Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Dizziness And Palpitations?
Question: suffering from dizziness and chest palpitations for 8 months. nothing on the CT scans or ECG's to indicate heart problems but medications are not relieving pain
Hi, try yoga and breathing exercise. It can be due to stress
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
she hasnt been able to work and is unable to drive her car. these attacks come on suddenly and last for a few minutes to a half hour. any stress has been reduced to minimal status and even while completely relaxed and episode can occur. one neurologist believes it is misfiring neurons in her brain cause an electrical short and prescribed nortriptyline and metoprolol to correct that but the episodes are continuing with no sign of relief.
Brief Answer:
So she's been seen by a neurologist
Detailed Answer:
I am now reading that she has been seen by a neurologist. And his take on this was "misfiring neurons causing an electrical short" which are leading to these multiple episodes of suddene dizziness. He may trying to tell you that he thinks she has what are called TAC's (Trigeminal Autonomic Cepahalgias).
In addition to the original list of problems I mentioned to you I think it is also absolutely necessary that we consider vascular causes to these episodes involving what is called the POSTERIOR CIRCULATION. I will be curious to hear about the neurologist's thoughts on if he considered what is often referred to as VERTEBROBASILAR INSUFFICIENCY. You didn't say that mother got an MRI of the brain or an MRA which I believe we need to get done in her.
Another question though.....are her episodes stable over the past 8 months or progressively getting worse. If you say they're getting worse can you be specific and tell me in what way or ways are they getting worse?
Has your mom ever kept a log of her episodes...in other words a diary so that she could have a documented record of when these episodes come on, exactly how long they last and how many she's getting in a day, any triggers to these episodes, etc.?
Have they ever done any kind of High Resolution imaging studies of the Inner Auditory Canal? She could potentially have a fistula within the inner ear itself or something architecturally wrong or impinging upon the cochlea. Does she have any ringing of the ears? Tinnitus? Any hearing loss that you can tell in one ear or the other?
Again, if any of this information has been helpful to you please provide some written feedback and a star rating which would be greatly appreciated. If there are no further questions or comments on this thread I'd also appreciate your CLOSING THE QUERY so that the network can process, archive, and credit the thread appropriately for future reference.
This query required 31 min. physician specific time to review, research, and respond in final draft for envoy.
So she's been seen by a neurologist
Detailed Answer:
I am now reading that she has been seen by a neurologist. And his take on this was "misfiring neurons causing an electrical short" which are leading to these multiple episodes of suddene dizziness. He may trying to tell you that he thinks she has what are called TAC's (Trigeminal Autonomic Cepahalgias).
In addition to the original list of problems I mentioned to you I think it is also absolutely necessary that we consider vascular causes to these episodes involving what is called the POSTERIOR CIRCULATION. I will be curious to hear about the neurologist's thoughts on if he considered what is often referred to as VERTEBROBASILAR INSUFFICIENCY. You didn't say that mother got an MRI of the brain or an MRA which I believe we need to get done in her.
Another question though.....are her episodes stable over the past 8 months or progressively getting worse. If you say they're getting worse can you be specific and tell me in what way or ways are they getting worse?
Has your mom ever kept a log of her episodes...in other words a diary so that she could have a documented record of when these episodes come on, exactly how long they last and how many she's getting in a day, any triggers to these episodes, etc.?
Have they ever done any kind of High Resolution imaging studies of the Inner Auditory Canal? She could potentially have a fistula within the inner ear itself or something architecturally wrong or impinging upon the cochlea. Does she have any ringing of the ears? Tinnitus? Any hearing loss that you can tell in one ear or the other?
Again, if any of this information has been helpful to you please provide some written feedback and a star rating which would be greatly appreciated. If there are no further questions or comments on this thread I'd also appreciate your CLOSING THE QUERY so that the network can process, archive, and credit the thread appropriately for future reference.
This query required 31 min. physician specific time to review, research, and respond in final draft for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
no MRI or MRA has been performed but the ENT said there were no fistulas or anything wrong with here inner auditory canal.
Brief Answer:
No architectural damage says ENT
Detailed Answer:
Ok...I guess...I'm not an ENT specialist but quite honestly, my philosophy is a little different when it comes to evaluating patients with significant symptoms and little answers....WORK THE PATIENT UP to your fullest capabilities and within reason...no need trying to BRAIN BIOPSIES or anything quite that drastic.
But I don't see why a high resolution study of the IAC with contrast couldn't be done just to say, "See, I told you so...." Sounds like he 's waiting for someone else to figure out what's going on. He may be absolutely right because statistically he's correct....IAC fistulas are much rarer than other problems such as tumors or vascular insufficiencies.
The other study that could be done if nothing else shows something first would be what's called a BAER (brainstem auditory evoked response) study which essentially checks the integrity of the auditory pathway from the inner ear all the way through the brainstem and into the temporal lobes and the auditory cortex. If there is any pathology along the way that would interfere with transmission of a normal signal such as would happen with a tumor or degenerative process in the brain or even toxic condition in the body affecting the audiovestibular system then, a BAER may show something.
Again, I'm just thinking out loud a bit. First and foremost I would say the MRI and the MRA should be obtained and I would definitely do them with contrast (gadolinium)......
Has anybody said anything about an ACOUSTIC NEUROMA? I know they said the CT scan didn't show anything but again, we're talking the difference between a test that can show things only down to 1/2" in diameter vs. a study that can show things as tiny as 1/20" in diameter and believe me even little teeny little nothings can be strategically placed in the brain to cause you MAJOR PROBLEMS!
So, I think an MRI of the brain and an MRA of the head and the neck are sorely needed in your mom's case before I'd feel comfortable saying these are either just runaway migraines with a vertiginous component or stress related or whatever anybody else is thinking is going on given the fact that her CT scans are not very interesting.
Again, if you'd like to further discuss these matters on this network I'm available or if you'd like to try a live teleconference just look me up at the previously given address and I'll be happy to assist to further.
Again, if any of this information has been helpful to you please provide a bit of written feedback and a STAR RATING which are much appreciated. If there are no further questions or comments on this thread your CLOSING THE QUERY so that the network can process, archive, and credit the thread appropriately for future reference would as well be magnanimously gestured in kind.
This query required 16 min. physician specific time to review, research, and respond in final draft for envoy.
No architectural damage says ENT
Detailed Answer:
Ok...I guess...I'm not an ENT specialist but quite honestly, my philosophy is a little different when it comes to evaluating patients with significant symptoms and little answers....WORK THE PATIENT UP to your fullest capabilities and within reason...no need trying to BRAIN BIOPSIES or anything quite that drastic.
But I don't see why a high resolution study of the IAC with contrast couldn't be done just to say, "See, I told you so...." Sounds like he 's waiting for someone else to figure out what's going on. He may be absolutely right because statistically he's correct....IAC fistulas are much rarer than other problems such as tumors or vascular insufficiencies.
The other study that could be done if nothing else shows something first would be what's called a BAER (brainstem auditory evoked response) study which essentially checks the integrity of the auditory pathway from the inner ear all the way through the brainstem and into the temporal lobes and the auditory cortex. If there is any pathology along the way that would interfere with transmission of a normal signal such as would happen with a tumor or degenerative process in the brain or even toxic condition in the body affecting the audiovestibular system then, a BAER may show something.
Again, I'm just thinking out loud a bit. First and foremost I would say the MRI and the MRA should be obtained and I would definitely do them with contrast (gadolinium)......
Has anybody said anything about an ACOUSTIC NEUROMA? I know they said the CT scan didn't show anything but again, we're talking the difference between a test that can show things only down to 1/2" in diameter vs. a study that can show things as tiny as 1/20" in diameter and believe me even little teeny little nothings can be strategically placed in the brain to cause you MAJOR PROBLEMS!
So, I think an MRI of the brain and an MRA of the head and the neck are sorely needed in your mom's case before I'd feel comfortable saying these are either just runaway migraines with a vertiginous component or stress related or whatever anybody else is thinking is going on given the fact that her CT scans are not very interesting.
Again, if you'd like to further discuss these matters on this network I'm available or if you'd like to try a live teleconference just look me up at the previously given address and I'll be happy to assist to further.
Again, if any of this information has been helpful to you please provide a bit of written feedback and a STAR RATING which are much appreciated. If there are no further questions or comments on this thread your CLOSING THE QUERY so that the network can process, archive, and credit the thread appropriately for future reference would as well be magnanimously gestured in kind.
This query required 16 min. physician specific time to review, research, and respond in final draft for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
