Subject Cervical herniated discs-lightheadedness, blurry vision
I am writing to you in hopes of finding some assistance with an ongoing medical problem that I have been having off and on since 2005. I have seen numerous medical specialists, but no one can seem to pinpoint my problem. First of all, I have a herniated disc at c4-5 level impinging on the cervical cord. I also have a disc herniation compressing on the left side of the cervical cord at C5-6. There is mild reversal of the lower cervical lordosis. My last cervical MRI was 12/1/06.
I used to get blurred, almost double vision when I turned my neck to the right, & sometime when bending my head backward. The vision would stay blurred for sometimes a few seconds, sometimes a minute. That lasted for several months and eventually subsided. I had MRI/MRA of the brain which was normal. I had a MRA of the carotid artery which only revealed minimal plaque in the left carotid artery. I had an ENG to test problems with the inner ear, that was also normal
Currently, I am having a spacey, lightheaded feeling. My neck is extremely stiff, and it feels almost as if the muscle stiffness is slowing blood flow to my brain. I am having numbness down both arms, stiffness in mid back, and numbness going down into legs also. My vision seems blurrier than usual at time. My question is are the herniated discs somehow reducing blood flow to my brain? What treatment, if any, can be done for this? I do not want surgery if that can be avoided. Are there any additional medical tests that you would recommend? I appreciate whatever help you can give me. I’ve become very frustrated at this point.
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
In general, in someone who has symptoms such as light-headedness or vertigo when they turn their neck, the most concerning thing would be that this is leading to a decrease in blood flow to the brain, similar to a TIA, called veretebrobasilar insufficiency resulting from compression of arteries to the brain that are already narrowed by plaque. That your MRA did not show narrowing of the arteries is reassuring, so assuming that the MRA was done well and was able to image specific arteries called the vertebral artery all the way along its course (from its origin at the aorta to where it ends), then vetrebrobasilar insufficiency would be less of a concern.
That would leave another possibility called cervicogenic dizziness as a cause to your symptoms. It would not explain your vision symptoms but could explain your light-headedness but not really your vision symptos. Cervical disease (such as a herniated disc in the cervical (neck) region or arthritis of the spine) can cause dizziness, not necessarily vertigo (room-spinning) per se but rather a whooziness or sort of light-headed dizziness. I will refer to this as cervicogenic dizziness. This notion of cervicogenic dizziness is not accepted by all medical practioners, it is controversial, as it is not well researched, difficult to diagnose, and difficult to conduct research on. However, it may be diagnosed in someone with neck pathology and dizziness in which no other cause is found. Therefore, it is a diagnosis of exclusion, after inner-ear and brain problems are excluded.
Even if your examination of your inner ear was normal, inner ear causes to your symptoms are still a possibility. Some conditions such as benign paroxysmal vertigo (BPPV) classically cause symptoms of dizziness with head movement such as neck turning.
In general, the treatment for a herniated disc includes pain-relieving medications if there is pain (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muslce relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications. With time, the disc may be resorbed (become less severe) with time. In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. It sounds like in your case there was some impingement on the cord; but your last MRI was several years ago, so it is possible that this has remained stable or even improved. If the compression on the cord is severe or causing specific symptoms such as weakness, sensory loss, or loss bowel and bladder control, surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain. One means of assessing whether or not the nerve being pressed on by your herniated disc is impaired is a test called an EMG/NCS which assesses how fast the nerve conducts electricity and how the muscle responds. This type of test is done by neurologists in most centers. In some patients, after conservative non-surgical therapy is tried for weeks and there is severe pain or if other symptoms/indications arise, surgery is the next step. Cervicogenic dizziness is not usually an indication for surgery.
I recommend continued follow-up with your physician, for further evaluation of your light-headedness and perhaps re-imaging of your spine. Physical therapy for your neck may be useful for you and even vestibular rehab if there is suspicion of an inner-ear contribution.
Thank you for using the forum, I hope you find this information useful, good luck.
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