Persistent Dizziness and Discomfort: A Neurological Perspective

Q: Persistent Dizziness and Discomfort: A Neurological Perspective

Hello： Many factors can cause symptoms of dizziness, such as anemia, autonomic dysfunction, inner ear imbalance, and even Meniere's disease. <br>Blood tests should include the differentiation of possible complications (anemia, hyperthyroidism/hypothyroidism, diabetes, recurrent v

Dizziness / Eyes / Ears / Soreness

Hello, I would like to ask about a sudden onset of dizziness I experienced one day, followed by discomfort and a feeling of pressure in one eye.
After visiting an ophthalmologist, I was told everything was fine.
Then, I started experiencing ear fullness on one side (which subsided when lying down), but an ENT specialist couldn't find anything wrong either.
Subsequently, I began to have shoulder pain.
One time, I experienced severe dizziness, and that night I started having difficulty breathing, a sensation of a foreign body in my throat, intense dizziness, and nausea that I couldn't relieve.
I thought it was gastroesophageal reflux.
Eventually, the nausea subsided, and my appetite returned.
However, I began to experience worsening dizziness daily, primarily a heavy-headed feeling (lying back or down provides some relief).
Currently, I still have significant dizziness, along with strange sensations in my eye and ear, all on the same side.
In the past few days, I've occasionally felt tightness and numbness on one side of my back and face.
I went to the hospital for a brain scan, but nothing was found.
I would like to know what these symptoms might indicate.
It has been a month since these issues began, and the dizziness has not improved.
What should I do? (The discomfort in my eye, ear, and head is all on the same side.)

Ru Ru, 20~29 year old female. Ask Date: 2018/09/18

Dr. Jiang Junyi reply Neurology

Hello: Many factors can cause symptoms of dizziness, such as anemia, autonomic dysfunction, inner ear imbalance, and even Meniere's disease.
Blood tests should include the differentiation of possible complications (anemia, hyperthyroidism/hypothyroidism, diabetes, recurrent vestibular neuritis, autoimmune diseases, neurosyphilis, and central nervous system disorders).
For female patients, it is important to rule out anemia or fluid deficiency that may lead to insufficient cerebral circulation.
Symptoms can be improved by replenishing fluids and electrolytes.
It is recommended that you discuss examinations and treatments with a neurologist.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Medical Center cares about you.

Reply Date: 2018/09/18

More Info

Hello! Thank you for sharing your concerns regarding your persistent dizziness and discomfort. Based on your description, it sounds like you are experiencing a complex set of symptoms that may involve multiple systems, including neurological, vestibular (related to balance), and possibly even psychological components.

Understanding Your Symptoms
1. Dizziness and Pressure Sensation: The sudden onset of dizziness, especially when accompanied by a feeling of pressure in one eye and ear, can be indicative of several conditions. One possibility is vestibular neuritis or labyrinthitis, which are inner ear disorders that can cause dizziness and balance issues. These conditions often arise after a viral infection and can lead to symptoms such as vertigo, imbalance, and sometimes hearing changes.

2. Shoulder Pain and Tension: The shoulder pain you mentioned could be related to muscle tension, which is often a response to stress or discomfort. When we experience dizziness, it can lead to anxiety, which may cause us to tense our muscles, particularly in the neck and shoulders.

3. Breathing Difficulties and Nausea: The episodes of breathing difficulties, throat discomfort, and nausea could suggest a panic attack or anxiety-related response, especially if they occur during periods of heightened stress or discomfort. It's not uncommon for anxiety to manifest physically, leading to sensations of tightness in the throat and difficulty breathing.

4. Neurological Evaluation: Since you've undergone neurological imaging that returned normal results, this is reassuring as it suggests that there are no significant structural abnormalities in the brain. However, persistent symptoms warrant further investigation, particularly if they are affecting your quality of life.

Potential Causes
Given the combination of symptoms, here are a few potential causes to consider:
- Vestibular Disorders: Conditions affecting the inner ear can lead to dizziness and balance issues. These may not always show up on standard imaging but can be diagnosed through specialized tests.

- Anxiety and Panic Disorders: Anxiety can lead to physical symptoms, including dizziness, feelings of pressure, and gastrointestinal discomfort. If you find that your symptoms worsen during stressful situations, this could be a contributing factor.

- Cervical Issues: Sometimes, issues in the cervical spine (neck) can lead to dizziness and shoulder pain due to nerve compression or muscle tension.

Recommendations
1. Follow-Up with Specialists: Since you've already seen an ophthalmologist and an ENT specialist, consider consulting a neurologist who specializes in vestibular disorders. They may recommend tests such as a vestibular function test or a balance assessment.

2. Physical Therapy: Vestibular rehabilitation therapy can be beneficial for individuals experiencing dizziness. A physical therapist can guide you through exercises designed to improve balance and reduce dizziness.

3. Manage Anxiety: If anxiety is a contributing factor, consider speaking with a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective in managing anxiety and its physical manifestations.

4. Lifestyle Modifications: Ensure you are staying hydrated, managing stress through relaxation techniques, and maintaining a healthy diet. Regular physical activity can also help alleviate tension and improve overall well-being.

5. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare provider in determining the best course of action.

Conclusion
Persistent dizziness and discomfort can be distressing, but with the right approach and support, it is possible to find relief. Continue to advocate for your health, seek appropriate specialists, and consider both physical and psychological aspects of your symptoms. Remember, you are not alone in this, and there are effective treatments available to help you regain your quality of life.

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