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
What is causing my persistent dizziness and balance issues after a severe episode four years ago?
đ§ž āϰā§āĻā§āϰ āϏāĻŽā§āĻĒā§āϰā§āĻŖ āĻāϤāĻŋāĻšāĻžāϏ āĻ āĻāĻĒāϏāϰā§āĻā§āϰ āϏāĻžāϰāϏāĻāĻā§āώā§āĻĒ (FINAL CASE SUMMARY) 1. āĻĒā§āϰāϧāĻžāύ āϏāĻŽāϏā§āϝāĻž (Chief Complaints) āĻĻā§āϰā§āĻāĻĻāĻŋāύ āϧāϰ⧠āĻŽāĻžāĻĨāĻžāϰ āĻā§āϤāϰ⧠āĻĻā§āϞā§āύāĻŋ / āĻāĻžāϏāĻžāϰ āĻ āύā§āĻā§āϤāĻŋ āĻšāĻžāĻāĻāĻž āĻ āĻĻāĻžāĻāĻĄāĻŧāĻžāϞ⧠āĻāĻžāϰāϏāĻžāĻŽā§āϝ āύāώā§āĻ āĻšāĻāϝāĻŧāĻž (imbalance) āϏāĻžāϰāĻžāĻā§āώāĻŖ āĻŽāĻžāĻĨāĻž āĻāĻžāϰ āĻ āĻāĻŋāĻŽāĻāĻŋāĻŽ āĻ āύā§āĻā§āϤāĻŋ āĻĒāĻĄāĻŧāĻžāĻļā§āύāĻž āĻŦāĻž āĻŽā§āĻŦāĻžāĻāϞ/āĻāĻŽā§āĻĒāĻŋāĻāĻāĻžāϰ āϏā§āĻā§āϰāĻŋāύ āĻĻā§āĻāϞ⧠āϏāĻŽāϏā§āϝāĻž āĻ āύā§āĻ āĻŦā§āĻĄāĻŧā§ āϝāĻžāϝāĻŧ āĻāϞāύā§āϤ āĻŦāĻžāϏ/āĻā§āϰā§āύ āĻĨā§āĻā§ āĻŦāĻžāĻāϰ⧠āϤāĻžāĻāĻžāϞ⧠āĻŽāĻžāĻĨāĻž āĻā§āϰāĻž āĻ āĻĻā§āϞā§āύāĻŋ āĻŦāĻžāĻĄāĻŧā§ āĻĻāĻžāĻāĻĄāĻŧāĻŋāϝāĻŧā§ āĻĨāĻžāĻāϞ⧠āĻĻā§āϰā§āĻŦāϞ āϞāĻžāĻā§, āĻšāĻžāϤ-āĻĒāĻž āĻāĻžāĻāĻĒā§, āĻā§āĻ āĻ āύā§āϧāĻāĻžāϰ āĻšāϝāĻŧā§ āĻāϏ⧠āĻŽāĻžāĻĨāĻž āύāĻžāĻĄāĻŧāĻžāϞ⧠āĻāĻĒāϏāϰā§āĻ āĻŦā§āĻĻā§āϧāĻŋ āĻĒāĻžāϝāĻŧ āĻŽāĻžāĻĨāĻž āĻā§āϰāĻžāϰ āϏāĻŽāϝāĻŧ āĻāĻĨāĻž āĻŦāϞāϤ⧠āĻ āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻ āϞāĻžāĻā§ 2. āϰā§āĻā§āϰ āĻļā§āϰ⧠(Detailed Onset History) āĻĒā§āϰāĻžāϝāĻŧ ā§Ē āĻŦāĻāϰ āĻāĻā§ āϏāĻŽāϏā§āϝāĻž āĻļā§āϰ⧠āĻšāϝāĻŧāĨ¤ āϤāĻāύ āĻāĻŽāĻŋ āĻĒāϰā§āĻā§āώāĻžāϰ āĻĒā§āϰāϏā§āϤā§āϤāĻŋāϰ āϏāĻŽāϝāĻŧ āĻāĻŋāϞāĻžāĻŽ āĻāĻŦāĻ āĻĒā§āϰāĻāĻŖā§āĻĄ āĻŽāĻžāύāϏāĻŋāĻ āĻāĻžāĻĒā§āϰ āĻŽāϧā§āϝ⧠āĻāĻŋāϞāĻžāĻŽāĨ¤ āϏā§āĻ āϏāĻŽāϝāĻŧ āĻāĻŽāĻŋ āϏāĻžāϰāĻžāĻĻāĻŋāύ āĻĒāĻĄāĻŧāĻžāĻļā§āύāĻž āĻāϰāϤāĻžāĻŽ āĻāĻŦāĻ āĻ āύā§āĻāĻā§āώāĻŖ āϧāϰ⧠āĻāĻāĻāĻžāĻŦā§ āĻŦāϏ⧠āĻŽāĻžāĻĨāĻž āĻĻā§āϞāĻŋāϝāĻŧā§ āĻĻā§āϞāĻŋāϝāĻŧā§ āĻĒāĻĄāĻŧāϤāĻžāĻŽ āĻāĻāĻĻāĻŋāύ āĻŽāĻžāĻāϰāĻŋāĻŦā§āϰ āĻĒāϰ⧠āĻĒāĻĄāĻŧāĻžāĻļā§āύāĻž āĻāϰāĻžāϰ āϏāĻŽāϝāĻŧ āĻāĻŽāĻŋ āĻā§āĻŦ āĻŦā§āĻļāĻŋ āĻĻā§āϞ⧠āĻĻā§āϞ⧠āĻĒāĻĄāĻŧāĻāĻŋāϞāĻžāĻŽāĨ¤ āĻšāĻ āĻžā§ āĻāϰ⧠āĻāĻāĻāĻŋ āĻā§āĻŦ āϤā§āĻŦā§āϰ āĻŽāĻžāĻĨāĻž āĻā§āϰāĻž (sudden severe dizziness episode) āĻšāϝāĻŧāĨ¤ āϤāĻāύ āϏāĻžāĻĨā§ āϏāĻžāĻĨā§ āĻāĻŽāĻŋ āĻā§āĻŦāĻŋāϞā§āϰ āĻāĻĒāϰ āĻŽāĻžāĻĨāĻž āĻĻāĻŋāϝāĻŧā§ āĻļā§āϝāĻŧā§ āĻĒāĻĄāĻŧāĻŋ āĻāĻŦāĻ āĻāĻŋāĻā§āĻā§āώāĻŖ āĻĒāϰ⧠āĻāĻŋāĻā§āĻāĻž āĻļāĻžāύā§āϤ āĻšāĻāĨ¤ āĻāϰ ā§§â⧍ āĻĻāĻŋāύ āĻĒāϰ āĻĨā§āĻā§ āĻāĻŽāĻŋ āϞāĻā§āώā§āϝ āĻāϰāĻŋ āϝā§: āĻāĻŽāĻŋ āĻāϰ āĻāĻā§āϰ āĻŽāϤ⧠āĻĻā§āϞ⧠āĻĻā§āϞ⧠āĻĒāĻĄāĻŧāϤ⧠āĻĒāĻžāϰāĻāĻŋ āύāĻž āĻĻāĻžāĻāĻĄāĻŧāĻŋāϝāĻŧā§ āĻĨāĻžāĻāϤ⧠āĻĒāĻžāϰāĻāĻŋ āύāĻž, āĻŽāύ⧠āĻšāϝāĻŧ āĻĒāĻĄāĻŧā§ āϝāĻžāĻŦ āϏāĻŦ āϏāĻŽāϝāĻŧ āĻĻā§āϞā§āύāĻŋ/āĻāĻžāϏāĻž āĻ āύā§āĻā§āϤāĻŋ āĻšāĻā§āĻā§ āĻāϰāĻĒāϰ āĻĨā§āĻā§ āϧā§āϰ⧠āϧā§āϰ⧠āĻāĻĒāϏāϰā§āĻ āϏā§āĻĨāĻžāϝāĻŧā§ āĻšāϝāĻŧā§ āϝāĻžāϝāĻŧ āĻāĻŦāĻ āϏāĻŽāϝāĻŧā§āϰ āϏāĻžāĻĨā§ āĻāϰāĻ āĻŦāĻžāĻĄāĻŧāϤ⧠āĻĨāĻžāĻā§āĨ¤ 3. āĻŦāϰā§āϤāĻŽāĻžāύ āĻ āĻŦāϏā§āĻĨāĻž (Current Condition) āĻāĻāύ⧠āĻāĻāύ⧠⧍ā§Ē āĻāύā§āĻāĻž āϧāϰ⧠āĻĻā§āϞā§āύāĻŋ/āĻāĻŋāĻŽāĻāĻŋāĻŽ āĻ āύā§āĻā§āϤāĻŋ āĻĨāĻžāĻā§ āĻāĻŦāĻžāϰ āĻāĻŋāĻā§ āϏāĻŽāϝāĻŧ (āĻŦāĻŋāĻļā§āώ āĻāϰ⧠āĻā§āĻĒāĻāĻžāĻĒ āĻŦāϏ⧠āĻĨāĻžāĻāϞā§) āϤā§āϞāύāĻžāĻŽā§āϞāĻāĻāĻžāĻŦā§ āĻāĻžāϞ⧠āĻĨāĻžāĻā§ āϏā§āĻā§āϰāĻŋāύ āĻĻā§āĻāĻž, āĻĒāĻĄāĻŧāĻžāĻļā§āύāĻž, āĻŽāĻžāĻĨāĻž āύāĻžāĻĄāĻŧāĻžāύ⧠āĻŦāĻž āĻāĻŋāĻā§āϝā§āϝāĻŧāĻžāϞ āĻāĻžāĻ āĻāϰāϞ⧠āĻĻā§āϰā§āϤ āĻāĻžāϰāĻžāĻĒ āĻšāϝāĻŧ āĻšāĻžāĻāĻāĻž āĻ āĻĻāĻžāĻāĻĄāĻŧāĻžāύā§āϤ⧠āĻāĻžāϰāϏāĻžāĻŽā§āϝ āĻāĻŽā§ āϝāĻžāϝāĻŧ āϤāĻŦā§ āĻŦāĻžāĻšā§āϝāĻŋāĻāĻāĻžāĻŦā§ āĻ āύā§āϝāϰāĻž āϏāĻžāϧāĻžāϰāĻŖāϤ āĻāĻŽāĻžāϰ āĻĻā§āϞā§āύāĻŋ āĻĻā§āĻāϤ⧠āĻĒāĻžāϝāĻŧ āύāĻž (subjective imbalance) 4. MRI āĻ āĻĒā§āϰā§āĻŦā§āϰ āϰāĻŋāĻĒā§āϰā§āĻ 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 āύāύā§āϝ āϏāĻāϞ āϧāϰāύā§āϰ āϰāĻā§āϤ āĻĒāϰā§āĻā§āώāĻž āĻĒāϰāĻŋāĻĒā§āϰā§āĻŖāĻāĻžāĻŦā§ āϏā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻāĨ¤ 5. āĻ āϤāĻŋāϰāĻŋāĻā§āϤ āĻāĻĒāϏāϰā§āĻ āĻŽāĻžāĻĨāĻž āĻāĻžāĻāĻĒāĻā§ āĻŦāϞ⧠āĻ āύā§āĻāĻŦ āĻšāϝāĻŧ(āĻŦāĻŋāĻļā§āώ āĻāϰ⧠āĻĻāĻžāĻāĻĄāĻŧāĻžāϞ⧠āĻŦāĻž āĻŽāĻžāĻĨāĻž āĻā§āϰāĻžāϰ āϏāĻŽāϝāĻŧ) āĻĻā§āϰā§āĻāĻā§āώāĻŖ āĻĻāĻžāĻāĻĄāĻŧāĻžāϞ⧠āĻĻā§āϰā§āĻŦāϞāϤāĻž āĻ āĻā§āĻ āĻ āύā§āϧāĻāĻžāϰ āĻšāϝāĻŧā§ āĻāϏ⧠āĻĒāĻĄāĻŧāĻžāĻļā§āύāĻž āĻŦāĻž āĻŽāĻžāύāϏāĻŋāĻ āĻāĻžāĻĒā§āϰ āĻāĻžāĻ āĻāϰāϞ⧠āĻāĻĒāϏāϰā§āĻ āĻ āύā§āĻ āĻŦā§āĻĄāĻŧā§ āϝāĻžāϝāĻŧ āĻĒāĻĄāĻŧāĻžāĻļā§āύāĻž āĻŦāϰā§āϤāĻŽāĻžāύ⧠āĻĒāϰāĻŋāĻĒā§āϰā§āĻŖ āĻŦāύā§āϧ đĨē 6. āĻā§āϰā§āϤā§āĻŦāĻĒā§āϰā§āĻŖ āĻŦā§āĻļāĻŋāώā§āĻā§āϝ (Key Clinical Features) āĻāϰ āĻŦāĻž āĻāĻŋāύāĻŋāϏāĻĒāϤā§āϰ āĻā§āϰ⧠āύāĻž (no spinning vertigo) āĻĒā§āϰāϧāĻžāύ āϏāĻŽāϏā§āϝāĻž āĻšāϞ⧠internal dizziness / floating / rocking sensation āĻāĻĒāϏāϰā§āĻ āĻāĻŋāĻā§āϝā§āϝāĻŧāĻžāϞ āϏā§āĻāĻŋāĻŽā§āϞā§āĻļāύ (āϏā§āĻā§āϰāĻŋāύ/āϞā§āĻāĻž/āĻāϞāύā§āϤ āĻĒāϰāĻŋāĻŦā§āĻļ) āĻ āĻŦāĻžāĻĄāĻŧā§ āĻŦāĻŋāĻļā§āϰāĻžāĻŽ āĻ āϏā§āĻĨāĻŋāϰ āĻĨāĻžāĻāϞ⧠āĻāĻŋāĻā§āĻāĻž āĻāĻŽā§ 7. āĻĒā§āϰā§āĻŦā§āϰ āĻāĻŋāĻāĻŋā§āϏāĻž āύāĻŋāĻāϰā§āϞāĻāĻŋāϏā§āĻā§āϰ āĻĒāϰāĻžāĻŽāϰā§āĻļ āύā§āĻāϝāĻŧāĻž āĻšāϝāĻŧā§āĻā§,āύāĻŋāĻāϰ⧠āĻ āĻā§āϞāĻāĻŋāϏā§āĻ āĻāϰ āĻĒāϰāĻžāĻŽāϰā§āĻļ āύā§āĻāϝāĻŧāĻž āĻšāϝāĻŧā§āĻā§ āĻĻā§āϰā§āĻ āϏāĻŽāϝāĻŧ āϧāϰ⧠āĻāĻĒāϏāϰā§āĻ āϏā§āĻĨāĻžāϝāĻŧā§, āϧā§āϰ⧠āϧā§āϰ⧠āĻŦā§āĻĻā§āϧāĻŋ āĻĒā§āϝāĻŧā§āĻā§ 8. āĻāĻŋāĻāĻŋā§āϏāĻā§āϰ āĻāĻžāĻā§ āĻ āύā§āϰā§āϧ (What I want to know) āĻāĻāĻŋ āĻāĻŋ āĻā§āϏā§āĻāĻŋāĻŦā§āϞāĻžāϰ (balance) āϏāĻŋāϏā§āĻā§āĻŽā§āϰ āϏāĻŽāϏā§āϝāĻž? PPPD / Vestibular migraine āĻāϰ āϏāĻŽā§āĻāĻžāĻŦāύāĻž āĻāĻā§ āĻāĻŋ? 9. āϏāĻāĻā§āώāĻŋāĻĒā§āϤ āϏāĻžāϰāĻžāĻāĻļ āĻĒā§āϰāĻžāϝāĻŧ ā§Ē āĻŦāĻāϰ āĻāĻā§ āĻĒāϰā§āĻā§āώāĻžāϰ āĻāĻžāĻĒ āĻ āĻāĻ āϤā§āĻŦā§āϰ āĻŽāĻžāĻĨāĻž āĻā§āϰāĻžāϰ āĻĒāϰ āĻĨā§āĻā§ āϏā§āĻĨāĻžāϝāĻŧā§āĻāĻžāĻŦā§ āĻŽāĻžāĻĨāĻžāϰ āĻā§āϤāϰ⧠āĻĻā§āϞā§āύāĻŋ, āĻāĻžāϰāϏāĻžāĻŽā§āϝāĻšā§āύāϤāĻž āĻāĻŦāĻ āĻāĻŋāĻā§āϝā§āϝāĻŧāĻžāϞ āĻāĻžāĻā§āϰ āϏāĻžāĻĨā§ āϏāĻŽā§āĻĒāϰā§āĻāĻŋāϤ āĻāĻĒāϏāϰā§āĻ āĻļā§āϰ⧠āĻšāϝāĻŧ, āϝāĻž āϧā§āϰ⧠āϧā§āϰ⧠āĻŦā§āĻĻā§āϧāĻŋ āĻĒā§āϝāĻŧā§ āĻŦāϰā§āϤāĻŽāĻžāύ⧠āĻĻā§āύāύā§āĻĻāĻŋāύ āĻā§āĻŦāύ āĻ āĻĒāĻĄāĻŧāĻžāĻļā§āύāĻžāϝāĻŧ āĻŦāĻĄāĻŧ āĻĒā§āϰāĻāĻžāĻŦ āĻĢā§āϞāĻā§āĨ¤ âī¸ END OF REPORT
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Doctors' responses
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 thereâs 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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