Dizziness and Tremors: Possible Causes and Next Steps

Shaking like an earthquake?

Hello, last month I experienced dizziness (feeling like the ground was shaking, and I was unsteady while walking).
During this time, my right little finger felt a bit numb.
I went to National Taiwan University Hospital for a consultation.
The doctor said that I seemed fine but recommended an MRI of my head.
Since the MRI appointment was scheduled for about three weeks later, my dizziness (unsteadiness while walking) resolved on its own after a little over a week.
However, when I close my eyes, I still feel a swaying sensation, and lying on my pillow also triggers this feeling.
Additionally, my body has been shaking (like feeling tremors while sitting in a chair, but I can't pinpoint what is causing the chair to shake).

Moreover, even though I sleep well, after exercising for just over ten minutes, I feel very fatigued.
After the MRI, I had a follow-up appointment (because I was very worried during the waiting period, I consulted another doctor to review the MRI report).
The doctor noticed I was anxious, and I expressed my concerns about possible cerebellar atrophy or Parkinson's disease.
He suggested that I might be overthinking it and that it could be autonomic nervous system dysfunction, as the MRI report showed no issues.
He prescribed me Ambien for seven days.
However, the swaying sensation when I close my eyes has not disappeared (though it seems less intense), and the tremors are not as frequent.
Recently, my right hand has been numb while riding my motorcycle, and I feel fatigued without doing much (I don't feel it much while sitting, but I get tired easily when standing).
I have checked my blood pressure, and it is normal.

Could you please advise on what might be causing these issues? Is it really autonomic nervous system dysfunction? (I understand that autonomic nervous system issues don't resolve quickly.) However, I am still a bit worried that it could be something else.
I hope you can provide some guidance on what areas I should investigate further.
I was thinking of waiting another month to see if the symptoms resolve; otherwise, I might need to check my heart or see if I have anemia.

Fanrao de ren, 30~39 year old female. Ask Date: 2013/06/10

Dr. Gao Chunde reply Neurology

Your symptoms do not resemble those of cerebellar atrophy or Parkinson's disease, and since the MRI did not show any abnormalities, you can be temporarily reassured.
The overall course of your condition is more consistent with what is referred to as inner ear imbalance, which is a transient dysfunction of the vestibular nerve, such as benign paroxysmal positional vertigo or vestibular neuritis.
However, these conditions will gradually improve; as long as you maintain a normal daily routine, the sensation of dizziness will slowly dissipate, as this is not a degenerative or malignant disease that would not recover.
Regarding your hand numbness, you may want to remind your physician, as they might check the peripheral nerves in your hand to determine if it is due to ulnar nerve issues or carpal tunnel syndrome, and then treat based on the examination results.

Reply Date: 2013/06/10

More Info

Dizziness and tremors can be concerning symptoms, and it's understandable that you're feeling anxious about them. Based on your description, it seems you've already taken some important steps by consulting with a physician and undergoing an MRI, which came back normal. This is a positive sign, as it rules out some serious neurological conditions. However, your ongoing symptoms, including the sensation of swaying when your eyes are closed, tremors, and fatigue, warrant further exploration.

Possible Causes of Your Symptoms
1. Vestibular Dysfunction: Given that you experienced dizziness and a sensation of swaying, it's possible that you have a vestibular disorder. The vestibular system, located in the inner ear, helps control balance. Conditions such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis can cause dizziness and balance issues. These conditions may not always show up on an MRI.

2. Anxiety and Stress: Your symptoms could also be exacerbated by anxiety. The mind-body connection is powerful, and stress can manifest physically in various ways, including dizziness and tremors. If you are feeling anxious about your health, it could contribute to your symptoms.

3. Autonomic Nervous System Dysfunction: Your doctor mentioned the possibility of autonomic nervous system dysregulation. This can lead to symptoms like dizziness, fatigue, and tremors. Conditions such as postural orthostatic tachycardia syndrome (POTS) or other forms of dysautonomia could be considered, especially if you notice changes in your heart rate or blood pressure when standing.

4. Peripheral Neuropathy: The tingling sensation in your right hand could indicate peripheral neuropathy, which can be caused by various factors, including vitamin deficiencies (like B12), diabetes, or other systemic conditions.
5. Fatigue: The fatigue you experience after minimal exertion could be related to several factors, including deconditioning, sleep quality, or even nutritional deficiencies.

Next Steps
1. Follow-Up with a Specialist: If your symptoms persist, consider consulting a neurologist or an ear, nose, and throat (ENT) specialist who focuses on vestibular disorders. They can perform specific tests to assess your balance and inner ear function.

2. Consider a Cardiologist: Since you mentioned fatigue and the possibility of heart-related issues, a cardiologist could evaluate your heart health, especially if you experience any palpitations or changes in heart rate.

3. Blood Tests: It might be beneficial to check for vitamin deficiencies, thyroid function, and other blood parameters to rule out conditions like anemia or metabolic issues that could contribute to your symptoms.

4. Physical Therapy: Vestibular rehabilitation therapy can be helpful if your dizziness is related to balance issues. A physical therapist specializing in vestibular disorders can provide exercises to improve your balance and reduce dizziness.

5. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare provider in determining the next steps.

6. Stress Management: Consider incorporating stress-reduction techniques such as mindfulness, yoga, or cognitive-behavioral therapy (CBT) to help manage anxiety, which may alleviate some of your physical symptoms.

Conclusion
While your MRI results are reassuring, it's essential to continue investigating the underlying causes of your symptoms. Dizziness and tremors can stem from various sources, and a comprehensive approach involving specialists and possibly additional tests will help clarify the situation. Be proactive in your health management, and don't hesitate to seek further evaluations if your symptoms persist or worsen.

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