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Suggest Treatment For Disequilibrium Along With Double Vision And Fatigue

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Posted on Wed, 14 Jan 2015
Question: I have disquilibrium that has gotten worse in the past week, double-vision, dropped some things (because of the disequlibruium), and fatigue. I have been to my primary care doctor, who did blood work and found nothing, went back to the the PA at my PC office, who diagnosed vertigo and told me to do "Epley" exericise. Saw the PA in my Neurologist's office last week (for a routine check up as she deals with my chronic migraines), told her all of this (on Monday) and on Friday she called in a prescription for Hydroxicine (sp?). I took it once and that was enough--did not like how it make me feel--very out of it. Went to ER on Friday of last week b/c I wanted to know what was going on. They did CT Scan, Chest xray, blood work, urine test--and found nothing. Today, the ENT found nothing, said it was not ENT related vertigo but seemed neurological to him and sounded like Multiple Sclerosis. I am skeptical since it seemed more of a catchall and that he couldn't help me and just said that, rather than actually knew. He gave me the names of two neurologists next door to him at a Sleep Clinic. I had a "Clean" MRI two years ago when the migraines got bad. I will schedule an appt with a full-on neurology institute (rather than my migraine doc) but at this point I am frustrated that a doctor has just dumped MS as a possibility right before the holidays when I won't get any answers until January. I know two people with MS--very close to me--not related by blood. Thank you for your time. AS
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Answered by Dr. Tushar Kanti Biswas (57 minutes later)
Brief Answer:
double-vision, disequlibruium

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

A combination of double vision,ataxia (disequilibrium) won't be an ENT problem like acute peripheral vestibulopathy /vestibular neuronitis or BPPV(benign paroxysmal positional vertigo) for which Epley's maneuver will be useful.
Double vision goes in favour of ophthalmoplegia,which could be due to Multiple sclerosis which can cause INO (internuclear ophthalmoplegia )and ataxia(disequilibrium) or it could be due to Wernicke's encephalopathy (ophthalmoplegia ,ataxia and confusion),if you are alcoholic.
Vertebro-basialr migraine can also cause constellation of vertigo,dizziness,
The investigation of choice in suspected multiple sclerosis is MRI brain and not CT scan which may miss many things.






Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1920 Questions

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Suggest Treatment For Disequilibrium Along With Double Vision And Fatigue

Brief Answer: double-vision, disequlibruium Detailed Answer: Hi, Thank you for your query. I can understand your concerns. A combination of double vision,ataxia (disequilibrium) won't be an ENT problem like acute peripheral vestibulopathy /vestibular neuronitis or BPPV(benign paroxysmal positional vertigo) for which Epley's maneuver will be useful. Double vision goes in favour of ophthalmoplegia,which could be due to Multiple sclerosis which can cause INO (internuclear ophthalmoplegia )and ataxia(disequilibrium) or it could be due to Wernicke's encephalopathy (ophthalmoplegia ,ataxia and confusion),if you are alcoholic. Vertebro-basialr migraine can also cause constellation of vertigo,dizziness, The investigation of choice in suspected multiple sclerosis is MRI brain and not CT scan which may miss many things. Regards Dr. T.K. Biswas M.D. XXXXXXX