Sudden Weakness in the Back of the Head and Limbs: Possible Causes and Next Steps

Sudden weakness in the back of the head and limbs?

Hello, doctor.
Over the past month, I have experienced two episodes of symptoms similar to what I described in the subject.
It feels like I am about to lose my balance, but my consciousness remains clear.
Additionally, I have been experiencing dry heaving intermittently throughout the month, and occasionally, I have sudden unilateral tinnitus or a feeling of pressure in my ears one or two times a day.
Last month, during the first episode, I went to the emergency room and had a CT scan of my head and neck, which showed no signs of an aneurysm.
I followed up with two visits; one included a blood test for embolism markers, which came back normal, and the other was a consultation with a neurologist who assessed my condition and found no major issues, although no electromyography or other tests were performed.
Today, I had a second episode, during which my heart rate spiked to about 150 beats per minute, and my blood pressure reached 139/93.
After resting for about 20 minutes, both returned to normal, and the sudden weakness in the back of my head and limbs, along with the dry heaving, also subsided, so I did not return to the emergency room.
Both episodes occurred shortly after dinner and lunch, respectively.
I would like to ask the doctor what further examinations I could consider in the future.
I am unsure if there might be issues related to the cerebellum or brainstem, or if this could be attributed to autonomic nervous system dysfunction, or if it is similar to what was discussed during my previous hospital visits, where anxiety was suggested as a possible factor.
Thank you for your patient response.

Shawn, 30~39 year old female. Ask Date: 2022/10/16

Dr. Jiang Junyi reply Neurology

Hello Mr.
Shawn,
You mentioned that "after the episode, my heart rate rises to about 150, and my blood pressure reaches 139/93, but after resting for about 20 minutes, both return to normal...
I'm not sure if there might be an issue with the cerebellum or brainstem, or if it is related to autonomic nervous system dysfunction." Abnormal autonomic nervous system function and inner ear imbalance can both contribute to your symptoms.
In addition to magnetic resonance imaging (MRI), we can arrange for autonomic nervous system testing and blood tests to assist in the evaluation.
Blood tests may include screening for possible complications such as anemia, hyperthyroidism/hypothyroidism, diabetes, recurrent vestibular neuritis, autoimmune diseases, neurosyphilis, and central nervous system disorders.

"The two episodes occurred after dinner and lunch," which is typically associated with instability in the autonomic nervous system and blood sugar levels following meals.
I recommend that you consult with different neurologists or cardiologists at the same facility to discuss further examinations and treatments, as this may provide you with different perspectives.
Thank you for your inquiry, and feel free to discuss any related questions further! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2022/10/16

More Info

Based on your description, it seems you are experiencing a concerning set of symptoms that include sudden weakness in the back of your head and limbs, episodes of dry heaving, unilateral tinnitus, and fluctuations in heart rate and blood pressure. These symptoms can be indicative of several potential underlying issues, and it is essential to approach them with caution.

Firstly, the sudden weakness you describe, particularly in the back of the head and limbs, could be related to neurological conditions. While your previous CT scans did not reveal any vascular malformations, it is still crucial to consider other possibilities such as transient ischemic attacks (TIAs) or even migraines with aura, which can sometimes present with neurological deficits. TIAs are often referred to as "mini-strokes" and can cause temporary weakness or numbness, typically resolving within 24 hours. Given that your symptoms have occurred in episodes, this is a possibility that should be explored further.

The episodes of dry heaving and the sensation of unilateral tinnitus could suggest a vestibular issue or a problem with the inner ear, which can affect balance and spatial orientation. This could also be related to migraines, as vestibular migraines can cause dizziness, tinnitus, and nausea. Additionally, the fact that your symptoms seem to occur after meals may suggest a connection to autonomic nervous system regulation, which can be influenced by digestion and blood flow.

Your elevated heart rate and blood pressure during these episodes could indicate a sympathetic nervous system response, often associated with anxiety or panic attacks. Anxiety can manifest physically in various ways, including increased heart rate, sweating, and gastrointestinal disturbances. However, it is essential to differentiate between anxiety-related symptoms and those stemming from a more serious medical condition.

Given the complexity of your symptoms, I recommend the following steps for further evaluation:
1. Neurological Evaluation: A comprehensive neurological examination by a specialist is crucial. This may include additional imaging studies such as an MRI of the brain to rule out any structural abnormalities, particularly in the cerebellum or brainstem.

2. Electrophysiological Studies: An electromyography (EMG) and nerve conduction studies may help assess the function of your nerves and muscles, particularly if there is concern about peripheral nerve involvement.

3. Vestibular Assessment: If you are experiencing balance issues or dizziness, a referral to an otolaryngologist (ENT) or a neurologist specializing in vestibular disorders may be warranted. They can perform tests to evaluate your inner ear function.

4. Cardiac Evaluation: Since you have experienced fluctuations in heart rate and blood pressure, a cardiac evaluation, including an ECG and possibly a Holter monitor, may be beneficial to rule out any arrhythmias or other cardiac issues.

5. Psychological Assessment: If anxiety is suspected to be a contributing factor, a consultation with a mental health professional may help address these concerns and provide coping strategies.

6. Lifestyle Modifications: In the meantime, consider keeping a symptom diary to track when these episodes occur, their duration, and any potential triggers (such as food intake, stress, or physical activity). This information can be invaluable for your healthcare provider in determining the underlying cause.

In conclusion, while your previous evaluations have not indicated any severe issues, the recurrence of your symptoms warrants further investigation. It is essential to remain proactive about your health and seek the appropriate specialist consultations to ensure that any potential underlying conditions are identified and managed effectively. Your health and well-being are paramount, and addressing these symptoms comprehensively will help you achieve a clearer understanding of your situation.

Similar Q&A

Persistent Dizziness and Weakness: Understanding Neurological Concerns

Three weeks ago, one day, I suddenly felt dizzy in the back of my head, and my limbs felt weak and sleepy. This has been happening for three consecutive weeks; even after getting a full 8 hours of sleep, it doesn't help. I feel very dizzy even when turning my head, and my le...

Dr. Ye Boshou reply Neurology
If you are experiencing dizziness, please visit a neurology clinic for an evaluation.

Understanding Weakness and Numbness in Limbs: Possible Causes and Concerns

Hello doctor, I experienced a sudden increase in blood pressure today, and I'm not sure why. Sometimes my hands feel weak, and I have a tingling sensation in the thumb area of my palm. I also feel weakness in my calves, and at times my legs feel weak, either both or just one...

Dr. Hong Weibin reply Neurology
Hello: Based on your description, it seems difficult to pinpoint a specific neurological disorder. If daily activities, including walking, exercising, and self-care, are not problematic, it may be due to psychosocial stress or environmental factors. It would be advisable to conti...

Sudden Weakness in Both Arms: Causes and Next Steps for Diagnosis

Hello Doctor, my mother was born in 1947 and has recently experienced sudden weakness in both hands (she describes it as a feeling like blood is not flowing to her hands). This has occurred 2 to 3 times in September. She mentioned that there is no specific time or action that tri...

Dr. Cai Zongzhang reply Neurology
Hello, Tong: Based on the description, the weakness in both hands is intermittent and non-persistent. It is important to consider cervical spine pain leading to nerve or spinal cord compression. It is recommended to visit a neurology clinic for examination.

Understanding Neurological Symptoms: When to Seek Immediate Help

Hello Doctor: Thank you for your clarification. I am currently scheduled for a brain MRI at the hospital, but the appointment is set for a month from now. The doctor has advised me to return for a follow-up after the examination. During this time, some of my original symptoms hav...

Dr. Jiang Junyi reply Neurology
Hello: Your symptoms may initially suggest common hyperventilation syndrome. Sudden weakness could also indicate cerebrovascular disease or abnormal electrical discharges. However, if the symptoms are urgent and you are concerned about further deterioration, it is advisable to vi...