Persistent Dizziness and Balance Issues: Seeking Solutions for Neurological Symptoms

Feeling of foot drop, imbalance, and abnormal sensations in the brain?

Hello doctors, three years ago I experienced a bout of dizziness that caused me to fall and lose consciousness, resulting in a chin injury that required seven stitches at the hospital.
However, a month later, I suddenly started experiencing headaches.
I underwent MRI scans of my brain and neck, EEG, auditory evoked potentials, and carotid ultrasound, all of which returned normal results.
Cardiac evaluations included an echocardiogram, a 24-hour Holter monitor, and a stress test, which diagnosed me with sinus bradycardia (heart rate around 50 bpm).
In terms of blood work, aside from slightly elevated total cholesterol and low-density lipoprotein (LDL), everything else was normal.

For the past three years, I have been suffering from persistent headaches and dizziness, which have now worsened to the point where I feel a sensation of stepping into empty space and experience a sense of imbalance while standing (I can run and jump normally).
Additionally, I have abnormal sensations in my head (with pain and pressure).
This condition has persisted for about six months now, and medications have not been effective.

Could you please advise on any potential ways to improve my condition or any tests I may have overlooked? Thank you for your time, doctors.

Wang Wang, 30~39 year old female. Ask Date: 2013/05/22

Dr. Gao Chunde reply Neurology

Symptoms can be side effects of medication or may indicate a sensory disturbance.
A detailed neurological examination by a neurologist should be conducted to assess this function.
If abnormalities are found, further tests may be arranged to evaluate the spinal nerves or peripheral nerves.

Reply Date: 2013/05/22

More Info

Persistent dizziness and balance issues can be quite distressing, especially when they have been ongoing for several years. Based on your description, it seems that you have undergone a comprehensive evaluation, including MRI scans, EEG, auditory evoked potentials, carotid ultrasound, and cardiac assessments, all of which returned normal results. However, your symptoms of persistent headaches, dizziness, and a sensation of imbalance indicate that further investigation may be warranted.

Possible Causes and Next Steps
1. Vestibular Disorders: Given your symptoms of dizziness and balance issues, it would be prudent to consider vestibular disorders. These can include conditions such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease. A specialized test called a vestibular function test can help assess the inner ear's function, which plays a crucial role in balance.

2. Cervical Spine Issues: Since you mentioned a history of a fall that resulted in a chin injury, it's possible that there could be underlying cervical spine issues contributing to your symptoms. A cervical spine MRI or CT scan may be beneficial to rule out any structural abnormalities or nerve compression that could be affecting your balance.

3. Neurological Evaluation: Although your previous neurological evaluations were normal, it may be worthwhile to seek a second opinion from a neurologist who specializes in balance disorders. They may recommend additional tests, such as a lumbar puncture to check for inflammatory or infectious processes, or advanced imaging techniques.

4. Autonomic Dysfunction: Your history of bradycardia (slow heart rate) may suggest autonomic dysfunction, which can contribute to dizziness and balance issues. A tilt table test can help assess how your body responds to changes in posture and may provide insights into whether you have conditions like Postural Orthostatic Tachycardia Syndrome (POTS) or other forms of dysautonomia.

5. Psychogenic Factors: Chronic dizziness can sometimes be exacerbated by anxiety or stress. If you have a history of anxiety or panic attacks, it may be beneficial to consult with a mental health professional. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can help manage the psychological aspects of chronic dizziness.

6. Medication Review: If you are currently on medication, it’s essential to review these with your healthcare provider. Some medications can have side effects that contribute to dizziness and balance issues.

Lifestyle Modifications
In addition to seeking further medical evaluation, consider implementing some lifestyle modifications:
- Hydration: Ensure you are well-hydrated, as dehydration can exacerbate dizziness.

- Balance Exercises: Engage in balance training exercises, which can help improve stability and reduce the sensation of imbalance. Physical therapy may be beneficial in this regard.

- Avoid Triggers: Identify and avoid any specific triggers that may worsen your symptoms, such as certain head movements or environments.

Conclusion
Persistent dizziness and balance issues can stem from various causes, and it’s crucial to approach this problem holistically. Given your extensive medical history, further specialized evaluations focusing on vestibular function, cervical spine health, and autonomic function may provide additional insights. Collaborating with a multidisciplinary team, including neurologists, physical therapists, and mental health professionals, can help you find effective strategies to manage your symptoms and improve your quality of life. If you have any further questions or concerns, please feel free to reach out for more information.

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