Prolonged Dizziness: Causes and Concerns in Neurology

I have been experiencing dizziness for over two weeks, and I have had similar episodes in the past?

Hello Doctor: I have been suffering from severe anxiety disorder for nearly four months.
I have consulted with a psychiatrist and am taking medications including - Sertraline / Escitalopram 20mg twice daily (one in the morning and one in the evening) and Zolpidem / Alprazolam (at bedtime).
I started taking Escitalopram about two weeks ago, and around the same time, I began experiencing dizziness.
This symptom also occurred about a year ago and lasted for about a month.
At that time, I thought it was due to anemia because my eyelids appeared pale, and after taking some iron supplements, it seemed to improve, so I didn't pay much attention to it afterward.
Recently, I have started feeling dizzy again.
The dizziness feels like I am unable to focus my vision on something, giving me a sense of detachment from reality, as if I cannot concentrate.
I am unsure if this is psychological; for example, when I visited a client this afternoon, my speech felt different from usual, less fluent.
Sometimes I feel like my reactions are slower, and I often get distracted by worrying about my health.
Occasionally, I suddenly forget things.
When I hold my hands up, my right middle finger sometimes shakes.
In specific positions, such as sitting upright or raising my left hand, I occasionally feel a dull pain in my upper left back, which eases when I change positions.
I also sometimes feel a sensation like an electric current passing through the same area of my upper back (similar to the feeling of electrical stimulation).
Occasionally, the dizziness improves, but sometimes I feel it even when I am not anxious.
This time, I feel it is unrelated to anemia because I recently had blood tests at a clinic, and my results showed normal values for - glycated hemoglobin (5.6), hemoglobin (15.8), hematocrit (48.2), MCV (88.6), MCH (29.0), and MCHC (32.8).
I also smoke (e-cigarettes), have diabetes (my highest glycated hemoglobin was 9.4, but after losing 3 kg and controlling my diet, my blood sugar has dropped to 5.6), and have high average blood pressure (over 130/90).
My triglycerides and cholesterol levels are also elevated.
I am 174 cm tall and weigh 82 kg.
I do not experience chest pain or cough, and my annual chest X-rays have always been normal.
I am scheduled for my first LDCT scan next week.
Therefore, I would like to confirm whether my symptoms could clinically be related to lung cancer metastasizing to the brain, or if they are purely due to a psychological disorder (autonomic nervous system dysfunction), or possibly side effects from the medication.
I am truly struggling to find the cause of my dizziness...

Mr. Zhang, 30~39 year old female. Ask Date: 2024/04/11

Dr. Jiang Junyi reply Neurology

Hello Mr.
Zhang,
You mentioned wanting to confirm whether your symptoms could clinically indicate lung cancer metastasizing to the brain.
Lung cancer with brain metastasis can present with different clinical manifestations depending on the location of the metastasis, and dizziness is relatively uncommon.
A brain MRI can be used to rule this out, but it may require out-of-pocket expenses.
It is generally advised to avoid exposure to risk factors, such as secondhand smoke.
You also mentioned having diabetes (with a maximum HbA1c of 9.4, which later decreased to 5.6 after losing 3 kg and controlling your diet), elevated average blood pressure (above 130/90), and high triglycerides and cholesterol.
This may warrant consideration of autonomic nervous system dysfunction (sympathetic nervous system issues) or vertebral artery insufficiency leading to cerebral circulation problems.
Symptoms can often be improved by hydration and electrolyte supplementation.
In addition to the MRI, blood tests can assist in evaluating dizziness and headaches.
These blood tests should include screening for possible complications such as hyperthyroidism/hypothyroidism, autoimmune diseases, neurosyphilis, and central nervous system disorders.
I recommend consulting a neurologist to discuss further examinations and treatment options.
Thank you for your inquiry, and feel free to reach out for further discussion.
Wishing you good health and peace,
Dr.
Jiang, Neurology, Taoyuan Hospital/Hualien Hospital

Reply Date: 2024/04/11

More Info

Prolonged dizziness can be a complex symptom with various potential causes, especially in individuals with a history of anxiety disorders. Your situation, characterized by dizziness, difficulty focusing, and other neurological symptoms, raises several important considerations.

Firstly, it’s essential to understand that dizziness can stem from both physiological and psychological factors. Given your history of anxiety, it is plausible that your symptoms may be exacerbated by psychological stress. Anxiety can lead to hyperventilation, which can cause dizziness and feelings of unreality or detachment from one’s surroundings. This is often referred to as "derealization" and can be distressing. Additionally, anxiety can manifest physically, leading to muscle tension and other somatic symptoms, which may contribute to your overall feeling of discomfort.

However, it is also crucial to consider other medical conditions that could be contributing to your dizziness. You mentioned a previous episode of dizziness that you attributed to anemia, which was resolved with iron supplementation. While your recent blood tests indicate normal hemoglobin levels, it’s important to note that other factors, such as electrolyte imbalances or dehydration, could also lead to dizziness. Given your diabetes and the fluctuations in blood sugar levels, it’s possible that episodes of hypoglycemia (low blood sugar) could contribute to your dizziness, especially if you are not eating regularly or managing your blood sugar effectively.

Your symptoms of right-hand tremors and the sensation of electric currents in your back could indicate neurological involvement. While these symptoms may be related to anxiety or stress, they could also suggest a need for further neurological evaluation. Conditions such as peripheral neuropathy, which can be associated with diabetes, or other neurological disorders should be considered. It is advisable to discuss these symptoms with a neurologist, who may recommend additional tests, such as an MRI or nerve conduction studies, to rule out any underlying neurological conditions.

Regarding your concerns about lung cancer metastasizing to the brain, while it is understandable to worry about serious conditions, it is essential to approach this with a rational perspective. The symptoms you describe, particularly the dizziness and cognitive changes, could be related to anxiety or other benign causes, especially given your normal imaging results and blood tests. However, if you have a history of smoking and are experiencing new neurological symptoms, it is prudent to discuss these concerns with your healthcare provider. They may recommend imaging studies, such as a CT scan or MRI, to rule out any serious conditions.

Lastly, medication side effects should not be overlooked. The medications you are taking for anxiety and depression can sometimes lead to dizziness and cognitive changes. It is important to have an open dialogue with your prescribing physician about your symptoms, as they may need to adjust your medication or explore alternative treatments.

In summary, your prolonged dizziness could be attributed to a combination of anxiety, potential neurological issues, and medication side effects. It is crucial to continue working with your healthcare providers to explore these possibilities thoroughly. Keeping a symptom diary, noting when dizziness occurs and any associated factors, can also be helpful in identifying triggers and patterns. Remember, addressing both the psychological and physical aspects of your health is vital for achieving overall well-being.

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