msscene/wp-content/2816.jpg

Depressing isn't it......I'm sitting at the computer desk at dawn as usual, skulling tea and plain biscuits, in a vain attempt to ward off my morning horror with balance.....

[JemmAus]

Bob, glad you mentioned the bit about sleeping. I was always wondering why I was "fine in bed" but within minutes of getting up, back to hanging on to the walls.

Mine is odd though as it tends to settle through the day - I am nearly ALWAYS worst in the morning. Don't know if that is 'normal' in this situation or not.

I have a plainly obvious cerebellar lesion. What annoys me is that it's been there since my first MRI near 4 years ago, but only my latest neuro even noticed it to mention it - it was never reported by the original radiologist and never pointed out as a possible reason for my balace issues by 5 previous neuros. Mind you, they were all mental from Queensland (where the heat melts your brain).

[COBOB]

Balance and falling is a pretty complex issue.  The cerebellum is in the infratentorial brain.  It takes input from the vestibular nerves (inner ears,)  joint position sensors, and muscles control sensors and provides feedback to the motor control cortex in the mid parietal portion of the brain.  Sensory, proprioceptive, and motor contol dysfunctions can all cause problems.

There is a constant feedback loop that happens  when we are not asleep.  When sleeping, hypotonia sets in to protect the body.  The continual feedback to the motor cortex causes the body to make minor adjustments to the muscles (usually core muscle is the trunk) to keep us upright.  This happens while we are walking, sitting, standing; just about anything we are doing while awake.   When thing go wrong, the systems goes into "emergency fall prevention."  The legs get wider apart, the knees bend (to lower the center of gravity,) and the arms move outward to act line a balance pole for a high wire walker.  We end up looking like a surfer on a surf board, if we are lucky.  That is where my balance is at this point.  When things go wrong, I end up in the surfer stance about 95% of the time.    

The point here is that there are several places where the "balance system" can fail.  Even if there is no lesion in the brainstem or cerebellum, a lesion in the spinal cord or cortical white matter can mess with sensory or motor function and "break" the feedback loop.  

The example that comes to my mind is that I can do 10-15 miles on the recumbent bike at the gym.  If I try and ride the upright bike I can do about 5-7 miles.  Afterward, my gut and back and shoulders are killing me.  The neurologist told me "Don't do that."  He explained that it was dangerous and I could take a header off either side of the bike at any time.  He said the recumbent was much safer and I could still get the exercise and keep my legs stretched out.

This is definitely one of the symptoms/signs that would be very hard to match to a particular lesions on an MRI.  This is also one of the cases where the 25 invisible lesions for every visible MRI lesion comes into play.  Just because there is no MRI demonstrable lesion on the cerebellum or any where in the infratentorial brain doesn't mean that there isn't something there.

Bob

[supermum_ms]

My MRI report doesn't state where exactly in the brain the lesions are, just white matter and deep white matter lesions. Funny but the last 2 pictures on that site are 'almost' an exact match to my slides and the combination of sx are strangely the same as mine lol.

Sumanadevii- I think you may need to work out a list of questions for your neuro, stating with 'why do I fall over?' etc. hopefully youve got a neuro who is ok with patient questions.

cheers...........JJ

PS i'm on another laptop but it will take a bit of getting use to lol

[Sumanadevii]

I never thought to ask my neuro why, I just figured it was from the MS.  After falling a bit too often I knew it wasn't safe for me without a walker.  A cane was never sturdy enough for me nor is a walker with wheels.  

Why does it happen?  I just assumed my legs were too weak to help me.  I guess there are a lot of things I don't ask my neuro about.  I just assume it is part of the monster.

[supermum_ms]

Sort of what i thought already but it sort of bites big time to read it in black and white. My arms are definetely involved right and dominant hand though I end up using my left a heck of a lot these days. DH is getting a tad over protective cause i keep falling, I want to help but i'm really just getting in the way.

I want a bath, gosh it scares the crap out of me just trying to wash in the shower, a bath would help take the balance issues away but heck i'm totally helpless and its not something i really ever feel comfortable with. Nothing compare with a wet rag doll, needing to be lifted out of the bath. LOL I gave up away my dignety having kids in teaching hospitals but this is something else!

Oh warning my computer is fried, like my brain lol not sure if i'll get on line for a while, I have a spare but it may take some time to fit it out with all my help tools, not sure so keep your fingers crossed dh can do it for me tonight.

Cheers.........JJ

[JemmAus]

Me again woops....this is the best article I ever found. I was going to post it straight up but it refused to load before, but now it seems to be working again

http://www.unitedspinal.org/msscene/2009/03/03/cerebellar-ms-a-case-study/

[JemmAus]

http://www.dizziness-and-balance.com/disorders/central/cerebellar/cerebellar.htm

[JemmAus]

LOL I was going to say, have you got any lesions on the cerebellum?

[supermum_ms]

Well I know i've lost my marbles, because once again I remembered what it was called, my seive of a brain is leaking! lol

For those wanting to know heres some info on Proprioception, Cerebella and Romberg's sign:

Romberg's test is positive if the patient sways or falls while the patient's eyes are closed. [4]

Patients with a positive result are said to demonstrate Romberg's sign or Rombergism. They can also be described as Romberg's positive. The basis of this test is that balance comes from the combination of several neurological systems, namely proprioception, vestibular input, and vision. If any two of these systems are working the person should be able to demonstrate a fair degree of balance. The key to the test is that vision is taken away by asking the patient to close their eyes. This leaves only two of the three systems remaining and if there is a vestibular disorder (labyrinthine) or a sensory disorder (proprioceptive dysfunction) the patient will become much more imbalanced.

And......

Romberg's test is not a test of cerebellar function, as it is commonly misconstrued. Patients with cerebellar ataxia will, generally, be unable to balance even with the eyes open;[5] therefore, the test cannot proceed beyond the first step and no patient with cerebellar ataxia can correctly be described as Romberg's positive.

And..........

The primary acknowledged function of the cerebellum is to provide feedback and fine-tuning for motor output. It is also associated with the sense of proprioception, which provides us with an intuitive map of the location of our body parts. Without proprioception, it would be impossible to remain balanced while walking in the dark -- we wouldn't have an intuitive sense of where our legs were located. Like many other parts of the brain, the cerebellum was originally associated with a single function, but with the advent of PET (positron emission tomography), fMRI, and other neural imaging techniques, it has been discovered that the cerebellum is activated in tasks requiring the delegation of attention and the processing of language, music, and other sensory temporal stimuli.
...........................

So with all that, i'm still not able to understand why the blasted neuro who had me stop and fall flat on my face and then fall over backwards getting up, when he was testing me for the Romberg's sign, didn't go ah ha! And that was before he found the unilateral hyper-reflex, uni ancle clonus and reactive muscle spasms.

Shhheeeesh what more does a girl need, i've got the lesions on MRI, i've got the clinical sx, relapsing remitting sx but what i dont have is an alternative dx to explain any of it lol!

Cheers..........JJ