Persistent Dizziness: Causes, Tests, and When to Get an MRI

Dizziness for more than two months?

Hello Doctor, I have been experiencing dizziness and shoulder and neck pain for the past two and a half months.
The symptoms include a constant feeling of dizziness throughout the day, without a sensation of spinning, nausea, unsteadiness while walking, and weakness in my limbs.
I find myself yawning frequently in the morning upon waking and also before going to bed at night.
My shoulders and neck feel stiff and sore, and pressing on them causes pain.
The temples are very tight and painful when pressed.
I visited Chang Gung Memorial Hospital's neurology department, where they arranged for a somatosensory evoked potential test, which came back normal, and a cervical spine X-ray, which was also normal.
When I asked the doctor if an MRI was necessary, he said it was not needed.
I am very concerned that there may be an issue with my brain.
The doctor mentioned that the somatosensory evoked potential test is used to check for brain problems.
Could you please help me understand what might be causing my current symptoms? How accurate is the somatosensory evoked potential test in detecting abnormalities in the brain? Can shoulder and neck pain lead to dizziness? Should I consider paying out of pocket for a brain MRI? Thank you for your assistance.

Niming, 30~39 year old female. Ask Date: 2019/10/30

Dr. Zhang Junwei reply Neurosurgery

Your issue is complex, and it is difficult to provide a complete answer without a thorough physical examination and tests.
I recommend consulting a neurology or neurosurgery outpatient clinic.

Reply Date: 2019/10/30

More Info

Persistent dizziness can be a challenging symptom to navigate, especially when it is accompanied by other discomforts such as neck pain and fatigue. Given your symptoms of constant dizziness, neck stiffness, and other associated issues, it is important to consider a variety of potential causes and the appropriate diagnostic tests.

Potential Causes of Dizziness
1. Vestibular Disorders: Conditions affecting the inner ear, such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease, can lead to dizziness. These conditions often present with a sensation of spinning or imbalance.

2. Cervical Issues: Neck pain and stiffness can indeed contribute to dizziness. Cervicogenic dizziness is a condition where neck problems lead to dizziness due to the close relationship between the cervical spine and the vestibular system.

3. Neurological Conditions: While less common, neurological issues such as migraines, multiple sclerosis, or even transient ischemic attacks (TIAs) can present with dizziness. Your concern about potential brain issues is valid, especially given the persistence of your symptoms.

4. Other Factors: Anxiety, dehydration, medication side effects, and even certain metabolic disorders can also lead to dizziness.

Diagnostic Tests
You mentioned that you underwent an evoked potential test, which is a useful tool for assessing the function of the nervous system, particularly the pathways involved in vision and hearing. While it can provide valuable information, it is not a comprehensive test for all neurological conditions. The normal results from this test are reassuring, but they do not completely rule out all potential issues.

Your neck X-ray being normal is also a positive sign, but it does not eliminate the possibility of other cervical spine issues, such as disc herniation or muscle strain, which may not be visible on X-ray.

MRI Considerations
Regarding the need for an MRI, it is a common tool used to visualize the brain and cervical spine. An MRI can help identify structural issues, such as tumors, lesions, or other abnormalities that might not be detected through other imaging methods. If your symptoms persist or worsen, or if you develop new symptoms such as severe headaches, visual changes, or weakness, an MRI may be warranted.

When to Seek Further Evaluation
1. Persistent Symptoms: If your dizziness continues for more than a few weeks without improvement, it is reasonable to seek further evaluation.

2. New Symptoms: If you experience new or worsening symptoms, such as severe headaches, changes in vision, or neurological deficits, you should consult your healthcare provider immediately.

3. Quality of Life: If dizziness significantly impacts your daily activities or quality of life, further investigation is justified.

Conclusion
In summary, while your current tests have not indicated any immediate concerns, your persistent symptoms warrant close monitoring. If you continue to experience dizziness and neck pain, consider discussing the possibility of an MRI with your healthcare provider. They can help weigh the risks and benefits based on your specific situation and symptoms. It is essential to advocate for your health and ensure that you receive the appropriate care and follow-up necessary to address your concerns.

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