Dizziness and Confusion: Possible Neurological Causes

Dizziness and altered consciousness?

Hello, doctor.
Since February of last year, I've been experiencing a heavy, dizzy sensation in my forehead and around my eyes.
This feeling has significantly impacted my daily life.
When I look at things, everything used to be clear, but since the onset of these symptoms, I often feel like my awareness can't keep up with my vision, and I even experience a bit of confusion.
I believe this heavy sensation is largely affecting my symptoms.

The symptoms first appeared one afternoon when I suddenly felt a heaviness in my forehead, and my vision gradually became blurry.
However, after resting for a bit, it improved somewhat, but the dizziness has persisted.
I have consulted an otolaryngologist, who confirmed that it is not sinusitis, and I also visited a neurologist and had an MRI, which showed no issues.
I would like to ask the doctor what other possible causes there might be.

Yu, 10~19 year old female. Ask Date: 2023/06/25

Dr. Jiang Junyi reply Neurology

Dear Mr.
Yu,
You mentioned that "the area between the eyebrows feels very heavy, and my vision is gradually becoming blurry, but it gets a bit better after resting." These symptoms may suggest autonomic nervous system dysfunction leading to decreased cerebral circulation, which can cause fainting.
The autonomic nervous system is regulated by the sympathetic and parasympathetic nervous systems; one acts as the accelerator, while the other serves as the brake.
The sympathetic nervous system is responsible for increasing heart rate, accelerating breathing, and increasing sweating during physical activity.
Once the activity ceases, the parasympathetic nervous system takes over, slowing the heart rate, reducing breathing, and decreasing sweating.
Fainting symptoms are commonly associated with reflex syncope, which can occur due to excessive stimulation of the vagus nerve, resulting in bradycardia and decreased cardiac output.
Other triggers include transitioning from a lying to a standing position, standing up suddenly after squatting, certain medications causing hypotension, significant reductions in blood volume, peripheral vasodilation in hot environments, and peripheral neuropathy.
I recommend consulting a neurologist to discuss the evaluation of your autonomic nervous system and potential treatments.
Thank you for your inquiry, and feel free to discuss any related questions further!
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2023/06/25

More Info

Dizziness and confusion can be distressing symptoms that significantly impact daily life. Given your description of a persistent sensation of heaviness in the forehead and eyes, along with feelings of disorientation and visual disturbances, it is essential to consider various neurological causes that could be contributing to your symptoms.

Firstly, it is important to note that dizziness can arise from a variety of sources, including vestibular disorders, neurological conditions, and even psychological factors. Since you have already undergone evaluations by an ENT specialist and a neurologist, including an MRI that returned normal results, we can explore other potential causes.

1. Vestibular Disorders: While you mentioned that an ENT ruled out sinusitis, other vestibular disorders could still be at play. Conditions such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease can cause dizziness and a sense of imbalance. These conditions often require specific tests, such as a vestibular function test, to diagnose.

2. Migraines: Migraines can present with a variety of neurological symptoms, including dizziness, visual disturbances (like aura), and confusion. This is known as vestibular migraine, where the headache may not always be prominent. If you have a history of migraines or if your symptoms correlate with headache episodes, this could be a potential cause.

3. Cervical Issues: Cervical spine problems, such as cervical spondylosis or disc herniation, can lead to dizziness due to nerve compression or reduced blood flow to the brain. If you have any neck pain or stiffness, this could be worth investigating further.

4. Medication Side Effects: If you are taking any medications, it is essential to consider that dizziness and confusion can be side effects. Review your medications with your healthcare provider to determine if they could be contributing to your symptoms.

5. Anxiety and Stress: Psychological factors can manifest physically, leading to symptoms like dizziness and a sense of confusion. Anxiety disorders can cause hyperventilation, which may lead to feelings of lightheadedness and disorientation. If stress or anxiety is a factor in your life, addressing it through therapy or relaxation techniques may provide relief.

6. Neurological Conditions: Although your MRI was normal, certain neurological conditions may not always be visible on imaging. Conditions such as multiple sclerosis or small vessel disease can sometimes present with vague symptoms like yours. If your symptoms persist or worsen, further neurological evaluation may be warranted.

7. Blood Pressure and Blood Sugar Levels: Fluctuations in blood pressure or blood sugar levels can also lead to dizziness and confusion. It may be beneficial to monitor these levels, especially if you have a history of hypertension or diabetes.

8. Dehydration or Nutritional Deficiencies: Ensure you are adequately hydrated and consuming a balanced diet. Deficiencies in vitamins, particularly B12, can lead to neurological symptoms, including dizziness and cognitive changes.

In conclusion, while you have already undergone some testing, it may be beneficial to follow up with your neurologist for further evaluation. A comprehensive approach, including a detailed history, physical examination, and possibly additional tests, will be crucial in identifying the underlying cause of your symptoms. Keeping a symptom diary, noting when symptoms occur and any associated factors, can also provide valuable information for your healthcare provider. Remember, persistent symptoms warrant further investigation to ensure appropriate management and treatment.

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