Symptoms: Difficulty Swallowing, Coordination Issues, and Double Vision

Dysphagia, ataxia leading to frequent falls, and diplopia?

Hello, I would like to ask which specialty should be consulted for these symptoms and what potential issues they may indicate.
My family member has recently reported that she has become very prone to falling, often misjudging distances which leads to stepping into empty spaces.
She experiences significant coordination problems, frequently dropping items (like her wallet or phone) and spilling drinks two to three times a day.
Recently, she has noticed that drinking liquids or eating solid foods often leads to choking.
Although she has had her vision checked and received a prescription, she still finds it difficult to see the computer screen, with letters appearing overlapped.
She also experiences ear pain and tinnitus, and often forgets to swallow after holding water in her mouth for five minutes.
These symptoms have persisted for over six months and seem to be gradually worsening.

Here is her current medical history: she has no cardiovascular diseases, smokes, drinks alcohol, is a 31-year-old female, has had severe asthma for over eight years, and her doctor has suggested further pulmonary function tests.
She has a history of corneal injury, which has resulted in significant visual disparity, suffers from nasal allergies, and frequently experiences gastric ulcers.
Thank you very much!

Zhang, 30~39 year old female. Ask Date: 2018/07/23

Dr. Huang Xunying reply Family Medicine

Hello, please schedule an appointment with the neurology department as soon as possible.
Thank you for your inquiry.

Reply Date: 2018/07/23

More Info

Based on the symptoms you've described regarding your family member's condition, it is essential to approach this situation with a comprehensive understanding of the potential underlying issues. The symptoms of difficulty swallowing, coordination problems, double vision, and the tendency to drop objects or misjudge distances can indicate several medical concerns that warrant further investigation.

Firstly, the difficulty swallowing (dysphagia) can arise from various causes, including neurological disorders, muscular issues, or even structural abnormalities in the throat or esophagus. Given that your family member has a history of severe asthma, it is crucial to consider whether there might be any respiratory complications affecting her swallowing ability. Asthma can lead to chronic cough and may contribute to swallowing difficulties if there is associated inflammation or sensitivity in the throat.

The coordination issues and frequent falls could suggest a neurological problem. Conditions such as multiple sclerosis, Parkinson's disease, or even a transient ischemic attack (TIA) could manifest with these symptoms. It is important to note that coordination problems can also stem from vestibular disorders, which affect balance and spatial orientation. The mention of ear pain and tinnitus (ear ringing) could further indicate a vestibular issue, as the inner ear plays a critical role in balance.

Double vision (diplopia) is another significant symptom that should not be overlooked. This can occur due to issues with the eye muscles, cranial nerve dysfunction, or even neurological conditions affecting the brainstem. Given her history of corneal injury, it is also possible that there could be residual effects impacting her vision.
The combination of these symptoms, particularly the gradual worsening over six months, suggests that a multidisciplinary approach is necessary. It would be advisable for her to see a neurologist to evaluate the coordination and vision issues comprehensively. A thorough neurological examination, including imaging studies like an MRI or CT scan, may be warranted to rule out any serious conditions.

Additionally, a consultation with an ear, nose, and throat (ENT) specialist could be beneficial, especially considering her ear pain and swallowing difficulties. The ENT can assess for any structural issues or infections that may be contributing to her symptoms.

Furthermore, given her history of allergies and gastrointestinal issues like peptic ulcers, it may also be worthwhile to consult a gastroenterologist. They can evaluate whether any esophageal problems are contributing to her swallowing difficulties.

In summary, your family member's symptoms are complex and multifaceted, indicating that a thorough evaluation by specialists in neurology, ENT, and possibly gastroenterology is essential. Early intervention and accurate diagnosis are crucial for managing her symptoms effectively and improving her quality of life. It is important not to delay seeking medical attention, especially since her symptoms have been progressively worsening.

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