HomeAnswersRadiologybasilar invaginationI have poor balance, dizziness, and difficulty swallowing. Why?

What is the cause for poor balance, dizziness, tingling in the fingers, difficulty standing and swallowing?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Vivek Chail

Medically reviewed by

iCliniq medical review team

Published At May 27, 2022
Reviewed AtOctober 12, 2023

Patient's Query

Hello doctor,

Can you please check my MRI carefully? My symptoms started nine years ago suddenly, and gradually these symptoms are progressing.

I have poor balance, difficulty swallowing, tingling in the fourth and fifth fingers, difficulty standing still for more than three minutes, slow heart rate, and dizziness. I am not on any medications and my blood test report is normal.

Answered by Dr. Vivek Chail

Hi,

Welcome to icliniq.com.

Thanks for writing to us. I hope you are not in much discomfort.

After reviewing your MRI (magnetic resonance imaging) brain and spine images (attachments removed to protect the patient's identity), my observations are below.

Brain:

  • There is mild cerebral and cerebellar atrophy, and the brain is showing early features of aging that are usually not visualized at your age.
  • There is prominent perioptic CSF (cerebrospinal fluid) surrounding the retrobulbar part of bilateral optic nerves, suggesting benign intracranial hypertension.
  • There are few small prominent perivascular spaces in the bilateral frontal lobes.
  • There is mild bilateral maxillary sinusitis.

Cervical spine:

  • There is a mild posterior thecal indentation in C4 to C5 and C5 to C6 disc levels and mild bilateral neural foraminal compromise in C5 to C6 disc levels. There is no spinal canal stenosis.

Thoracic spine:

  • There is no posterior disc bulge.
  • There is no spinal canal stenosis.

Lumbar spine:

  • There is mild lumbar spondylosis. In addition, there is mild posterior disc bulge in L3 to L4 and L4 to L5 disc levels, causing mild bilateral neural foraminal compromise.
  • There is no spinal canal stenosis.

Few Tarlov's cysts are visualized in the spinal canal at S1 to S2 vertebral levels and are not a significant finding.

Regards and thanks.

Patient's Query

Hello doctor,

Thank you for the reply.

What is your recommendation for the next step?

I was also diagnosed with basilar invagination and the rotation of my C2 to the top, compressing the brain stem. And the reason for increased intracranial pressure is because blockage of spinal fluid in the brain stem area. I do not know whether it is a correct diagnosis or not. I want to know your opinion about this diagnosis, your recommendation for the next step, and the underlying reason for my symptoms.

Many thanks and best regards.

Answered by Dr. Vivek Chail

Hi,

Welcome back to icliniq.com.

In reply to the follow-up,

Benign or idiopathic intracranial hypertension is usually a diagnosis of exclusion. This condition is diagnosed after ruling out the common causes of raised pressure in the CSF fluid in the brain and spine. There is no one particular cause for this condition, and research is going on and is challenging. However, decreased compliance of the vertebral veins in the spine might be one of the causes, but again it is difficult to pinpoint a cause in many individuals.

In your MRI brain, the cerebral ventricles are not dilated, and therefore any mechanical obstruction to the flow of CSF is less likely. However, decreased flow in the veins of the spine can be one of the causes relatable to basilar invagination that might indirectly cause the increase in pressure.

Based on your difficulties and symptoms, you need to follow up with a neurologist every three to four months and continuously monitor. In most cases, medications help to balance the pressure and control symptoms. If the symptoms get worse, then surgical procedures might be needed. The general recommendation is to review symptoms every three to four months to ensure you are in good health.

Regards and thanks.

Patient's Query

Hi doctor,

Thank you for the reply.

I will upload my five MRI reports taken since seven years to clarify regarding cerebellar atrophy. Could you please check if the atrophy is progressing? Or any new finding that may help to find the exact reason for symptoms.

Thanks.

Answered by Dr. Vivek Chail

Hi,

Welcome back to icliniq.com.

Thanks for writing to us.

The cerebellar atrophy in the five MRI brain scans done since seven years is relatively constant and does not show any significant worsening. The other findings of benign intracranial hypertension are also visualized and almost the same. Many of the symptoms in your condition might show improvement and worsen from time to time due to changes in pressure of the CSF fluid. In the MRI scans, we do not measure the pressure of CSF fluid and what we see are the consequences of the increased pressure.

As a patient, you might experience changes in symptoms even without significant changes in MRI brain scan findings. Therefore, it is recommended to consult your doctors every three or four months.

Regards and thanks.

Patient's Query

Hello doctor,

Thank you for the reply.

I am so happy that there are no significant changes in my MRI brain. Unfortunately, in the place where I reside, I cannot go to a specialist directly, and the general practitioner would refer me to a specialist. I have never done a spinal tap. Do you recommend it? Does my slow heart rate related to the pressure of the CSF?

I had a very bad groin fungal infection when my symptoms suddenly started. Could a brain fungal infection be the reason for my symptoms?

Regards and thanks.

Answered by Dr. Vivek Chail

Hi,

Welcome back to icliniq.com.

Medical protocols and health care facilities are changing every day, and if your symptoms are severe, they will surely provide you with adequate guidance and a follow-up as needed. In addition, you can have a word with your general practitioner and specialist to provide you with necessary relaxations for an early follow-up if your symptoms worsen quickly.

A spinal tap procedure needs to be done only if your neurologist insists as a part of follow-up and treatment.

Skin fungal infections are very common in the groin area and are usually limited to the skin. Brain fungal infections happen in severely ill people and those suffering from conditions causing a lowering of immunity. If your groin infection has been treated completely, then your immunity is good, and there is no need to worry about fungal infections taking the systemic route and reaching the brain.

Regards and thanks.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Vivek Chail
Dr. Vivek Chail

General Practitioner

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