Dizziness: When to See a Neurologist for Symptoms

Dizziness issues

Hello, doctor.
I would like to ask about my recent dizziness issues.
Two years ago, I was hospitalized for hyperthyroidism and heart failure.
After being discharged, I occasionally experienced a sensation similar to the shaking of an elevator or the feeling of being on a boat, but this gradually diminished, and I didn't pay much attention to it.
However, this month, after catching a cold, I experienced two episodes of severe dizziness, where even lying down did not alleviate the spinning sensation for about two hours.
Additionally, I have been feeling chest tightness and a sense of inadequate breathing.
One day, after experiencing chest tightness, I began to have arrhythmias and thought my heart issues had recurred.
I consulted a cardiologist, and the chest X-ray showed no enlargement, and the ECG was normal.
However, the doctor mentioned that it might not have manifested during the examination, so it seemed that my heart was not significantly affected.
He suggested that it could be due to hyperventilation and prescribed Ambien for a week.
However, the day after my doctor's visit, I started feeling dizzy again, and it has been three consecutive days of feeling like I'm on a boat upon getting up.
The dizziness feels pulsating, somewhat in sync with my heartbeat, and lasts all day.
When I walk and turn my head, I suddenly feel faint and need support.
Since August, my vision has been blurry, but it clears up after blinking.
I am unsure if these combined symptoms are related or if I need to see different specialists.
I apologize for asking, but what do you think is the issue? Should I see an ENT specialist, an ophthalmologist, or a neurologist? If I see a neurologist, what tests would they perform for diagnosis? Thank you.

Sa, 30~39 year old female. Ask Date: 2015/11/30

Dr. Gao Chunde reply Neurology

It could be vestibular migraine, or it may be caused by benign paroxysmal positional vertigo (BPPV) or vestibular neuritis.
It is recommended to consult a neurologist, who will conduct a thorough history and examination to determine the appropriate direction for further diagnostic testing.

Reply Date: 2015/11/30

More Info

Dizziness can be a complex symptom with various underlying causes, and it is essential to approach it with a thorough understanding of potential medical conditions. Given your history of hyperthyroidism and heart failure, along with the recent episodes of dizziness, it is crucial to consider a comprehensive evaluation by a neurologist.

Dizziness can manifest in different forms, such as vertigo (a spinning sensation), lightheadedness, or a feeling of imbalance. In your case, the sensation of feeling like you are on a boat or experiencing a "shaking" sensation when using an elevator could indicate vestibular dysfunction, which is related to the inner ear's balance system. This is particularly relevant since you mentioned that these symptoms intensified after a recent cold, which could have affected your inner ear or overall balance.

Your symptoms of chest tightness and irregular heartbeats are also concerning. While your cardiologist has ruled out significant heart issues based on the tests performed, it is essential to consider that anxiety or panic attacks can sometimes manifest with physical symptoms that mimic cardiac issues. The fact that you experienced dizziness that persists even when lying down, along with the sensation of your head spinning in sync with your heartbeat, suggests that there may be a neurological component to your symptoms.

Given the complexity of your symptoms, it would be wise to consult a neurologist. They can perform a detailed neurological examination and may recommend several diagnostic tests, including:
1. MRI or CT Scan: These imaging studies can help rule out structural abnormalities in the brain that could be causing your dizziness.

2. Vestibular Testing: This may include tests such as videonystagmography (VNG) or electronystagmography (ENG) to assess the function of your inner ear and its connection to your balance system.

3. Blood Tests: To check for any metabolic or hormonal imbalances that could contribute to your symptoms, especially considering your history of hyperthyroidism.

4. Electroencephalogram (EEG): If there are concerns about seizure activity or other neurological issues, an EEG may be warranted.

5. Tilt Table Test: This test can help assess how your body responds to changes in position, which may be relevant given your history of heart issues and dizziness.

In addition to seeing a neurologist, it may also be beneficial to consult an ear, nose, and throat (ENT) specialist, especially if there are concerns about your inner ear function. They can evaluate for conditions such as Meniere's disease or vestibular neuritis, which can also cause dizziness.

Overall, it is essential to approach your symptoms holistically. Keeping a symptom diary that tracks when your dizziness occurs, its duration, and any associated symptoms (like chest pain or heart palpitations) can provide valuable information for your healthcare providers. This comprehensive approach will help ensure that any underlying conditions are identified and treated appropriately, leading to better management of your symptoms and improved quality of life.

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