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What is causing my persistent dizziness and balance issues after a severe episode four years ago?
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Nervous System Disorders
Question #30654
46 days ago
152

What is causing my persistent dizziness and balance issues after a severe episode four years ago?

Client_4be811

🧾 āϰ⧋āĻ—ā§€āϰ āϏāĻŽā§āĻĒā§‚āĻ°ā§āĻŖ āχāϤāĻŋāĻšāĻžāϏ āĻ“ āωāĻĒāϏāĻ°ā§āϗ⧇āϰ āϏāĻžāϰāϏāĻ‚āĻ•ā§āώ⧇āĻĒ (FINAL CASE SUMMARY) 1. āĻĒā§āϰāϧāĻžāύ āϏāĻŽāĻ¸ā§āϝāĻž (Chief Complaints) āĻĻā§€āĻ°ā§āϘāĻĻāĻŋāύ āϧāϰ⧇ āĻŽāĻžāĻĨāĻžāϰ āϭ⧇āϤāϰ⧇ āĻĻ⧁āϞ⧁āύāĻŋ / āĻ­āĻžāϏāĻžāϰ āĻ…āύ⧁āĻ­ā§‚āϤāĻŋ āĻšāĻžāρāϟāĻž āĻ“ āĻĻāĻžāρāĻĄāĻŧāĻžāϞ⧇ āĻ­āĻžāϰāϏāĻžāĻŽā§āϝ āύāĻˇā§āϟ āĻšāĻ“āϝāĻŧāĻž (imbalance) āϏāĻžāϰāĻžāĻ•ā§āώāĻŖ āĻŽāĻžāĻĨāĻž āĻ­āĻžāϰ āĻ“ āĻāĻŋāĻŽāĻāĻŋāĻŽ āĻ…āύ⧁āĻ­ā§‚āϤāĻŋ āĻĒāĻĄāĻŧāĻžāĻļā§‹āύāĻž āĻŦāĻž āĻŽā§‹āĻŦāĻžāχāϞ/āĻ•āĻŽā§āĻĒāĻŋāωāϟāĻžāϰ āĻ¸ā§āĻ•ā§āϰāĻŋāύ āĻĻ⧇āĻ–āϞ⧇ āϏāĻŽāĻ¸ā§āϝāĻž āĻ…āύ⧇āĻ• āĻŦ⧇āĻĄāĻŧ⧇ āϝāĻžāϝāĻŧ āϚāϞāĻ¨ā§āϤ āĻŦāĻžāϏ/āĻŸā§āϰ⧇āύ āĻĨ⧇āϕ⧇ āĻŦāĻžāχāϰ⧇ āϤāĻžāĻ•āĻžāϞ⧇ āĻŽāĻžāĻĨāĻž āĻ˜ā§‹āϰāĻž āĻ“ āĻĻ⧁āϞ⧁āύāĻŋ āĻŦāĻžāĻĄāĻŧ⧇ āĻĻāĻžāρāĻĄāĻŧāĻŋāϝāĻŧ⧇ āĻĨāĻžāĻ•āϞ⧇ āĻĻ⧁āĻ°ā§āĻŦāϞ āϞāĻžāϗ⧇, āĻšāĻžāϤ-āĻĒāĻž āĻ•āĻžāρāĻĒ⧇, āĻšā§‹āĻ– āĻ…āĻ¨ā§āϧāĻ•āĻžāϰ āĻšāϝāĻŧ⧇ āφāϏ⧇ āĻŽāĻžāĻĨāĻž āύāĻžāĻĄāĻŧāĻžāϞ⧇ āωāĻĒāϏāĻ°ā§āĻ— āĻŦ⧃āĻĻā§āϧāĻŋ āĻĒāĻžāϝāĻŧ āĻŽāĻžāĻĨāĻž āĻ˜ā§‹āϰāĻžāϰ āϏāĻŽāϝāĻŧ āĻ•āĻĨāĻž āĻŦāϞāϤ⧇ āĻ…āĻ¸ā§āĻŦāĻžāĻ­āĻžāĻŦāĻŋāĻ• āϞāĻžāϗ⧇ 2. āϰ⧋āϗ⧇āϰ āĻļ⧁āϰ⧁ (Detailed Onset History) āĻĒā§āϰāĻžāϝāĻŧ ā§Ē āĻŦāĻ›āϰ āφāϗ⧇ āϏāĻŽāĻ¸ā§āϝāĻž āĻļ⧁āϰ⧁ āĻšāϝāĻŧāĨ¤ āϤāĻ–āύ āφāĻŽāĻŋ āĻĒāϰ⧀āĻ•ā§āώāĻžāϰ āĻĒā§āϰāĻ¸ā§āϤ⧁āϤāĻŋāϰ āϏāĻŽāϝāĻŧ āĻ›āĻŋāϞāĻžāĻŽ āĻāĻŦāĻ‚ āĻĒā§āϰāϚāĻŖā§āĻĄ āĻŽāĻžāύāϏāĻŋāĻ• āϚāĻžāĻĒ⧇āϰ āĻŽāĻ§ā§āϝ⧇ āĻ›āĻŋāϞāĻžāĻŽāĨ¤ āϏ⧇āχ āϏāĻŽāϝāĻŧ āφāĻŽāĻŋ āϏāĻžāϰāĻžāĻĻāĻŋāύ āĻĒāĻĄāĻŧāĻžāĻļā§‹āύāĻž āĻ•āϰāϤāĻžāĻŽ āĻāĻŦāĻ‚ āĻ…āύ⧇āĻ•āĻ•ā§āώāĻŖ āϧāϰ⧇ āĻāĻ•āĻ­āĻžāĻŦ⧇ āĻŦāϏ⧇ āĻŽāĻžāĻĨāĻž āĻĻ⧁āϞāĻŋāϝāĻŧ⧇ āĻĻ⧁āϞāĻŋāϝāĻŧ⧇ āĻĒāĻĄāĻŧāϤāĻžāĻŽ āĻāĻ•āĻĻāĻŋāύ āĻŽāĻžāĻ—āϰāĻŋāĻŦ⧇āϰ āĻĒāϰ⧇ āĻĒāĻĄāĻŧāĻžāĻļā§‹āύāĻž āĻ•āϰāĻžāϰ āϏāĻŽāϝāĻŧ āφāĻŽāĻŋ āϖ⧁āĻŦ āĻŦ⧇āĻļāĻŋ āĻĻ⧁āϞ⧇ āĻĻ⧁āϞ⧇ āĻĒāĻĄāĻŧāĻ›āĻŋāϞāĻžāĻŽāĨ¤ āĻšāĻ āĻžā§Ž āĻ•āϰ⧇ āĻāĻ•āϟāĻŋ āϖ⧁āĻŦ āϤ⧀āĻŦā§āϰ āĻŽāĻžāĻĨāĻž āĻ˜ā§‹āϰāĻž (sudden severe dizziness episode) āĻšāϝāĻŧāĨ¤ āϤāĻ–āύ āϏāĻžāĻĨ⧇ āϏāĻžāĻĨ⧇ āφāĻŽāĻŋ āĻŸā§‡āĻŦāĻŋāϞ⧇āϰ āωāĻĒāϰ āĻŽāĻžāĻĨāĻž āĻĻāĻŋāϝāĻŧ⧇ āĻļ⧁āϝāĻŧ⧇ āĻĒāĻĄāĻŧāĻŋ āĻāĻŦāĻ‚ āĻ•āĻŋāϛ⧁āĻ•ā§āώāĻŖ āĻĒāϰ⧇ āĻ•āĻŋāϛ⧁āϟāĻž āĻļāĻžāĻ¨ā§āϤ āĻšāχāĨ¤ āĻāϰ ā§§â€“ā§¨ āĻĻāĻŋāύ āĻĒāϰ āĻĨ⧇āϕ⧇ āφāĻŽāĻŋ āϞāĻ•ā§āĻˇā§āϝ āĻ•āϰāĻŋ āϝ⧇: āφāĻŽāĻŋ āφāϰ āφāϗ⧇āϰ āĻŽāϤ⧋ āĻĻ⧁āϞ⧇ āĻĻ⧁āϞ⧇ āĻĒāĻĄāĻŧāϤ⧇ āĻĒāĻžāϰāĻ›āĻŋ āύāĻž āĻĻāĻžāρāĻĄāĻŧāĻŋāϝāĻŧ⧇ āĻĨāĻžāĻ•āϤ⧇ āĻĒāĻžāϰāĻ›āĻŋ āύāĻž, āĻŽāύ⧇ āĻšāϝāĻŧ āĻĒāĻĄāĻŧ⧇ āϝāĻžāĻŦ āϏāĻŦ āϏāĻŽāϝāĻŧ āĻĻ⧁āϞ⧁āύāĻŋ/āĻ­āĻžāϏāĻž āĻ…āύ⧁āĻ­ā§‚āϤāĻŋ āĻšāĻšā§āϛ⧇ āĻāϰāĻĒāϰ āĻĨ⧇āϕ⧇ āϧ⧀āϰ⧇ āϧ⧀āϰ⧇ āωāĻĒāϏāĻ°ā§āĻ— āĻ¸ā§āĻĨāĻžāϝāĻŧā§€ āĻšāϝāĻŧ⧇ āϝāĻžāϝāĻŧ āĻāĻŦāĻ‚ āϏāĻŽāϝāĻŧ⧇āϰ āϏāĻžāĻĨ⧇ āφāϰāĻ“ āĻŦāĻžāĻĄāĻŧāϤ⧇ āĻĨāĻžāϕ⧇āĨ¤ 3. āĻŦāĻ°ā§āϤāĻŽāĻžāύ āĻ…āĻŦāĻ¸ā§āĻĨāĻž (Current Condition) āĻ•āĻ–āύ⧋ āĻ•āĻ–āύ⧋ ⧍ā§Ē āϘāĻ¨ā§āϟāĻž āϧāϰ⧇ āĻĻ⧁āϞ⧁āύāĻŋ/āĻāĻŋāĻŽāĻāĻŋāĻŽ āĻ…āύ⧁āĻ­ā§‚āϤāĻŋ āĻĨāĻžāϕ⧇ āφāĻŦāĻžāϰ āĻ•āĻŋāϛ⧁ āϏāĻŽāϝāĻŧ (āĻŦāĻŋāĻļ⧇āώ āĻ•āϰ⧇ āϚ⧁āĻĒāϚāĻžāĻĒ āĻŦāϏ⧇ āĻĨāĻžāĻ•āϞ⧇) āϤ⧁āϞāύāĻžāĻŽā§‚āϞāĻ•āĻ­āĻžāĻŦ⧇ āĻ­āĻžāϞ⧋ āĻĨāĻžāϕ⧇ āĻ¸ā§āĻ•ā§āϰāĻŋāύ āĻĻ⧇āĻ–āĻž, āĻĒāĻĄāĻŧāĻžāĻļā§‹āύāĻž, āĻŽāĻžāĻĨāĻž āύāĻžāĻĄāĻŧāĻžāύ⧋ āĻŦāĻž āĻ­āĻŋāĻœā§āϝ⧁āϝāĻŧāĻžāϞ āĻ•āĻžāϜ āĻ•āϰāϞ⧇ āĻĻā§āϰ⧁āϤ āĻ–āĻžāϰāĻžāĻĒ āĻšāϝāĻŧ āĻšāĻžāρāϟāĻž āĻ“ āĻĻāĻžāρāĻĄāĻŧāĻžāύ⧋āϤ⧇ āĻ­āĻžāϰāϏāĻžāĻŽā§āϝ āĻ•āĻŽā§‡ āϝāĻžāϝāĻŧ āϤāĻŦ⧇ āĻŦāĻžāĻšā§āϝāĻŋāĻ•āĻ­āĻžāĻŦ⧇ āĻ…āĻ¨ā§āϝāϰāĻž āϏāĻžāϧāĻžāϰāĻŖāϤ āφāĻŽāĻžāϰ āĻĻ⧁āϞ⧁āύāĻŋ āĻĻ⧇āĻ–āϤ⧇ āĻĒāĻžāϝāĻŧ āύāĻž (subjective imbalance) 4. MRI āĻ“ āĻĒā§‚āĻ°ā§āĻŦ⧇āϰ āϰāĻŋāĻĒā§‹āĻ°ā§āϟ MRI of brain : Impression: MR image morphology of: Mild hypoplastic cerebellum - may be part of spectrum of Spinocerebellar cortical atrophy. VHIT report :Comment: Right Posterior canal is hypo active. Other canals are normal. VEMP report :Waves are Present in both tracings OVEMP and cVEMP but not in normal time indicating abnormality in Utricle VNG report :Conclusion: The oculomotor tests were abnormal. DHP and the other positional tests were normal. There was no canal paresis or directional preponderance to any side on estimation of caloric induced nystagmus intensity. These findings were suggestive of abnormality in the central vestibulo-ocular system. ECG :ECG report is normal X-ray report :normal chest skiagram. āĻ…āύāĻ¨ā§āϝ āϏāĻ•āϞ āϧāϰāύ⧇āϰ āϰāĻ•ā§āϤ āĻĒāϰ⧀āĻ•ā§āώāĻž āĻĒāϰāĻŋāĻĒā§‚āĻ°ā§āĻŖāĻ­āĻžāĻŦ⧇ āĻ¸ā§āĻŦāĻžāĻ­āĻžāĻŦāĻŋāĻ•āĨ¤ 5. āĻ…āϤāĻŋāϰāĻŋāĻ•ā§āϤ āωāĻĒāϏāĻ°ā§āĻ— āĻŽāĻžāĻĨāĻž āĻ•āĻžāρāĻĒāϛ⧇ āĻŦāϞ⧇ āĻ…āύ⧁āĻ­āĻŦ āĻšāϝāĻŧ(āĻŦāĻŋāĻļ⧇āώ āĻ•āϰ⧇ āĻĻāĻžāρāĻĄāĻŧāĻžāϞ⧇ āĻŦāĻž āĻŽāĻžāĻĨāĻž āĻ˜ā§‹āϰāĻžāϰ āϏāĻŽāϝāĻŧ) āĻĻā§€āĻ°ā§āϘāĻ•ā§āώāĻŖ āĻĻāĻžāρāĻĄāĻŧāĻžāϞ⧇ āĻĻ⧁āĻ°ā§āĻŦāϞāϤāĻž āĻ“ āĻšā§‹āĻ– āĻ…āĻ¨ā§āϧāĻ•āĻžāϰ āĻšāϝāĻŧ⧇ āφāϏ⧇ āĻĒāĻĄāĻŧāĻžāĻļā§‹āύāĻž āĻŦāĻž āĻŽāĻžāύāϏāĻŋāĻ• āϚāĻžāĻĒ⧇āϰ āĻ•āĻžāϜ āĻ•āϰāϞ⧇ āωāĻĒāϏāĻ°ā§āĻ— āĻ…āύ⧇āĻ• āĻŦ⧇āĻĄāĻŧ⧇ āϝāĻžāϝāĻŧ āĻĒāĻĄāĻŧāĻžāĻļā§‹āύāĻž āĻŦāĻ°ā§āϤāĻŽāĻžāύ⧇ āĻĒāϰāĻŋāĻĒā§‚āĻ°ā§āĻŖ āĻŦāĻ¨ā§āϧ đŸĨē 6. āϗ⧁āϰ⧁āĻ¤ā§āĻŦāĻĒā§‚āĻ°ā§āĻŖ āĻŦ⧈āĻļāĻŋāĻˇā§āĻŸā§āϝ (Key Clinical Features) āϘāϰ āĻŦāĻž āϜāĻŋāύāĻŋāϏāĻĒāĻ¤ā§āϰ āĻ˜ā§‹āϰ⧇ āύāĻž (no spinning vertigo) āĻĒā§āϰāϧāĻžāύ āϏāĻŽāĻ¸ā§āϝāĻž āĻšāϞ⧋ internal dizziness / floating / rocking sensation āωāĻĒāϏāĻ°ā§āĻ— āĻ­āĻŋāĻœā§āϝ⧁āϝāĻŧāĻžāϞ āĻ¸ā§āϟāĻŋāĻŽā§āϞ⧇āĻļāύ (āĻ¸ā§āĻ•ā§āϰāĻŋāύ/āϞ⧇āĻ–āĻž/āϚāϞāĻ¨ā§āϤ āĻĒāϰāĻŋāĻŦ⧇āĻļ) āĻ āĻŦāĻžāĻĄāĻŧ⧇ āĻŦāĻŋāĻļā§āϰāĻžāĻŽ āĻ“ āĻ¸ā§āĻĨāĻŋāϰ āĻĨāĻžāĻ•āϞ⧇ āĻ•āĻŋāϛ⧁āϟāĻž āĻ•āĻŽā§‡ 7. āĻĒā§‚āĻ°ā§āĻŦ⧇āϰ āϚāĻŋāĻ•āĻŋā§ŽāϏāĻž āύāĻŋāωāϰ⧋āϞāϜāĻŋāĻ¸ā§āĻŸā§‡āϰ āĻĒāϰāĻžāĻŽāĻ°ā§āĻļ āύ⧇āĻ“āϝāĻŧāĻž āĻšāϝāĻŧ⧇āϛ⧇,āύāĻŋāωāϰ⧋ āĻ…āĻŸā§‹āϞāϜāĻŋāĻ¸ā§āϟ āĻāϰ āĻĒāϰāĻžāĻŽāĻ°ā§āĻļ āύ⧇āĻ“āϝāĻŧāĻž āĻšāϝāĻŧ⧇āϛ⧇ āĻĻā§€āĻ°ā§āϘ āϏāĻŽāϝāĻŧ āϧāϰ⧇ āωāĻĒāϏāĻ°ā§āĻ— āĻ¸ā§āĻĨāĻžāϝāĻŧā§€, āϧ⧀āϰ⧇ āϧ⧀āϰ⧇ āĻŦ⧃āĻĻā§āϧāĻŋ āĻĒ⧇āϝāĻŧ⧇āϛ⧇ 8. āϚāĻŋāĻ•āĻŋā§ŽāϏāϕ⧇āϰ āĻ•āĻžāϛ⧇ āĻ…āύ⧁āϰ⧋āϧ (What I want to know) āĻāϟāĻŋ āĻ•āĻŋ āϭ⧇āĻ¸ā§āϟāĻŋāĻŦ⧁āϞāĻžāϰ (balance) āϏāĻŋāĻ¸ā§āĻŸā§‡āĻŽā§‡āϰ āϏāĻŽāĻ¸ā§āϝāĻž? PPPD / Vestibular migraine āĻāϰ āϏāĻŽā§āĻ­āĻžāĻŦāύāĻž āφāϛ⧇ āĻ•āĻŋ? 9. āϏāĻ‚āĻ•ā§āώāĻŋāĻĒā§āϤ āϏāĻžāϰāĻžāĻ‚āĻļ āĻĒā§āϰāĻžāϝāĻŧ ā§Ē āĻŦāĻ›āϰ āφāϗ⧇ āĻĒāϰ⧀āĻ•ā§āώāĻžāϰ āϚāĻžāĻĒ āĻ“ āĻāĻ• āϤ⧀āĻŦā§āϰ āĻŽāĻžāĻĨāĻž āĻ˜ā§‹āϰāĻžāϰ āĻĒāϰ āĻĨ⧇āϕ⧇ āĻ¸ā§āĻĨāĻžāϝāĻŧā§€āĻ­āĻžāĻŦ⧇ āĻŽāĻžāĻĨāĻžāϰ āϭ⧇āϤāϰ⧇ āĻĻ⧁āϞ⧁āύāĻŋ, āĻ­āĻžāϰāϏāĻžāĻŽā§āϝāĻšā§€āύāϤāĻž āĻāĻŦāĻ‚ āĻ­āĻŋāĻœā§āϝ⧁āϝāĻŧāĻžāϞ āĻ•āĻžāĻœā§‡āϰ āϏāĻžāĻĨ⧇ āϏāĻŽā§āĻĒāĻ°ā§āĻ•āĻŋāϤ āωāĻĒāϏāĻ°ā§āĻ— āĻļ⧁āϰ⧁ āĻšāϝāĻŧ, āϝāĻž āϧ⧀āϰ⧇ āϧ⧀āϰ⧇ āĻŦ⧃āĻĻā§āϧāĻŋ āĻĒ⧇āϝāĻŧ⧇ āĻŦāĻ°ā§āϤāĻŽāĻžāύ⧇ āĻĻ⧈āύāĻ¨ā§āĻĻāĻŋāύ āĻœā§€āĻŦāύ āĻ“ āĻĒāĻĄāĻŧāĻžāĻļā§‹āύāĻžāϝāĻŧ āĻŦāĻĄāĻŧ āĻĒā§āϰāĻ­āĻžāĻŦ āĻĢ⧇āϞāϛ⧇āĨ¤ âœ”ī¸ END OF REPORT

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Your persistent symptoms indeed suggest an issue related to the vestibular system, but pinpointing the exact cause requires a look at various possible conditions. Based on your description, this could be due to Persistent Postural-Perceptual Dizziness (PPPD) or vestibular migraine. PPPD is characterized by non-spinning dizziness and imbalance, which aligns with your description of persistent internal dizzines/floating sensations that worsen with visual stimulation and improve with rest. The background of stress and the symptom persistence also fit. Vestibular migraine is another possibility, particularly if there’s any history of migraine headaches. It can present with similar symptoms even without a headache during the dizziness episodes. Both conditions can coexist or overlap, making diagnosis challenging. The hypoactive right posterior canal and abnormalities in central vestibulo-ocular function from your reports hint towards central vestibular issues, pushing PPPD or vestibular migraine higher in differential diagnosis.

To manage these symptoms, consider seeking a specialist in vestibular disorders who can confirm the diagnosis with the context of your full medical history and prior test results. Treatment typically includes vestibular rehabilitation therapy, which can help your brain adapt to the dizziness by practicing balance exercises. Cognitive-behavioral therapy also often plays a role, especially for PPPD, addressing the psychological component of particularly persistent dizziness tied to stress and anxiety. Medication options, including certain SSRIs or migraine preventatives, might be recommended based on the specific diagnosis and your overall health profile. Getting guidance on lifestyle modifications, like reducing screen time and managing stress, could also contribute to symptom management. Quick follow-up with a healthcare professional is advised to explore these pathways in detail to improve your quality of life.

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Hello dear See you have combination of Balance issues Cognitive dysfunction Focus impairment However it can be modified by following precautions Do meditation Take good balanced diet for good health Engage in social media Indulge in hobbies like reading and writing Avoid overthinking Avoid junk food and alcohol/ smoking Set your goals for every day In addition please get following tests routinely for confirmation CBC Serum ferritin Serum tsh Serum dopamine and serotonin Serum bradykinin EMR Mri Ct scan Brain USG Hopefully you recover soon Regards

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