Unexplained Dizziness: Seeking Answers Beyond Medication Relief

Q: Unexplained Dizziness: Seeking Answers Beyond Medication Relief

Hello： You have many symptoms, and my final recommendation is to focus on examinations at the same medical center to gain a deeper understanding. <br>If you are concerned about a previous stroke, you can rule it out by undergoing a self-paid MRI of the brain. <br>Regarding your t

Persistent dizziness with no clear cause ~ I can only relieve the symptoms with sedatives each time?

Hello Doctor: My dizziness symptoms occur several times a day, characterized by brief episodes of fatigue, lethargy, weakness, and occasional short bouts of dizziness and nausea.
These episodes are unpredictable and typically last between 5 to 30 minutes.
Over the past year, I have visited various departments in a large hospital and undergone numerous tests, with 95% of the results being normal.
However, the following issues were identified: (1) I have hypertension, which is controlled with medication, and my blood pressure readings are normal daily, sometimes even lower than average; (2) I have a peptic ulcer and duodenal ulcer with gastroesophageal reflux, which are also managed with medication; (3) my total cholesterol once spiked to 269, but I am currently on lipid-lowering medication, and my total cholesterol is now 170; (4) I have benign arrhythmia, which can be managed with medication when I feel unwell; (5) an inner ear examination showed slight imbalance; (6) I have very mild cataracts.
However, during episodes when I feel very uncomfortable, taking the prescribed medication does not always help, but I have found that taking Xanax almost immediately alleviates my discomfort, making me feel normal again.
Although the frequency of these episodes has decreased this year, they are still quite uncomfortable when they occur, and I worry they might be a precursor to a stroke.
I have seen several neurologists at a large hospital and had an EEG, all of whom said I am fine.
While it is possible that the symptoms described above are interrelated, I cannot determine if they are connected to the episodes since they often resolve by the time I reach the emergency room, where tests also return normal results.
However, the symptoms persist intermittently.
My question is: what tests should I undergo to more easily identify the cause? Although I am on medication for the issues mentioned, the problems still occasionally arise.
I even wonder if the detailed examinations I had at the large hospital truly identified the problem.
Nine out of ten doctors suggested that I might have a dysautonomia issue.
While sedatives do provide immediate relief for my symptoms, I still question whether it could genuinely be a dysautonomia problem as the doctors suggest.
I feel quite troubled and am unsure which department to consult at the large hospital.
Please help clarify my doubts.
Thank you.

Mr. Wang, 40~49 year old female. Ask Date: 2018/01/23

Dr. Jiang Junyi reply Neurology

Hello: You have many symptoms, and my final recommendation is to focus on examinations at the same medical center to gain a deeper understanding.
If you are concerned about a previous stroke, you can rule it out by undergoing a self-paid MRI of the brain.
Regarding your tendency to feel fatigued, have you considered the possibility of sleep apnea? If you have this condition, it can lead to daytime concentration issues and frequent drowsiness.

1.
Obstructive Sleep Apnea (OSA): This is the most common type, accounting for about 90% of patients.
Soft tissue near the throat can obstruct the airway, causing the upper airway to become narrower, which leads to snoring and breathing cessation.
Common triggers include anatomical abnormalities of the upper airway, excessive relaxation of the airway muscles, and obesity.
2.
Central Sleep Apnea: This occurs when the brain is unable to send signals to the muscles that control breathing due to a stroke, trauma, or other issues.
If you have sleep apnea, it can increase the burden on the cardiovascular system and raise the risk of cardiovascular diseases such as hypertension, arrhythmias, coronary artery disease, myocardial infarction, heart failure, and stroke.
Clinically, patients with poorly controlled conditions like diabetes and hypertension often have underlying sleep apnea syndrome.
I recommend that you consult a sleep medicine specialist to discuss testing and treatment options.
Wishing you good health, peace, and joy.
Dr.
Tao cares about you.

Reply Date: 2018/01/23

More Info

Unexplained dizziness can be a perplexing and distressing symptom, especially when it occurs alongside other sensations such as fatigue, weakness, and nausea. Your detailed account of your medical history and the various tests you've undergone is very helpful in understanding your situation. It seems that you have already ruled out many potential causes through extensive medical evaluations, which is a significant step in addressing your concerns.

From what you've described, it appears that you have several underlying health conditions, including hypertension, peptic ulcers, and benign arrhythmias, all of which are being managed with medication. The fact that your blood pressure is well-controlled and that your cholesterol levels have improved is encouraging. However, the persistent episodes of dizziness and associated symptoms can still be troubling, especially when they disrupt your daily life.

Given that the majority of your tests have returned normal results, and considering the input from multiple specialists suggesting a possible autonomic nervous system issue, it may be beneficial to explore this avenue further. The autonomic nervous system regulates involuntary bodily functions, including heart rate, blood pressure, and digestion. Dysregulation in this system can lead to symptoms like dizziness, fatigue, and even gastrointestinal disturbances.

Here are some recommendations for further evaluation and management:
1. Consult a Neurologist Specializing in Autonomic Disorders: Since many doctors have suggested that your symptoms may be related to autonomic dysfunction, it could be helpful to see a neurologist who specializes in this area. They may conduct specific tests, such as tilt table testing, to assess how your body responds to changes in position and to evaluate autonomic function more thoroughly.

2. Consider a Comprehensive Evaluation of Vestibular Function: Since you mentioned some imbalance in your inner ear, a vestibular rehabilitation specialist could help assess your balance and dizziness. They may recommend exercises to improve your vestibular function and reduce dizziness.

3. Psychological Evaluation: Given that anxiety and stress can exacerbate physical symptoms, a consultation with a mental health professional may be beneficial. Cognitive-behavioral therapy (CBT) is particularly effective for managing anxiety and can help you develop coping strategies for dealing with your symptoms.

4. Lifestyle Modifications: Since you have a history of gastrointestinal issues, dietary adjustments may also play a role in managing your symptoms. Keeping a food diary to identify any potential triggers for your symptoms could be useful. Additionally, ensuring adequate hydration and maintaining a balanced diet can support overall health.

5. Medication Review: If you find that certain medications, like the benzodiazepine you mentioned, provide immediate relief, it may be worth discussing with your doctor the possibility of adjusting your medication regimen. While these medications can be effective for acute anxiety, they are not typically recommended for long-term use due to potential dependency issues.

6. Regular Monitoring: Since your symptoms are episodic, keeping a detailed log of when they occur, their duration, and any associated activities or stressors can provide valuable information for your healthcare providers. This log can help identify patterns that may lead to a better understanding of your condition.

7. Stay Informed and Advocate for Yourself: Continue to seek answers and advocate for your health. If you feel that your concerns are not being addressed, don’t hesitate to seek a second opinion or explore other specialists who may offer new insights.

In conclusion, while it can be frustrating to deal with unexplained dizziness, a multidisciplinary approach involving neurologists, vestibular specialists, and mental health professionals may provide the comprehensive care you need. Remember that managing chronic symptoms often requires patience and persistence, and you are not alone in this journey.

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