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Am I losing balance due to diomex medicine prescribed for meneires?

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I had vertigo 4 weeks ago lasted less than - minute... I am still feeling off balanced, like the inside of my head is moving... Did hearing test was normal, did eng and the electromagraphy? Ecog? Was a little abnormal 50% on right ear and 54% in left ear.. Vng balance tests were normal.. Can that make me feel off balance? He prescribed diomex and thinks I have meneires? Can that be? I had spinning 2x.. One time minimal and 2x violent that left me with the off balance. Can this be serious? I thought there was hearing loss with menieres
Posted Tue, 24 Dec 2013 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer: All queries addressed ma'am Detailed Answer: Hello ma'am and welcome. Thank you for writing to us. Let me start off by listing the various causes for vertigo, they are: -Benign paroxysmal positional vertigo: Is the most common cause for vertigo, and can be diagnosed or ruled out with the help of ENG or VNG, which was normal in your case -Vertigo associated with migraines: These are associated with migraine headaches, which you have not listed in your query -Inflammation of the inner ear (eg. acute vestibular neuritis) -Labyrinthitis: Associated with hearing loss, which is not present in your case -Acoustic neuroma: Which is a benign tumor growing on the vestibular nerve, and is ruled out with the help of an MRI -Meniere's disease: Is associated with 'fluctuating' hearing loss, which means the hearing loss may come or go or not be present at all -Other more serious causes are all present in the brain, for which an MRI is indicated As you can see ma'am, most of the conditions are ruled out; leaving only Meniere's disease and other conditions related to the brain. I would advise an MRI, which is normal (hopefully), leaves us with only Meniere's disease as the most plausible diagnosis. So, my answer to your query after the above explanation would be: Yes, Meniere's disease is a possibility. The spinning itself is a symptom of the condition ma'am; severity can only be assessed based on the diagnosis (i.e. the condition). And finally, as I have explained earlier, hearing loss may or may not be present with Meniere's disease ma'am. We should not rule out the condition if hearing loss is absent or has not yet settled in. I hope I have succeeded in answering all your queries ma'am. Please feel free to write back to me for any further clarifications or if I have not explained anything well enough, I would be more than happy to help. Best wishes.
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Follow-up: Am I losing balance due to diomex medicine prescribed for meneires? 33 minutes later
Do u I had a stroke?
 
 
Answered by Dr. Shoaib Khan 20 minutes later
Brief Answer: Most probably not; it is protocol to order an MRI Detailed Answer: Hello once again ma'am. Most probably not, as there have to be a dozen other symptoms if you did suffer a stroke. But, there is a condition called a silent stroke, where a patient does not have any external symptoms at all, but I doubt this is your diagnosis. I have only advised an MRI, as it is protocol to advise or order an MRI in all patients who have vertigo, to rule out the worst, and then concentrate on the less serious causes. I hope you understand. Please feel free to write back to me for any further clarifications ma'am, I would be more than happy to help you. Best wishes.
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Follow-up: Am I losing balance due to diomex medicine prescribed for meneires? 42 minutes later
I Am so scared... Another healthcare magic doctor is is insisting I had one.. Can u see my other posts.. Can u read his posts and help me understand
 
 
Answered by Dr. Shoaib Khan 17 minutes later
Brief Answer: Paste the link or send me the query number ma'am Detailed Answer: Hello ma'am. No I cannot ma'am, why don't you copy and paste the link in the address bar after opening the discussion and send it over to me. Or you can just send me the query number, like for example our query number is : 84431; as you can see on top. I will explain in the most elaborate manner what he or she is trying to explain. I am looking forward to your response. Do not worry ma'am, all will be fine. Best wishes.
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Follow-up: Am I losing balance due to diomex medicine prescribed for meneires? 51 minutes later
Answered By: Dr. XXXXXXX Karanwal Internal Medicine Specialist
 
 
Answered by Dr. Shoaib Khan 6 minutes later
Brief Answer: Doctors name will not suffice ma'am Detailed Answer: Hello once again ma'am. Unfortunately I will not be able to view the discussion with just the doctors name. As mentioned in my previous post I will either require the query number or the link from the discussion. You could also just copy and paste all the text and I shall put forward my comments from there on. Best wishes ma'am.
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Follow-up: Am I losing balance due to diomex medicine prescribed for meneires? 9 minutes later
Brief Answer: it was probably a minor stroke. MRI Brain required Detailed Answer: Hi there, Thanks for your query. Firstly, in order to PINPOINT the exact cause of your problems; give you a SOUND professional advice; and, TRUE VALUE FOR YOUR MONEY, may I request you to kindly provide additional information as follows :- # Have you been having headaches with nausea or vomiting, double vision prior to onset of vertigo 4 weeks back? # Are you a patient of high blood pressure, diabetes, heart disease or obesity?? # Did you vomit when you felt the room spinning, 4 weeks back? # Please share with me, any other problems, if any, in as much details as possible. Nevertheless, pending receipt of the additional information, vertigo and unsteady gait occur due to problem of either, internal ear, cerebellum (posterior part of the brain) or the brainstem (described below). As the onset of problems were abrupt, and still persisting, it was probably a minor stroke of either the cerebellum or the upper part of spinal cord (called brainstem) which connects to the brain. The possible causes of stroke are :- 1. A thromboembolism causing obstruction to blood flow in the artery supplying the cerebellum or the brainstem. 2. High blood pressure, causing a minor bleed. 3. High cholesterol levels promote deposition of cholesterol in the lumen of blood vessels (called plaques, which jut inside the arteries and consequent narrowing with obstruction to blood flow). Sometimes, a piece of the plaque- in the main arteries supplying the brain- dislodges, gets carried by the blood stream to arteries of the brain, cutting off the blood supply. 4. Diabetes is a potential risk for strokes. 5. Rarely, a tumor of the nerve which supplies the internal ear (tumor is called Accoustic neuroma), which produces both : vertigo and unsteady gait. I PERSONALLY AM OF THE OPINION THAT YOUR TREATING DOCTOR SHOULD HAVE ADVISED MRI OF BRAIN or Angio-MRI in the first instance to see for evidence of infarct/bleeding in the brain. Consult your doctor and apprise him of my opinion. I am certain that he will agree with my opinion; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. It would however, be a pleasure to receive the additional information as requested, in addition to the test reports, which you must have received by now. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Dr. XXXXXXX Karanwal Replied by Dr. XXXXXXX Karanwal , 21 hours ago Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also. Have you been having headaches with nausea or vomiting, double vision prior to onset of vertigo 4 weeks back? # Are you a patient of high blood pressure, diabetes, heart disease or obesity?? No, low blood pressure, no obesity and no diabetes # Did you vomit when you felt the room spinning, 4 weeks back? i did not vomit # Please share with me, any other problems, if any, in as much details as possible. i woke up one morning with severe spinning, i sat up and threw me back and room spun for a few seconds… Asked by Me , 21 hours ago Have you been having headaches with nausea or vomiting, double vision prior to onset of vertigo 4 weeks back? i had a headache the day before nothing major.. no double vision ever. Asked by Me , 21 hours ago Doctor's reply to your question above... Brief Answer: Causes : minor stroke or internal ear problem Detailed Answer: Hi ma'am, Thanks for the prompt input. After analyzing the complete information, the possible causes narrow down to either a minor stroke, problem of the internal ear; or, lesion of the nerve which connects the internal ear with the brain. Hence, I expect your treating doctor to order MRI Brain at the earliest. Please do share with me, the reports of the tests carried out recently. Till then, Have a nice day Dr. XXXXXXX Karanwal Replied by Dr. XXXXXXX Karanwal , 20 hours ago Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also. I asked him and he said that it is not a stroke… neurologist said it was not a stroke… now i am so scared… he said i would have had numbness on one side, and other symptoms.. Asked by Me , 20 hours ago Doctor's reply to your question above... Brief Answer: Stroke due to vertebro-basilar artery involvement Detailed Answer: Well ma'am, I am personally of the opinion that it was stroke due to disruption of blood supply in a branch of the vertebro-basillar artery. A vertebra-basilar and a carotid angiogram will give us the exact idea. Kindly discuss my entire opinion with your doctor during your next visit. Regards, Dr. XXXXXXX Karanwal Replied by Dr. XXXXXXX Karanwal , 20 hours ago Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also. i feel off balance is that the same as feeling unsteady… the symptoms are much better now that 2 weeks ago… he said with labrnthis it takes awhile to go away… if its that. also i have had only one episode of spinning which was that violent one 4 weeks ago. s if i am sitting i feel my head swaying…but its not constant… its with head movement Asked by Me , 20 hours ago Doctor's reply to your question above... Brief Answer: Test reports will give the exact cause of problem Detailed Answer: Yes. Off balance and feeling unsteady are same and called ataxia. Further, as mentioned earlier, the possible lesion is either * in the internal ear, * the nerve connecting internal ear to the brain; and, * cerebellum. Involvement of internal ear is called Labyrinthitis, while that of the nerve is called Vestibular Neuronitis. A SINGLE episode (without recurrence) of spinning sensation (vertigo) without nausea or vomiting, is unusual in Labyrinthitis. However, occurrence of unsteady feeling with head movement- as just brought out by you- does go in favor of Labyrinthitis or Vestibular neuronitis. Lastly, your neurologist and ENT Specialist are the best judge as they must have reached to a certain conclusion after carrying out thorough medical examination. It would therefore be advisable to wait for the test reports, which will localize the exact cause. Till then,Yes. Off balance and feeling unsteady are same and called ataxia. Further, as mentioned earlier, the possible lesion either in the internal ear, the nerve connecting internal ear to the brain; and, cerebellum. Involvement of internal ear is called Labyrinthitis, while that of the nerve is called Vestibular Neuronitis. A SINGLE episode (without recurrence) of spinning sensation (vertigo) without nausea or vomiting, reduces the possibility of Labyrinthitis Take care Dr. XXXXXXX Karanwal Replied by Dr. XXXXXXX Karanwal , 19 hours ago Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also. One more question, will the vng and eng results tell us what it is? My mom had the same thing and she got the off balance feeling...for weeks. I hope this was not a stroke... I have 2 little kids.. They say the epley stops the vertigo Asked by Me , 19 hours ago All my test were normal... Other than He said my left ear had 54% versus my right ear at 50% and that is what is making me off balance. Electromamgraohy test? Put me on diomex Asked by Me , 19 hours ago R u going to reply? Asked by Me , 3 hours ago Doctor's reply to your question above... Brief Answer: VNG and ENG test reports are inconclusive. Detailed Answer: Hi there, Firstly, I am really sorry for the delay WHICH WAS DUE TO ERRATIC INTERNET CONNECTIVITY. I have gone through the reports, which- I am afraid- could not interpret. I will therefore request you to kindly quote the "interpretation" of the test. Further, the entire sequence of events indicate a "mixed " type of vertigo. Incidentally, there are two types of vertigo : * "Peripheral" (due to involvement of internal ear and the nerve). It is associated with nausea + vomiting (BUT YOU DID NOT HAVE EITHER OF THESE SYMPTOMS). It recovers within a few days to few weeks). * " Central" (due to involvement of posterior brain(CEREBELLUM) and/or brainstem. Vomiting, nausea is uncommon (AS IN YOUR CASE). The unsteadiness or off-balance feeling persists for months. Your feeling of unsteadiness is still persisting, though 4 weeks have elapsed. Hence, I STILL FEEL THAT YOUR PROBLEMS ARE DUE TO BRAINSTEM / CEREBELLUM. Further, a minor/minimal stroke (affecting either the brainstem or cerebellum) is still a possibility. Proceeding further, the inner ear’s vestibular organs (internal ear) and the associated nerves and brain centers form a complex system that serves many functions and can be affected by a number of outside systems. VNG and ENG tests diagnose the involvement of internal ear or nerve. In your case are inconclusive/equivocal. HENCE, I WILL STILL RECOMMEND MRI of brain, focusing particularly on cerebellum and brainstem, TO diagnose/rule out lesions of these regions of the brain. Regarding Epley Maneuver, it is curative only in a particular type of "Peripheral" problem, called Benign Paroxysmal Positional Vertigo (BPPV). This condition is characterized by breaking off of minute particles (in the internal ear) and floating/drifting into other parts of the internal ear. Epley maneuver relocates the particles in their original site. IN YOUR CASE, THE PROBLEMS ARE NOT DUE TO BPPV. HENCE, IT WILL NOT BE EFFECTIVE IN YOUR CASE. Lastly, I hope you meant "electromanography" which is carried out to diagnose glaucoma. Prescription of Diamox suggests that your ENT doctor has also found evidence of co-existing Glaucoma. Lastly, I cannot comment on the cause of similar symptoms in your mother. Similar tests, as in your case, along with MRI Brain will conclusively pinpoint the cause. I will therefore suggest that you take Betahistine tablets till such time you are perfectly normal. Your doctor will titrate its dose. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Dr. XXXXXXX Karanwal
 
 
Answered by Dr. Shoaib Khan 20 minutes later
Brief Answer: I agree on requesting for an MRI Detailed Answer: Hello once again ma'am. I have gone through the entire discussion, which was quite lengthy and hence the delay in response. As you can go through my first response, I have also mentioned the exact same information, but in a simpler manner which should be adopted to explain to patients (who do not belong to a medical background). I have also ruled out all the causes the respected doctor has ruled out in his 3-4 responses, and have requested for an MRI. But, I would still have to say that a stroke, although not ruled out, is less likely in your case ma'am. As mentioned in my first response, I would still suspect an internal ear condition and other conditions with the brain to be the cause. Other conditions of the brain (eg. Stroke, tumor, etc.) have not been ruled out as an MRI has not been conducted. So these causes still remain on the list. As for the Epleys maneuvor you have spoken about, this is only helpful if you are diagnosed with BPPV; and if conducted by a trained professional; but this will not be helpful in your case. Please do discuss and request for an MRI, after which we can rule out the worst and concentrate on more simple conditions ma'am. And most importantly, we were taught in medical school, to order an MRI as part of protocol, which is why I am surprised why 2 doctors (your neurologist and ENT specialist) have both not found it important or necessary to order an MRI. I would say it is safer to rule out the worst instead of making the patient face the consequences; if god forbid a blind diagnosis were to be made without adequate investigation. I hope this helps. Do not worry ma'am, both the internal medicine doctor and I would be more than happy to be proved wrong, once the MRI returns a normal report, as we only wish to rule out the worst; which would be in our patients best interest. Hope this is clear ma'am. Best wishes.
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Follow-up: Am I losing balance due to diomex medicine prescribed for meneires? 1 hour later
I am so nervous that this is a stroke now or a tumor... So what you are saying is..that this is a central problem.. I thought the vng who did the test said it did not look central from what he saw... Actually my vng was normal.
 
 
Answered by Dr. Shoaib Khan 7 hours later
Brief Answer: VNG is not specific unfortunately Detailed Answer: Hello ma'am. Yes, a VNG is certainly helpful, which also comforts me a little by indicating the absence of a central problem, but the issue is that a VNG is not considered a specific test, and is usually helpful in ruling out or diagnosing BPPV, but not really contributive in ruling out a central problem completely. I hope this is clear. But please, do not panic or get scared ma'am. Request for an MRI at the earliest which shall put all of us at rest once it returns a normal result. Best of luck and best wishes.
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