Dr. Hardik Nareshbhai Rajyaguru
Neurology
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
Hi doctor,
About two months ago, I was left with a feeling that can be described as off balance. It happens mostly when I walk. Whenever I take a step, like when my body shifts weight to one leg, it feels as though I sunk into the ground. I feel that in my head as well, like my vision shifts. After a while of walking I start to feel dizzy, but without the room spinning, more like a lightheaded feeling and falling into something. And then, I get slight visual distortions. I can replicate the same sensation when I sit down and squeeze either buttock, such as if I was walking. Also in my lower back, I have been feeling a constant tremor that changes with position. When I lay down, I can still feel that tremor in my back. Sometimes, it feels as though my body jerks rapidly. If I close my eye, it gets even worst. It feels as though everything is wobbling. I was referred to a neurologist, but it has been extremely difficult to get in contact. I have been to an ear nose and throat (ENT) specialist, who said my ears are fine. He then referred me to an ear, nose and throat institution and they said that I have vestibular migraines. But, I am not sure if it is this as I rarely get headaches. The ENT had no clue as to the back and leg issues and said that if I have migraines that it would not cause those other sensations. Everything started after having a jolt feeling in my chest and in the mid upper section. Doctors said it was bronchospasm. They gave me an inhaler, which never helped for really bad cough that I was having. And, I was also told that I have acid reflux as I was having extreme abdominal pain. I might also have a stomach ulcer and for which I am waiting for an appointment.
Hi,
Welcome to icliniq.com. I appreciate the way you have described your symptoms. This set of symptoms arises when the sensory part of your nervous system is affected. Now, I would like to know a little more specific information. Do you feel more imbalance while walking in the dark such as at night? Do you feel any difference in hot and cold sensations? Are you able to feel minor tremors in your soles when you are traveling by vehicle? Do you have any neck pain? Please let me know the above details, so that I can give you a better suggestion.This does not seem to be a migraine. It is a sensory syndrome and I am asking all the above questions to find out its origin brain versus spine.
Patient's Query
Thank you doctor,
The imbalance is about the same in the night. I do feel tremors while in the car, basically any sitting or standing position. I do not have neck pain. One thing I did forget to mention is that about a year and a half ago, I had a back injury. Since then, I have had nerve pain along one of the legs. But, I never felt anything close to what I feel presently.
Hi,
Welcome back to icliniq.com. The history of trauma to your back carries a lot of relevance. We have three systems in the body, which maintains balance. 1. Internal part of the ear. 2. Cerebellum - smaller brain. 3. Sensory system, tracts of which pass through the spine. If your internal ear is creating problems, then your symptom profile would have been different. If it was cerebellum, then you would have experienced incoordination in your limbs all the time. So, we are left with sensory system.Sensory system is a long path starts from the toes and reaches to the head. A problem anywhere along the line can present the way you have presented. You have a history of back injury, which typically produces changes in the spinal column after a long time and can produce pressure on the cord and sensory symptoms. Also, you have visual symptoms and that can be present in sensory dysfunction due to brain issues. To find the location of an issue, I would advise you to get an magnetic resonance imaging (MRI) brain with whole spine screening. This was about structural problems. There can also be a metabolic issue. The most common one is vitamin B12 deficiency, which can present this way. I would suggest you to get your Vitamin B12 levels in blood checked.
Patient's Query
Hi doctor,
I will try to get an magnetic resonance imaging (MRI) soon. I had actually tried vitamin B12 initially, but no improvement.
Hi,
Welcome back to icliniq.com. I understand that you can go for scans. But, I would suggest you please get the vitamin B12 levels done. If it is normal, then we would be able to rule out one possibility. If it is abnormal, then it may need to be corrected with injections initially followed by tablets. When they are very low to produce symptoms, they may not improve with oral medicines. I would suggest that if you are taking any supplements now, please stop them for 24 hours before the vitamin B12 level test.
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