Chronic Dizziness and Visual Disturbances: When to Seek Help

Q: Chronic Dizziness and Visual Disturbances: When to Seek Help

Hello： Your symptoms seem to be more related to neurology. <br>Regarding the central nervous system： 1. <br>You experience motion sickness almost every time you are in a vehicle, and strong odors also make you feel dizzy (possibly a variant of migraine?). <br>2. <br>You often cho

Chronic dizziness and impaired visual acuity?

Hello Doctor, I was diagnosed with a tendency to feel dizzy from hunger as a child, often without realizing it (not feeling hungry or wanting to eat).
Now, I eat three meals on time, but I still experience dizziness for no apparent reason.
Sometimes I have migraines (mostly on the left side), and at times my head feels heavy, making it very uncomfortable unless I lie down.
I try to take deep breaths but feel like I can't get enough air, and the dizziness feels trapped and won't release.
If I suddenly stop while walking, I experience a sudden wave of dizziness, and turning my head also triggers it.
My balance is generally poor, and I often feel unsteady, but it doesn't reach the point of severe vertigo where I can't stand or walk; I just tend to lean to one side without falling.
Additionally, I have visual issues that have troubled me since my school days, such as skipping lines while reading, missing words, or even entire paragraphs (several lines of text) without noticing.
Sometimes I misinterpret what I see, like reading a single-sided page as double-sided (the words "single" and "double" often appear together).
When writing, I also confuse words, such as writing "呼吸" (breathe) as "呼收" (absorb) or "法律" (law) as "津" (two characters combined).
I can copy the same text incorrectly, writing "A" as "B" or misreading "12" as "21." I also mix up similar words when writing or typing, such as writing "不會" (not able) as "無會" (no meeting) or "沒有" (not have) as "不有" (not have).
There have been instances where I misjudge distances while walking; for example, I saw a chair in front of me and lifted my foot to step over it, but still kicked the chair.
I also misjudged the distance to someone in front of me and ended up stepping on their heel instead of going around them.
Sometimes, when someone extends their hand to give me something, I still accidentally touch their body when I reach for it.
Although this doesn't happen every time, it occurs frequently enough to raise concern.
Lastly, I often choke on water (I feel like I'm about to choke at the moment of swallowing), and sometimes I do choke while other times I don't.
Choking shouldn't be a reflex action, right? Eating food is generally fine; I can eat slowly without issues, but if I rush, I easily choke.
For your reference, I often get motion sickness in cars, almost always feeling dizzy when in a vehicle, and strong, pungent odors also make me dizzy.
I had blood tests done, and my hemoglobin was around 11, indicating mild anemia, but it shouldn't cause such discomfort, right? My blood oxygen level was tested at 100, and the clinic doctor said it was normal.

Once, during a very cold winter, I was so cold that I shivered and couldn't sleep, with my heart racing strongly and quickly for almost a week.
I went to the hospital for a cardiac ultrasound, and the results were normal.
Occasionally, I experience mild chest pains for a second or two (sometimes on the left side, sometimes on the right, so it shouldn't be a heart issue?).
I have seen an ophthalmologist, who ruled out strabismus and worsening myopia.
Should I seek medical attention? If so, which specialty would you recommend? (Neurology, ENT, or psychiatry?) Sometimes I feel normal, but when symptoms arise, they significantly impact my life, especially the dizziness, which is very bothersome.
I also worry about misreading things affecting my work, causing some psychological stress.
Thank you.

Fan Fan, 20~29 year old female. Ask Date: 2019/06/02

Dr. Jiang Junyi reply Neurology

Hello: Your symptoms seem to be more related to neurology.
Regarding the central nervous system: 1.
You experience motion sickness almost every time you are in a vehicle, and strong odors also make you feel dizzy (possibly a variant of migraine?).
2.
You often choke when drinking water (brainstem reflex?).
3.
You noticed an obstruction in front of you, and when you lifted your foot to step over it, you still kicked the chair (spatial awareness issue).
4.
You have visual problems, often skipping lines and missing words while reading during your school years (possibly related to the cerebral cortex?).
Regarding the autonomic nervous system: 1.
Your heart beats strongly and rapidly, persisting for almost a week.
2.
You feel a heavy sensation in your head, and it is very uncomfortable unless you lie down; you want to take deep breaths but feel unable to catch your breath.
I recommend that you consult a neurologist for examination and discussion.
Wishing you good health.
Sincerely, Dr.
Jiang from Taoyuan Hospital, Neurology Department.

Reply Date: 2019/06/02

More Info

It sounds like you're experiencing a complex array of symptoms that are significantly impacting your daily life. Chronic dizziness, visual disturbances, and the issues you've described with perception and coordination can be quite distressing. Let's break down your symptoms and discuss when it might be appropriate to seek further medical evaluation.

Understanding Your Symptoms
1. Chronic Dizziness: The sensation of dizziness can stem from various causes, including vestibular disorders, neurological issues, or even anxiety. Given your history of migraines and the sensation of feeling off-balance, it might be worthwhile to explore vestibular function. Conditions like vestibular migraine can cause dizziness and balance issues without the typical headache.

2. Visual Disturbances: The problems you describe with reading, such as skipping lines or mixing up letters and words, could indicate a visual processing issue. This might not necessarily be related to your eyesight but could involve how your brain interprets visual information. Conditions like dyslexia or other learning disabilities can manifest in this way, even if you have normal vision.

3. Coordination and Distance Judgment: The difficulty you experience in judging distances and your tendency to bump into objects may suggest issues with spatial awareness, which can be linked to neurological function. This could be related to your dizziness and balance problems.

4. Swallowing Difficulties: The sensation of choking or difficulty swallowing can be alarming. This could be due to a variety of reasons, including esophageal issues or even anxiety. If this is a frequent occurrence, it warrants further investigation.

5. Anemia and Other Health Concerns: Your mild anemia (hemoglobin of 11) might contribute to feelings of fatigue and dizziness, but it seems unlikely to be the sole cause of your symptoms. It's good that your blood oxygen levels are normal, as this rules out some respiratory issues.

When to Seek Help
Given the complexity of your symptoms, it would be advisable to seek a comprehensive evaluation. Here are some recommendations on which specialists to consider:
- Neurologist: Given your symptoms of dizziness, migraines, and visual disturbances, a neurologist can assess for any underlying neurological conditions. They may conduct imaging studies or other tests to evaluate brain function and rule out conditions such as multiple sclerosis or other neurological disorders.

- Otolaryngologist (ENT): An ENT specialist can evaluate your vestibular system, which is crucial for balance. They can perform tests to assess inner ear function, which might explain your dizziness and balance issues.

- Psychiatrist or Psychologist: If anxiety or stress is a significant factor in your symptoms, consulting a mental health professional could be beneficial. They can help you develop coping strategies and assess whether your symptoms are exacerbated by psychological factors.

- Speech and Language Therapist: If swallowing difficulties persist, a speech therapist can evaluate your swallowing function and provide strategies to manage this issue.

Conclusion
Your symptoms are multifaceted, and while they may not all be interconnected, they certainly warrant a thorough investigation. It’s essential to communicate openly with your healthcare providers about the full range of your symptoms, as this will help them make a more accurate diagnosis. Keeping a symptom diary, noting when symptoms occur and their severity, can also be helpful for your doctors.

In summary, seeking help from a neurologist and an ENT specialist would be a good starting point. They can work together to provide a comprehensive evaluation of your symptoms. Remember, you are not alone in this, and there are professionals who can help you navigate these challenges. Don't hesitate to reach out for the support you need.

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