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I'm on week 4 of feeling extremely dizzy- the

Sent to Health Experts April 09 12:59 PM

I'm on week 4 of feeling extremely dizzy- the dizziness is not of a fainting-sort, it's more like disturbed balance and/ or disequillibrium as well as dizzy spells when I move my head. The "dizziness" lasts all day long, with no relief as the day progresses. My [new] doctor (family practice) diagnosed me with BPPV and I have undergone 2 weeks of balance therapy. I now, however, feel worse than before. My CT from 2 weeks ago revealed an enlarged sella turcica. My VNG results suggest evidence of significant vestibular dysfunction due to delayed saccades. My doctor is convinced this is all due to displaced canaliths, but I have no recent history of URI, cold, head trauma, etc. I am a 32 year old female patient- blood work from 2.5 wks ago (CHEM and CBC) was unremarkable- with a normal WBC. Should I be concerned about the enlarged sella turcica and seek neurological consult? I have not experienced any abnormal hormonal changes (amenorrhea, galactorrhea, etc.), but the headache is intesifying, as is the fog-brain feeling, extreme fatigue, and overall dizziness. I am currently perfoming the Epley maneuver at home, sleeping upright, etc. but to no relief. Am I being impatient with BPPV, or is there something else going on? Does BPPV occur in patients in their 30s with no recent history of infection? My ears look fine (according to the doc). How long doess BPPV last? Also, I do not feel like the room is "spinning" as in true vertigo, but rather, dizzy spells following head movement and a general sense of disturbed balance most of the day. Please advise.

Edited by Customer (name blocked for privacy) on April 9 2006 at 1:11 PM

 

Optional Information:
Female , Age: 32

Already Tried:
CT of sinuses are clear, but taking Flonase per Dr. rec; Antivert is recommended, but I only take it occassionally at night - it makes me extremeley drowsy

Customer (name blocked for privacy)
Status:  Closed   Value: $10
Answer
April 9 2:46 PM (1 hour and 46 minutes and 43 seconds later)
         
REPLIEDCheck Mark
You have anterior inferior cerebellar artery syndrome.During a physical exam I will ask a patient to look back and forth between my two fingers to check the patient for accuracy, late onset, speed, and conjugate movement. Saccadic eye movements are eye movements that refixate. Delayed saccades occur with cortical lesions. Anterior inferior cerebellar artery (AICA) syndrome is accompanied by vertigo. Vertigo without hearing loss is commonly the transient ischemic attack associated with AICA distribution ischemia. The extent of this stroke is extremely variable. Symptoms similar to Meniere's disease e.g. fluctuating vertigo can be caused by impending TIA's. Diagnosis is made by MRI.

Empty sella syndrome is not a life-threatening illness. Your sella turcica is the bony structure at the base of your brain that contains your pituitary gland. In empty sella syndrome the sella turcica enlarges which makes the pituitary gland shrink ("CT from 2 weeks ago revealed an enlarged sella turcica"). The cause of this is due to a defect in the tissue that usually keeps cerebral spinal fluid separated from the sella turcica. The cerebral spinal fluid puts pressure on your pituitary gland and the walls of your sella turcica. This syndrome usually occurs in women who are overweight and middle aged; however, it does sometimes occur when a pituitary tumor necroses. 50 % of patients with empty sella syndrome have headaches and high blood pressure.


Edited by morekare on April 9 2006 at 2:48 PM

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Dr. Hanson -- Doctor (MD) -- 99% Positive Feedback on 820 Health Accepts
Diplomate, American Board of Quality Assurance & Utilization Review Physicians
Reply
April 9 3:48 PM (1 hour and 2 minutes and 24 seconds later)
         
Reply to Dr. Hanson's Post: Thanks, Dr. Hanson, but I am a little confused. What is the etiology of AICA? Are you suggesting that BPPV is a mis-diagnosis? As far as the enlarged sella turcica is concerned, if anything, I had been almost hypotensive these past few weeks (lowest BP = 92/54; BP has since risen to an average of 105/60 ish). Is it possible that an enlarged sella turcica may not be problematic after all? And, do you recommend I seek a neuro-consult and have an MRI? Besides the sella turcica, my brain CT was unremarkable.
Customer (name blocked for privacy)
Answer
April 9 4:53 PM (1 hour and 5 minutes and 3 seconds later)
         
ACCEPTEDCheck Mark
ETIOLOGY OF ANTERIOR INFERIOR CEREBELLAR ARTERY (AICA) SYNDROME

Your inner ear is supplied by the internal auditory artery which comes from the anterior internal cerebellar artery and occasionally from the basilar artery. There are 3 branches from your internal auditory artery. Your anterior vestibular supplies blood to your anterior and lateral semicircular canals (SCC) and the utricle which is part of your inner ear containing the receptors for your body's sense of balance. The semi-circular canals lead to and from the utricle. Your cochlear vestibular artery has 2 branches which supply blood to the posterior SCC and the saccule which is a small chamber of your inner ear. A cochlear branch is responsible for high-frequency tones and a pure cochlear artery is responsible for low-frequency tones. The lateral and anterior SCC and the utricle have very little collateral circulation which makes them susceptible to ischemia (lack of blood flow). This is why vertigo without hearing loss is the transient ischemic attack associated with anterior inferior cerebellar artery ischemia.

Without viewing your CAT scan and other chart information I hesitate to say whether or not an enlarged sella turcica is problematic. There are many variables that need to be considered. However, from the information that you've given I will say that it is not a problem. Once you and your neurologist treat the AICA then your presenting symptoms of foggy brain, headache, and dizziness should be eliminated.I recommend that you be evaluated by a Board Certified Neurologist and have an MRI so that you will receive appropriate treatment rather than wasting your time and money with dead end diagnoses and treatments ("I am currently perfoming the Epley maneuver at home, sleeping upright, etc. but to no relief.").

Edited by morekare on April 9 2006 at 4:54 PM

Please click the green "ACCEPT" button.     A "BONUS" and "POSITIVE FEEDBACK" are appreciated!
Dr. Hanson -- Doctor (MD) -- 99% Positive Feedback on 820 Health Accepts
Diplomate, American Board of Quality Assurance & Utilization Review Physicians
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