Neurological Symptoms: Seeking Solutions for Chronic Fatigue and Dizziness

Hello, Dr. Jiang?

In April 2019, I received a combined measles vaccine and was taking medication for Helicobacter pylori.
After 1-3 days, I experienced severe throat pain, persistent phlegm, general weakness, and fatigue.
I consulted an otolaryngologist and underwent a neck ultrasound and laryngoscopy, both of which showed no issues.
Subsequently, I visited a traditional Chinese medicine practitioner, and my throat pain improved.
However, I then developed dizziness, persistent weakness, fatigue, frequent yawning, hand weakness, unsteady walking, occasional blurred vision, glare when looking at lights at night, occasional palpitations, and insomnia.
I would wake up around 6-7 AM, and these symptoms persisted daily, with dizziness and weakness being most severe in the afternoon and occasionally worsening in the morning and evening.
I consulted an ophthalmologist, who performed tests for intraocular pressure, vision, and visual field; only the visual field test showed slight defects.
I also underwent brainstem auditory evoked potential testing, CT scans, electrocardiograms, myasthenia gravis testing, and blood tests (for anemia, diabetes, thyroid, adrenal, and liver function), all of which returned normal results.
Due to my work, I spend long hours on the computer, leading to stiffness in my shoulders and neck.
A neck X-ray revealed some curvature, but the orthopedic specialist stated it was not significant.
Ultimately, the doctors diagnosed me with autonomic nervous system dysregulation.
I also consulted a psychiatrist and took B vitamins and antidepressants for nearly 2-3 months without improvement.
By July 2020, I still experienced dizziness, though it was not continuous.
Currently, my symptoms include dizziness, general weakness, fatigue, frequent yawning, hand weakness, unsteady walking, occasional blurred vision, glare at night, occasional palpitations, insomnia, and waking up around 6-7 AM, with these symptoms being consistent daily.
I would like to ask Dr.
Jiang for any recommendations.

wa, 30~39 year old female. Ask Date: 2020/09/04

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it is unclear whether you are experiencing overweight issues.
It may also be necessary to consider sleep apnea: if you have this condition, it can lead to daytime concentration difficulties and frequent drowsiness.

There are generally two types of sleep apnea: obstructive sleep apnea and central sleep apnea.

1.
Obstructive Sleep Apnea (OSA): This is the most common type, accounting for about 90% of cases.
It occurs when the soft tissues around the throat block the airway, causing the upper airway to become narrower, which leads to snoring and breathing interruptions.
Common triggers include anatomical abnormalities of the upper airway, excessive relaxation of the airway muscles, and obesity.
2.
Central Sleep Apnea (CSA): This type occurs when the brain fails to send the appropriate signals to the muscles that control breathing due to issues such as stroke, trauma, or other problems affecting the brain.
Patients with sleep apnea are at increased risk for cardiovascular complications due to interruptions in breathing and oxygen deprivation during sleep, which can lead to conditions such as hypertension, arrhythmias, coronary artery disease, myocardial infarction, heart failure, and stroke.
Clinically, patients with poorly controlled diabetes and hypertension often have underlying sleep apnea syndrome.
I recommend that you consult a sleep medicine specialist for evaluation and treatment.
Wishing you good health and peace.
Dr.
Jiang, Neurology, Taoyuan Medical Center.

Reply Date: 2020/09/04

More Info

Chronic fatigue and dizziness can be incredibly challenging symptoms to navigate, especially when they persist despite numerous medical evaluations and treatments. Based on your detailed history, it seems that you have undergone a comprehensive workup, including imaging studies, blood tests, and evaluations by various specialists. While it is reassuring that many serious conditions have been ruled out, the ongoing nature of your symptoms suggests that further exploration is warranted.

Firstly, it is essential to consider the possibility of chronic fatigue syndrome (CFS), which is characterized by persistent fatigue that is not alleviated by rest and is often worsened by physical or mental activity. CFS can also present with cognitive difficulties, sleep disturbances, and other symptoms that overlap with what you are experiencing. The fact that your symptoms intensified after receiving the measles vaccine could suggest a post-viral fatigue syndrome, which has been reported in some cases following vaccinations or viral infections.

Another aspect to consider is the role of the autonomic nervous system. Dysautonomia, or autonomic nervous system dysfunction, can lead to symptoms such as dizziness, fatigue, and heart palpitations. This condition can be triggered by various factors, including stress, prolonged illness, or even physical deconditioning. Given your history of neck stiffness and potential musculoskeletal issues, it may be worthwhile to explore whether physical therapy or other interventions could help alleviate some of the physical tension contributing to your symptoms.

Additionally, you mentioned experiencing visual disturbances, such as blurriness and glare at night. These symptoms could be related to a condition called visual snow syndrome or other visual processing issues. A thorough evaluation by an ophthalmologist or a neuro-ophthalmologist may provide further insights into these visual symptoms.

Regarding your treatment with antidepressants and B vitamins, it is important to note that not all patients respond to these medications in the same way. If you have not experienced any improvement after a reasonable trial period, it may be beneficial to discuss alternative treatment options with your healthcare provider. This could include exploring other classes of medications, such as those specifically targeting neuropathic pain or fatigue, or even considering cognitive behavioral therapy (CBT) to help manage the psychological aspects of chronic illness.

Lastly, lifestyle modifications can play a significant role in managing chronic fatigue and dizziness. Ensuring adequate hydration, maintaining a balanced diet, and incorporating gentle exercise, such as walking or yoga, can help improve overall well-being. Additionally, practicing good sleep hygiene and stress management techniques, such as mindfulness or relaxation exercises, may also contribute positively to your symptoms.

In summary, while your symptoms are complex and multifaceted, a multidisciplinary approach involving neurologists, rheumatologists, physical therapists, and mental health professionals may provide the most comprehensive care. It is crucial to advocate for yourself and continue seeking answers until you find a treatment plan that works for you. Remember, you are not alone in this journey, and there are healthcare providers who are willing to help you navigate these challenges.

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