Blackouts, Dizziness, and Tinnitus: Neurological Concerns

Flashing black in the eyes, dizziness, tinnitus?

For the past three to four months, I have occasionally experienced episodes of my vision going black.
Initially, it felt like a cloth was being placed over my eyes from above for a second and then lifted.
However, as of yesterday, the blackout sensation changed to feeling like someone suddenly turned off the lights, lasting only about a second.
Recently, I experienced dizziness to the point where I had to hold onto something for support.
After removing my mask and sitting down to rest, I felt somewhat better, but the dizziness persisted for several hours.

In recent years, I have frequently experienced tinnitus, which used to be high-pitched but has recently included occasional low thumping sounds, sometimes unilateral, especially noticeable at night while sleeping.
Since middle school, I have had occasional headaches, but they have been infrequent.
Initially, the pain was localized to my temples, but now it radiates from my neck to my temples.
Typically, the pain resolves after a good night's sleep.
There is a family history of stroke in my household, and I am very concerned that these symptoms could be precursors to a stroke or a brain tumor.
My anxiety has escalated to the point where I feel depressed; during the Lunar New Year family dinner, while everyone else was laughing, I was crying while eating.
I am very afraid.

I have undergone several examinations: at the ophthalmology clinic, I had a fundus examination; at Fu Jen Catholic University’s cardiology department, I had an echocardiogram and an electrocardiogram; and at the neurology department, I had a neck ultrasound and another fundus examination, which revealed a retinal tear in my right eye.
The cardiologist noted that there is a slight issue with a heart valve not closing properly, but it is not significant.
However, I have not undergone a brain MRI.

six four, 20~29 year old female. Ask Date: 2023/01/21

Dr. Peng Shiwei reply Neurology

Hello, based on your symptoms, my first step would be to rule out unilateral carotid artery stenosis causing transient visual disturbances, or cardiac issues such as arrhythmias that could lead to similar symptoms.
However, if the carotid ultrasound and cardiac evaluations come back normal, the likelihood of having a brain tumor should be considered very low.
If you are still concerned and the symptoms persist, you may discuss with your neurologist whether an MRI scan is necessary.
Thank you for your inquiry.

Reply Date: 2023/01/21

More Info

Understanding the symptoms of blackouts, dizziness, and tinnitus can be quite complex, especially when considering the potential neurological concerns that may arise. Based on your description, it seems you are experiencing a combination of visual disturbances, dizziness, and tinnitus, which can be indicative of several underlying conditions.

Firstly, the episodes of "blacking out" or experiencing visual disturbances, such as seeing a dark veil or a sudden loss of vision, can be related to various factors. These may include transient ischemic attacks (TIAs), which are often referred to as "mini-strokes," or they could be related to migraines with aura. Migraines can cause visual disturbances and are sometimes accompanied by dizziness. Given your family history of stroke, it is essential to take these symptoms seriously and discuss them with a healthcare professional.

Dizziness, especially if it is severe enough to require you to hold onto something for support, can be caused by several issues. It could be related to vestibular disorders, which affect the inner ear and balance, or it could be due to orthostatic hypotension, where blood pressure drops significantly when standing up. Additionally, anxiety and panic attacks can also manifest as dizziness and may be exacerbated by your concerns about your health.

Tinnitus, or ringing in the ears, is another symptom that can have multiple causes. It can be associated with hearing loss, ear infections, or even neurological conditions. The fact that you are experiencing both high-frequency tinnitus and a more rhythmic "thumping" sound could suggest different underlying issues. It is not uncommon for tinnitus to fluctuate in intensity and character, and stress or anxiety can often exacerbate these symptoms.

Given your concerns about a potential stroke or brain tumor, it is crucial to pursue further evaluation. While you have undergone several tests, including eye examinations and cardiac evaluations, a brain MRI (magnetic resonance imaging) would be a valuable next step. An MRI can provide detailed images of the brain and help identify any structural abnormalities, such as tumors or signs of previous strokes.

In addition to imaging studies, it may be beneficial to consult with a neurologist who can perform a comprehensive evaluation of your symptoms. They may consider conducting additional tests, such as blood tests to check for any metabolic or hematological issues, and possibly a referral for vestibular testing if balance issues persist.

Lastly, it is important to address the emotional toll that these health concerns are taking on you. Anxiety and depression can significantly impact your quality of life, and it may be helpful to speak with a mental health professional. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can provide support and coping strategies to manage your anxiety about your health.

In summary, while your symptoms may be concerning, a thorough evaluation by a healthcare professional is essential to determine the underlying causes. It is crucial to address both the physical and emotional aspects of your health to ensure a comprehensive approach to your well-being. Please consider scheduling an appointment with a neurologist and discussing the possibility of an MRI to further investigate your symptoms.

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