Brief Answer:
Cause of your symptoms

Detailed Answer:
Hi XXXXXXX thanks for asking from HCM.


I can understand your concern. The cause of such symptoms at your age could be
due to damage to either one of them or both

- Brain

- Spinal cord

Now there are few possibilities, you should discuss with your physician or neurologist.

- Cervical cord myelopathy - It can cause spastic tremors in all limbs, imbalance due to spasticity/sensory system damage, vertigo on neck bending, sometimes even ringing in ear also.

It is very common in old age female due to osteoporotic spine. You mentioned that your MRI was normal. I assume that was brain. So please ask your doctor to get

- MRI cervical spine
- X ray cervical spine
to confirm

- Parkinson disease - It is a neurological disease in which brain MRI is normal. It occurs due to chemical dopamine disturbance in brain. It presents as tremors (resting), balance problem or gravity catching gait, rigidity in limbs, excessive slowness in movements. It is not necessary that all the symptoms are present at same time.

Kindly ask your neurologist to rule it out by clinical examination and if needed, levodopa test.

- Vitamin B12 deficiency - It can cause above mentioned symptoms or non compressive myelopathy. But it usually does not cause ringing in ear. But it is very common problem to occur.

- Demyelinating disorder like multiple sclerosis - It can be one of the cause. But it is less likely as your MRI brain was normal and considering this age group.

But possibility can not be ruled out.

Hope it will give you some insight and you can discuss these points. If still in doubt, do let me know.

Thanks. Take care.

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Brief Answer:
ALS possibility and role of spinal tap

Detailed Answer:
Hi XXXXXXX welcome back.

ALS possibility can not be ruled out in you. However, it generally affects younger age and presents with muscular weakness, change in speech, swallowing difficulty, tremors may occur.

It does not cause vertigo, ringing in ear. In your case, few symptoms and age do not match its criteria.

Now coming to your anxiety, it is not that you do not have much time left. Now a days, in any kind of above mentioned illness (Multiple sclerosis, Parkinson, ALS), survival is almost 5-10 years. And it is also satisfactory survival on medication, not painful survival. You just need to relax. First wait for the confirmation of diagnosis.

Spinal tap is a very good investigations to rule out many possibilities. It can tell you

- Altered protein level in CSF - Like in MS (multiple sclerosis), there is rise in M clonal band. It can be detected in CSF.

- CSF protein and sugar level - Generally in MS and ALS, protein level will be raised. Sugar level remains normal.
In infection, sugar level can decrease.

Now other useful tests for you are

- Nerve conduction studies of affected limb nerves. It will rule out any neuropathy. Also demyelination.

- Electromyography to test the muscles power and strength

- Bone densiometery - It is to find out degree of osteoporosis in you.

In the end of your question, you mentioned that there was whiplash injury and concussion. It can be the cause of all of your symptoms. Whiplash injury and concussion can change cord and brain changes in late stage and may result into myelopathy, ringing in ear, balance problem, weakness.

I suggest you, you must get MRI cervical spine to know about any trauma sequelae. It will really help you.

Hope you will find it useful. Please let me know, if any doubt.
Thanks. Take care

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Brief Answer:
Thank you very much for the appreciation

Detailed Answer:
Hi XXXXXXX XXXX, welcome back.


Thanks a lot for the appreciation. Please let me know if you find any difficult. Do not worry about it, you will be alright. Have faith.

Take care.

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