How to know the reason for bouts of dizziness?
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 37-year-old male. I have been getting bouts of dizziness, which can be described as an electric shock in my head. There is also a feeling of nerve twitch in my temple. I also found that my reaction time is a bit slower. I did a cardiac screening, which involved a stress echo. The echo test and Holter monitor are all clear. My doctor referred me to an ear, nose, and throat (ENT) and suggested magnetic resonance imaging (MRI) of the brain and both ears. The ENT suggested tests to check my vision and to check for vertigo. The test report states that my eye movement was out of coordination, which is consistent with a central lesion. My questions are:
Hello,
Welcome to icliniq.com.
You are suffering from dizziness and electric shock over your face with some incoordination of your eyes as per your ophthalmologist. Nothing from cardiac, eye and ear, nose and throat (ENT). The problem seems to be a neurological disorder. It is good that your magnetic resonance imaging (MRI) Brain is normal, which means no structural lesion like tumor or mass or demyelination. Still, there are many reasons that cannot be seen on MRI and we need to evaluate those. The answer to your questions is:
So, give me a detailed description of your dizziness bouts. How did it start, any trigger? How long it is lasting, and what is the duration of your disease? Does it aggravate with position change? Are you suffering from slurred speech, or imbalance while walking? I want to see your MRI brain, and you might need an MRI brain with angiography and contrast injection study. Then I will give further advice.
I hope this helps.
Patient's Query
Hello doctor,
I have had these symptoms for over 2 years. They come and go and can last anywhere from 2 to 3 minutes to 2 hours. I also wanted to advise that in the last three years, I have had 3 MRIs (magnetic resonance imaging).
Hello,
Welcome back to icliniq.com.
I have seen your magnetic resonance imaging (MRI), which is normal. Are you suffering from a ringing sound in your ear or vomiting-like sensations? Any history of slurring of speech or blurred vision? Are you suffering from a headache or migraine? You will need an MRI Brain with angiography and if needed gadolinium contrast study. Are you having any kind of addiction? Please give me your medication history, if any. I want to see your routine reports like complete hemogram, erythrocyte sedimentation rate (ESR), serum electrolytes, serum creatinine, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), hepatitis C antibody test (HCV), urine routine.
Patient's Query
Hello doctor,
I do get ringing in my ears from time to time longest duration is 5 to 10 minutes. No slurred speech, and no addiction.
Hello,
Welcome back to cliniq.com.
What about headaches? That means episodic dizziness and tinnitus. I think it looks like peripheral vertigo not central. I saw the blood routine reports. Now please do an audiogram with brain stem evoked response audiometry (BERA), and magnetic resonance imaging (MRI) with contrast.
I hope this helps you.
Patient's Query
Hello doctor,
So to confirm it is not likely to be a degenerative disease or brain disease? I will do the mentioned tests and let you know.
Hello,
Welcome back to icliniq.com.
It does not seem to be a neurodegenerative disease. And no major brain disease. Yes please do it and show it to me.
I hope it helps.
Patient's Query
Hello doctor,
I will get the needed tests done. One thing I wanted to also mention is that when I am driving I find it hard to keep focusing on the road.
Hello,
Welcome back to icliniq.com.
First, show me these reports (MRI) and if possible simultaneously take a second in-person opinion of a nearby neuro physician.
Patient's Query
Hello doctor,
I can now confirm that I have had magnetic resonance imaging (MRI) with contrast and it was unremarkable. When I went to the ear, nose, and throat (ENT) they checked my hearing and advised it was fine. I have also been for more blood work which came back fine. I do not know what else it could be.
Hello,
Welcome back to icliniq.com.
Good to hear that your MRI is normal and no hearing loss as confirmed by your ear, nose, and throat (ENT) specialist. Now I have gone through your videonystagmography (VNG) report which shows some high-frequency vestibulopathy and square wave jerks. High-frequency vestibulopathy can explain your intermittent dizziness but square wave jerks in your case are a completely normal phenomenon it is not related to any degenerative cerebellar or cerebral syndrome. How are you now any new symptoms?
Patient's Query
Hello doctor,
Still get dizzy spells when standing up and now also just walking. Around lasts anywhere from 2 minutes to 10 hours. What do you think this is?
Hello,
Welcome back to icliniq.com.
This is due to high-frequency vestibulopathy. There is no more test for this. You learn vestibular exercise and gait training. I think you should consult with another neurologist in person.
Patient's Query
Hello doctor,
I have now had ringing in my ears lasting for four 1 week what does this mean is this a risk for stroke? What are the stroke risks?
Hello,
Welcome back to icliniq.com.
You do not have risk factors of stroke-like your age is just 37, no diabetes mellitus, high blood pressure (BP), or high cholesterol. So the risk of stroke is less. It is more likely vestibular problems. I will advise you to start tablet Diamox (Acetazolamide) 125 mg 1 tablet in the morning and 1 tablet at night, you might get some pins and needles sensation in your hands but it will disappear after stopping treatment. If no response in 2 weeks then please inform me we will try an antiplatelet to prevent and reduce stroke risk.
Patient's Query
Hello doctor,
Is tinnitus a risk factor for a stroke or is it a sign?
Hello,
Welcome back to icliniq.com.
Not alone but you are having a simultaneous dizzy spell which can be a part of a stroke. But as I told you, you do not have any risk factors like diabetes mellitus (DM), high blood pressure (BP), and cholesterol, so the chances are less.
I hope this helps.
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