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Have Had Progressive Dizziness And Extreme Fatigue With Headache. Looking For Suggestion

Posted on Thu, 11 Oct 2012

Question: I have had progressive dizziness and extreme fatigue with headache and muscle cramping for 3 months. My heart flutters when I lie down to take a nap and at bed time in the evening. If I attempt to take a nap, I often wake up with tingling (restless arm & leg feeling). I have frequent facial flushing, increased with caffiene/nicotine, accompanied by headache and ringing in ears. Abdominal and pelvic CT show nothing, and lab values look good except for mildly elevated leukocytes and monocytes %. No weight loss to speak of, and not much fever, but some night sweats (not too bad). I am recently-diagnosed/infected HIV+, and have been on Truvada and Isentriss for 2 months.
Suggestions?

Answered by Dr. Rahul Tawde (2 hours later)

Dear XXXXXX,
Thanks for writing in. You seem to be suffering distirbing symptoms for which there is no apparent cause other than what you have noted.
After going thru ur history there is nothing which points specifically towards any specific endocrine disorder. These symptoms can be as much due to a non endocrine problem as an endocrine problem. Adrenal insufficiency and thyroid problem can lead to similar symptoms. Vitamin d deficiency can lead to weakness, muscle aches and easy fatiguability. Since you are saying that ur blood reports are normal it is worthwhile testing for endocrine problems.
I suggest following tests to rule out any endocrine problem- vitamin D levels,8am ACTH &Cortisol, T3, T4,TSH[THYROID FUNCTION TESTS]. I also advise you to take multivitamin supplements, calcium tablets. It may be worthwhile doing yoga to rejuvinate and regain lost energy. Also discuss with ur doc whether these symptoms could be related to HIV prodrome or the side effects of medications. There may be a component of depression which is compounding the problem.
Get the tests Ive suggested and lets see if anything comes out. Im ready to help you in all possible way from an endocrine perspective. Get back to me for any other queries.
Wishing you speedy recovery and good health.
Shivaprasad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rahul Tawde (12 minutes later)

I am very concerned that this may be a lymphoma of the brain.
But, I've had no seizure, just cramping, clumsiness, and problems with vision.
The ringing in my ear (left mostly) and facial flushing may or may not be consistent with CNS lymphoma, and the onset of HIV was probably this past January 2012. Do you think that acute HIV onset can cause CNS Lymphoma to arise suddenly?
Also, I have some neuropathy when trying to sleep that comes and goes.
Still curious. I would like to think this is all thyroid, but I'm rather scared.

Answered by Dr. Rahul Tawde (40 hours later)

Its most unlikely for cns lymphoma to present this way, its usually seen in advanced stage of HOV imfectipn- so forget about that. I dont think thyroid is responsible for these complaints. In case get the tests Ive advised lets see what comes out
Thanks
Shivaprasad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rahul Tawde (5 hours later)

Just one last follow-up question, please.
Thyroid tests look good. Vitimin D level looks good. (Just tested with primary MD.)

If we consider:
- dizziness (particularly with motion)
- headache (odd pattern - gripping neck, crown, and forehead)
- fatigue
- muscle weakness / clumsiness
- ringing in ears (left ear prominent)
- eye pressure (feeling of muscular tension in eyes, Right eye prominent)
- migratory muslce spasm (mid/center chest, left flank, right flank)
- no injury (ever)
I'm thinking a head/neck CT or MRI would be the next step.
I'm suspicious of brain tumor, and I would prefer not to have a seizure before it is determined as time to check. (No history of seizure disorder, only a feeling sometimes that I may convulse.)

Thank you.

Answered by Dr. Rahul Tawde (38 hours later)

Hi,

Thanks for writing back and I am sorry about the delay in my response.

I am glad that the thyroid hormone levels and Vitamin D level is normal.

Yes, you may go ahead with the CT or MRI of the brain. It would help us in ruling out any organic brain lesion such as a primary brain lymphoma. However, this is not common in HIV until the CD4+ counts drop to a level lower than 200. I would be interested to know about your current CD4+ counts to look for the possibility of Lymphoma, or other opportunistic infections in HIV.

I agree with you. You should not be waiting for the complications to arise. Please go ahead and get the CT/MRI brain done.

Hope this helps you.

Regards,

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar