Symptoms: Dizziness, Headaches, and Optic Nerve Swelling

Dizziness, headache, and optic nerve edema?

Hello Doctor, since May 20th of this year, I have experienced symptoms such as blurred vision, dizziness, headaches, a sensation of something stuck in my throat, and difficulty breathing.
After visiting an ENT clinic, the doctor suggested it might be anxiety disorder and prescribed medication, which helped somewhat.
However, the dizziness has been intermittent and continues to this day.
After receiving the AstraZeneca vaccine on June 20th, I experienced palpitations that reached 140 beats per minute, leading to a visit to the emergency room where I was given a sedative.
I also took Xanax, which provided some relief, but within three weeks, the palpitations became frequent again.
After two and a half months without episodes, the palpitations returned this month, prompting three visits to the emergency room.
I underwent cardiovascular examinations, including a 24-hour Holter monitor and echocardiogram, which showed no significant issues.
Later, a psychiatrist suggested it might be panic disorder and prescribed medication for three weeks.
However, I felt very uncomfortable after taking it for one day and stopped, only taking the medication as needed during episodes.
I have also been experiencing persistent blurred vision, leading to an eye examination where the doctor found optic nerve edema and referred me to a neurologist for hospitalization.
What kind of tests should I expect during this examination? Given my long-term insomnia, dizziness, headaches, optic nerve edema, palpitations, tremors, numbness in my hands and feet, difficulty breathing, and the sensation of something stuck in my throat, what could be causing these symptoms? I truly feel very distressed.
Thank you, Doctor.

Wu Min, 30~39 year old female. Ask Date: 2021/10/02

Dr. Jiang Junyi reply Neurology

Dear Ms.
Wu,
There are many causes of headaches.
If your headaches are related to your menstrual cycle, the likelihood of migraines is higher.
However, conditions such as anemia, autonomic dysfunction, and inner ear imbalance may also contribute to your symptoms.
First, it is important to rule out anemia or dehydration, which could lead to insufficient cerebral circulation.
Symptoms such as dizziness and headaches can be improved by replenishing fluids and electrolytes.
Blood tests can assist in evaluating your condition.
These tests should include screening for possible complications such as anemia, hyperthyroidism, diabetes, recurrent vestibular neuritis, autoimmune diseases, neurosyphilis, and central nervous system disorders.

You mentioned "optic nerve edema," which may indicate increased intracranial pressure.
This aspect requires brain imaging studies for further diagnosis.
I recommend that you visit a neurology clinic for follow-up examinations.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to preventive health measures before and after your medical visits.
Thank you for your inquiry.
If you have any further questions, feel free to discuss them!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2021/10/02

More Info

Your symptoms of dizziness, headaches, visual disturbances, and other associated issues such as throat tightness and difficulty breathing are indeed concerning and warrant a thorough evaluation by a neurologist. The combination of these symptoms can be indicative of several underlying conditions, and it is essential to approach this systematically.

Firstly, the presence of visual disturbances, particularly the swelling of the optic nerve (optic disc edema), is a significant finding. This condition can arise from various causes, including increased intracranial pressure, inflammation, or even systemic conditions such as hypertension or certain infections. The fact that you have experienced headaches and dizziness alongside these visual symptoms raises the suspicion of a possible neurological issue that needs to be addressed.

Given your history of anxiety and panic attacks, it is also important to consider how these psychological factors may contribute to your physical symptoms. Anxiety can manifest in various ways, including dizziness, palpitations, and a sensation of tightness in the throat. However, the presence of optic nerve swelling suggests that there may be a more complex interplay of factors at work.

In terms of the diagnostic workup, the neurologist will likely consider several tests to evaluate your condition comprehensively. These may include:
1. Magnetic Resonance Imaging (MRI): This is crucial for visualizing the brain and surrounding structures to rule out any mass lesions, inflammation, or other abnormalities that could explain your symptoms.

2. Lumbar Puncture (Spinal Tap): If increased intracranial pressure is suspected, a lumbar puncture may be performed to measure the pressure of the cerebrospinal fluid (CSF) and analyze its composition for signs of infection or inflammation.

3. Visual Field Testing: This can help assess the extent of any visual field loss associated with optic nerve swelling.

4. Blood Tests: These may be conducted to check for systemic conditions such as thyroid dysfunction, inflammatory markers, or infections that could be contributing to your symptoms.

5. Electrocardiogram (ECG) and Holter Monitoring: Given your episodes of palpitations, these tests can help assess your heart's rhythm and rule out any cardiac issues.

6. Neuro-ophthalmological Evaluation: A specialist may be consulted to further assess the optic nerve and visual pathways.

Your symptoms of long-term insomnia, persistent dizziness, headaches, and the recent onset of heart palpitations and tremors could be indicative of a multifactorial condition. Conditions such as migraines, tension-type headaches, or even more serious issues like intracranial hypertension or multiple sclerosis could be considered based on your symptoms and examination findings.

It is also essential to address your mental health, as anxiety and panic disorders can exacerbate physical symptoms. Working closely with both a neurologist and a mental health professional can provide a more holistic approach to your treatment.

In conclusion, while your symptoms are distressing and complex, a thorough evaluation by a neurologist is the appropriate next step. They will guide you through the necessary tests and help formulate a treatment plan that addresses both your physical and psychological health. Please ensure you communicate all your symptoms clearly during your appointments, as this will aid in accurate diagnosis and management. Your health and well-being are paramount, and seeking help is a crucial step towards feeling better.

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