Deafness/Hearing Impairment/months of feelings of dizziness
QUESTION: A radiologist and ENT came to different conclusions, so I'd like your thoughts. I realize that this case is not a perfect fit for your area of expertise, but there are no experts listed in ENT per se.
I am the patient's conservator. Last fall he showed up at the ER with a high fever complaining of dizziness. The flu was diagnosed and subsequently ran its course. However, the dizziness persisted for weeks, then months, and still persists.
But it's more of a perception of dizziness, rather than actual vertigo. There's no loss of balance involved. He often complains that his field of vision is spinning or jerking or that he feels pulled to one side, but there's never been any outward sign of disequilibrium.
Other symtoms include more visual distortions and a headache with a feeling of pressure behind the eyes. The severity of the symptoms wax and wane but don't seem to disappear completely.
Transient estrobia was apparently observed on two occasions this year: once by a neuro-ophthamologist at an office visit and once by the patient's co-workers.
The patient was run through a battery of hearing and balance tests, and everything checked out. An EEG also came back normal.
An MRI was also done, and I've attached a composite images. The views 1A and 1B are SAG T1, view 5 is AX FLAIR, view 6 is AX BFFE, view 7 is AX T1 THINS PRE, view 8 is AX T1 THINS +C, and view 9 is COR T1 THIN +C.
More recently, a CT scan was made, and two slices are also attached as ct(lo).jpg.
The patient is autistic and has a history of OCD. One of his fixations is on his body. He had the flu about ten years ago, and it was accompanied by similar dizziness, which scared him greatly at that time.
The patient had multiple ear infections as a child, and tubes were placed in his ears early in his life.
For years (continuing to the present) he has exhibited what might be called mild facial spasms. Every so often his face will slightly contort for a few seconds, and he will appear to be "out of it." Over the years this has motivated speculation about absence seizures, but EEGs have provided no real evidence. He hasn't taken anti-convulsants for over a decade.
What would you most suspect based on his history and this MRI and CT imaging?
I'm really sorry, but you are correct that this is out of my area of expertise. Balance issues are tough a lot of the time. Many doctors blow over the idea of digging deeper and trying to determine a true problem, so I commend you all for not just throwing a pill at this and being done.
You describe vertigo so there is the assumption that the vestibular system is involved but to what degree, I can not speculate.
There are Otologists that specialize in vestibular pathology, and since this has been a problem for some time, I would consider seeking a consultation with one.
I'm sorry I couldn't be more help.
Kelley Linton, AuD
Doctor of Audiology
---------- FOLLOW-UP ----------
QUESTION: Thank you for your response. I know it's not your field of expertise, but I'd like to ask a followup.
The patient does *not* have a balance issue. He complains of inward sensations of dizziness but there are no outward signs. I have not seen him be unsteady or lose his balance once in all these months. I've seen him lift up his foot to tie his shoe. I cannot even do that myself. As I wrote, "it's more of a perception of dizziness, rather than actual vertigo."
Do you know of any condition that would cause the sensation of vertigo without any corresponding loss of balance?
I have not because Vertigo is somewhat of a "perception" and the symptom is loss of balance. The brain is telling the inner ear you are falling when you really aren't or vice-avers. Dizziness and Vertigo are very different and usually from different pathology.
True, unprovoked vertigo will usually have a pathology of some type...albeit, some are serious and some are not.
Dizziness can be from circulation lagging behind movement, dehydration, medications, etc. It can also have serious pathology or not serious pathology but is not typically related to the inner ear.
Vertigo is usually pretty violent and loss of balance is a norm.