Too much happening....

[Pumpkincaker]

Hello,
I am a 49 year old woman with autoimmune APS, Raynauds, Pernicious Anemia, vitiligo and various little problems.  I have been on coumadin since a stroke in 2000.  My aunt passed from debilitating MS many years ago and a distant relative has it as well.  I have been to my doctor many times and he referred me to a Neuro that I saw this week.  I have had dizzy moments...more like things move up and down...no spinning.  It throws me off quite a bit.  Initially I thought my INR was too high and went to the docs office.  It was normal and they examined me to find abnormal eye movement (which I was unaware of) and extremely hyper reflexes.  They sent me for MRIs which they say do not indicate MS but there are white matter changes that are unspecific.  A few days following this I had extreme sharp pain in my wrist that worsened with any weight on my arm or when I held anything. At the same time my left knee began to swell up and become painful and I couldnt walk right.  By the time I could see my doc the symptoms started to subside as if they had never happened.  About 6 weeks passed and it occured again but the pain was in my lower back and right hip.  I tripped and fell several times.  I lost my balance twice as if someone tipped the room backwards.  Went to the doc and they said to hold my B12 injections to check the level.  The symptoms contiuned....and my B12 levels came back low indicating it wasnt the B12.  Soon following the symptoms subsided.  During these times I have this brain fog that is hard to explain...it stops me from functioning how I usually do.  Saw the Neuro this week.  He said that I need to reduce my salt intake and stop caffiene consumption and drink ginger ale and that I should see a vast improvement.  ???   He is referring me to a dizziness test.  He claims this is vertigo and possible Meineres.  I know my body...there is something more going on...what do you think?  I need help.

[Christopher R Newey, DO]

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 a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

You have a complicated history so it is possible that there is more “going on”, but it is difficult without knowing more and actually evaluating you. When some people use the term dizziness, they often mean vertigo, or room-spinning. Others mean a light-headed, whoozy feeling.

If by dizziness you mean vertigo (room-spinning), the causes could be either the inner ear or the brain. Inner ear causes of vertigo most commonly include benign positional vertigo (BPPV), which is due to small particle in the inner ear that moves out of place, and can be repositioned with simple head maneuvers. The symptoms often include vertigo that occurs with turning of the head, often while turning over in bed. Another cause, if your symptoms are associated with tinnitus (ear ringing) and hearing loss is called Meniere’s disease and can be treated with medications and sometimes surgery. And so on, several other causes from inner ear problems exist.

Vertigo can also be due to problems in the brain. The most common is a benign tumor called a schwanoma (also called acoustic neuroma). This is diagnosed by MRI of the brain. Multiple sclerosis can cause vertigo, but often, other symptoms are present as well. A normal MRI of the brain excludes multiple sclerosis. Thyroid problems can also lead to vertigo. If you do have “nonspecific” white matter changes, you may need a lumbar puncture to evaluate these further. They could secondary to the APS or other possibilities such as hypertension, high cholesterol, migraines, etc.

If by dizziness you actually mean light-headedness, causes could include low blood pressure such as due to dehydration or autonomic dysfunction, cardiac problems, and several other non-neurologic causes. Anemia can cause light-headedness as well.

You should continue working with your neurologist. Vestibular testing would be helpful to determine if the cause is from the ear or not.

Most academic medical centers have appointment lines for self-referrals that can be found by internet searching the medical center of your choosing.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Pumpkincaker]

I also have sharp intermitten pains in my legs and bottoms of my feet.  At the end of the day I may have what the doc says is restless leg syndrome...my legs have a mind of their own and twitch and jerk to the point of becoming painful after several hours.  

To add the last part of what I feel is attributed to whatever is going on in my body/brain...is that my emotions have been so sensitive to the point of crying for no obvious reason.  My daughters are worried....as am I.

Sorry for the long post...there seems to be so much happening.
Thank you for any help or advice you can give me.

Do you have to have a referral to see a Neurologist at Cleveland Clinic?

Thank you.