Persistent Dizziness: Neurological Causes and Next Steps - Neurology

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Feeling dizzy all day long?


Hello doctor, I have been experiencing dizziness since early May (it's not a spinning sensation, but I feel lightheaded all day).
Initially, I thought it was heat exhaustion due to the combination of feeling hot and dizzy, but now I only have dizziness without any other symptoms.
I have a history of nasal congestion and allergies, but my daily routine is normal.
I have visited major hospitals and consulted both ENT and neurology specialists.
The ENT examinations included hearing tests, balance assessments, inner ear temperature differences, eye movement tests, and brainstem reflexes, all of which were normal.
The neurology evaluations included awake EEG, brainstem auditory evoked potentials, and carotid ultrasound, which also showed no issues.
The doctor prescribed medication for cerebral circulation, but it hasn't helped; in fact, I feel even more dizzy and have developed headaches recently.
What other tests can I undergo, or is there a possibility of any intracranial lesions that would require further examinations (like a CT scan)? Thank you.

Niming, 30~39 year old female. Ask Date: 2023/09/25

Dr. Jiang Junyi reply Neurology


Hello: You mentioned that "the ENT examination includes hearing tests, balance assessments, inner ear temperature differentials, eye movement tests, and brainstem response, while the neurology examination includes awake EEG, brainstem auditory evoked potentials, and carotid ultrasound," but it seems that blood tests were not conducted.
Conditions such as anemia, autonomic dysfunction, and inner ear imbalance could contribute to your physical symptoms.
It is essential to first rule out anemia or fluid deficiency that may lead to insufficient cerebral circulation.
Symptoms can be improved by replenishing fluids and electrolytes.
In addition to brain imaging, dizziness and headaches can be evaluated through blood tests.
Blood tests can help identify possible complications (anemia, hyperthyroidism/hypothyroidism, diabetes, recurrent vestibular neuritis, autoimmune diseases, neurosyphilis, and central nervous system disorders).
I recommend that you consult a neurologist to discuss further examinations and treatment.
Thank you for your inquiry, and feel free to discuss further.
Wishing you good health, safety, and happiness.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2023/09/25

More Info


Persistent dizziness can be a challenging symptom to navigate, especially when initial evaluations do not yield clear answers. Given your description of the dizziness starting in early May, along with the absence of other symptoms and the thorough examinations you have already undergone, it is essential to consider a few potential neurological causes and next steps.


Understanding Potential Causes
1. Vestibular Disorders: Even though you have undergone tests for inner ear function, vestibular disorders can sometimes be subtle and may not always show up on standard tests. Conditions like vestibular neuritis or benign paroxysmal positional vertigo (BPPV) could cause persistent dizziness without significant spinning sensations.

2. Cervical Vertigo: Issues related to the cervical spine can lead to dizziness. If there are any underlying neck problems, such as cervical spondylosis or muscle tension, they could contribute to your symptoms.

3. Migrainous Vertigo: Migraines can present with dizziness as a primary symptom, even without the classic headache. This type of dizziness can be triggered by various factors, including stress, certain foods, or hormonal changes.

4. Neurological Conditions: While less common, persistent dizziness can sometimes be a sign of neurological conditions such as multiple sclerosis or other central nervous system disorders. Given that your brain wave and auditory tests were normal, these conditions may be less likely, but they cannot be entirely ruled out without further investigation.

5. Psychogenic Dizziness: Anxiety and stress can manifest physically, leading to symptoms like dizziness. If you have been experiencing increased stress or anxiety, this could be a contributing factor.


Next Steps
Since you have already undergone a comprehensive evaluation, including tests for hearing, balance, and brain function, and have not found a definitive cause, consider the following steps:
1. Further Imaging: A CT scan or MRI of the brain may be warranted to rule out any structural abnormalities that were not detected in previous tests. This is particularly important if your symptoms have worsened or if you develop new symptoms.

2. Referral to a Specialist: If you have not yet seen a neurologist specializing in dizziness or vestibular disorders, this could be a beneficial next step. They may have additional insights or tests that could help identify the cause of your symptoms.

3. Vestibular Rehabilitation Therapy (VRT): If a vestibular disorder is suspected, VRT can be an effective treatment. This therapy involves exercises designed to improve balance and reduce dizziness.

4. Lifestyle Modifications: Keeping a symptom diary can help identify potential triggers for your dizziness. Additionally, ensuring adequate hydration, managing allergies (given your history of nasal congestion), and maintaining a balanced diet may help alleviate some symptoms.

5. Psychological Evaluation: If stress or anxiety is suspected to be a contributing factor, consulting with a mental health professional may provide strategies to manage these feelings, which could, in turn, alleviate your dizziness.

6. Follow-Up with Current Medications: Since you mentioned that the medication prescribed for brain circulation did not help, it would be wise to discuss this with your doctor. They may consider adjusting your treatment plan or trying alternative medications.


Conclusion
Persistent dizziness can stem from various causes, and it often requires a multifaceted approach to diagnosis and treatment. Given that your initial tests have not revealed a clear cause, further imaging and possibly a referral to a specialist may be beneficial. Additionally, consider lifestyle modifications and follow-up on your current treatment plan to ensure you are receiving the most effective care. Always communicate openly with your healthcare providers about your symptoms and any changes you experience, as this will help guide your ongoing evaluation and management.

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