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Imbalance, instability, have polymyalgia rheumatica. What can be done?

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General & Family Physician
Practicing since : 2005
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I have a problem with imbalance and instability. This problem started about 7 or 8 years ago and has gradually gotten worse. I don't know if it has something to do with polymyalgia rheumatica that I was diagnosed with 6 years ago with lingering symptoms.
Even though I am 86 years old I don't want doctors to throw up their hands saying, "You're too old so what can be done?"
Posted Thu, 13 Sep 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Prasad 5 hours later
Hi,

Thanks for the query.

Balance and stability functions of body are governed/maintained by brain and inner ear. At the age of 86, we do expect some degenerative changes that can affect brain and inner ear resulting in instability.

Polymyalgia rheumatica is an inflammatory condition where the typical symptoms are pain and not imbalance/instability. So it is unlikely that these symptoms are related to polymyalgia rheumatica.

I understand your concern and I would definitely not entirely attribute these symptoms to old age yet. To be able to understand the problems better and verify if you have any other associated causes, I would like you to answer the following questions:

1. Imbalance and instability for 7-8 years is a long time; can you tell me if there is/are some factors which precipitates/aggravates it?
Do you feel worse while standing/walking? How about at rest?

2. Are there any other associated symptoms like stiffness, limb weakness, dizziness, double vision, headache, memory impairment, back / neck pain, etc?

3. How is your hearing been? Is there any hearing impairment - one or both ears?
Is there an ear discharge, ringing sensation in your ears?

4. Have you met a doctor and evaluated for the symptoms? Any brain scans done or other relevant investigations done. If so, can you upload them here (you may use the upload report/picture option available on this web page)?

5. Any history of drug consumption? - If you are or were on regular medications can you name them?

Awaiting your response

Regards
Dr. Prasad
Above answer was peer-reviewed by
 
Follow-up: Imbalance, instability, have polymyalgia rheumatica. What can be done? 21 hours later
Thank you for your reply. Answers are after your questions.
1. Imbalance and instability for 7-8 years is a long time; can you tell me if there is/are some factors which precipitates/aggravates it?
Answer: I know of nothing that precipitated it and nothing aggravates it per se.
At rest I am fine. When I am going to walk I have to stand up and get my bearings first before walking and if I turn fast I lose my balance.

2. Are there any other associated symptoms like stiffness, limb weakness, dizziness, double vision, headache, memory impairment, back / neck pain, etc?
Answer: Some weakness from age, but I have no problems with anything listed in this question.

3. How is your hearing been? Is there any hearing impairment - one or both ears?
Is there an ear discharge, ringing sensation in your ears?
Answer: No to both.
I have deafness and am using hearing aids in both ears. I went to an audiologist and was told the imbalance is not from that.

4. Have you met a doctor and evaluated for the symptoms? Any brain scans done or other relevant investigations done. If so, can you upload them here (you may use the upload report/picture option available on this web page)?
Answer: I have gone to an audiologist, a neurologist, and a rheumatologist and none could help me. They did a Ct scan on my brain which was negative. Nothing unusual for my age. I don’t have the reports or picture to upload.

5. Any history of drug consumption? - If you are or were on regular medications can you name them?
Answer: Never smoked, drank or did drugs. I don’t take prescription drugs.
Thank you
 
 
Answered by Dr. Prasad 3 hours later
Hi,

Thanks again for providing the needed information.

As you said you are fine at rest it is perhaps the change in position/movements which brings in the imbalance/instability. A persisting problem should cause symptoms at all positions and all place. This fact rules out many of the serious conditions. If you are convinced this fact and that polymyalgia rheumatica has nothing to do with imbalance and instability issues, I shall proceed to discuss (based on the information you provided) further about this issue.

Like I mentioned in my previous reply balancing abilities are maintained by ear and brain structures. As suggested by your audiologist, it seems your ears are fine and working well (apart from the age related hearing difficulty). That being said, Dix-Hallpike test is done to detect / diagnose benign positional vertigo (BPV) where one feels transient dizzy + imbalance upon change of position as in turning. I hope BPV is also ruled out by your specialist.

The sudden loss of posture/imbalance/fall on sudden turning may be attributed to sluggish reflexes. Parkinsonism is a neurological condition where there is profound degeneration of basal ganglia resulting in marked reduction in body reflexes. Other symptoms such as slowness of activities, short stepping gait, stiffness of joint movement (especially that of wrist) and masked face is usually associated with it. Presuming that you were able to type the above message without many difficulties, parkinsonism per se is unlikely. But if you have the associated symptoms too we may try one or two of the antiparkinsonism drugs, of course after weighing the risk and see if you improve.

Cervical spondylosis, where in age related degeneration of cervical spine can influence the amount of blood flow to the brain can cause imbalance on change of posture.

Blood pressure fluctuations, metabolic disturbances - electrolytes, Arthropathy especially of the knees can impair free movements. The lack of free movement can hamper your ability to balance and walk normally.

The most important of all, cerebellar dysfunctions are known to occur at this age due to atrophic changes - age or chronic vascular changes. This can explain all the symptoms.

The bottom line is all it is probably age which has brought in the above changes causing the difficulties. However whether or not something is way beyond age can only be determined by further evaluation. Perhaps getting a complete health check up that involves blood pressure record, EKG, Neurological assessment, Knee joint X-rays, MRI brain scans and blood test can be helpful.

Hope this answer is informative and answers your query. Let me know if you have further doubts.
Please close this discussion if you have no more follow ups.

Best Wishes
Dr. Prasad
Above answer was peer-reviewed by
 
Follow-up: Imbalance, instability, have polymyalgia rheumatica. What can be done? 44 hours later
Someone else has been writing these letters to you on my behalf. I would not be able to do it myself.
I have no vertigo (BPV).
I have no arthropathy.
No Parkinsonism.
If you have any other ideas let me know. Otherwise thank you for your responses.
BTW I don't have a computer so I asked my friend to go to her house to assist me but then she had to wait until she saw me again to give me your responses so that is why it took so long to respond back to you.
 
 
Answered by Dr. Prasad 22 hours later
Hi and thanks again,

I apologize for the delayed response.

I am pleased to know that you do not suffer from any other associated ailment.

Though I am sure that the instability and imbalance issues are not related to polymyalgia rheumatica, without a detailed examination / tests I cannot narrow down the close possibility from the aforementioned conditions.

The most probable reason which I can think is age related / vascular cause of cerebellar functions with lowered reflexes. I wish you to work with your treating doctor to discover if any other cause has been left out.

Wish you good health

All the Best!
Dr. Prasad
Above answer was peer-reviewed by
 
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