Brief Answer: Please enlighten me with the update Detailed Answer: Hi Ma'am, It's a great pleasure hearing from you again. I have gone through the MR Angiogram, which is normal. I am trying to search for the entire sequence of discussions we had last time. In the meanwhile, could you please enlighten me about * the outcome of your visit to Neurologist on 23 Dec 2013? What did the Neurologist say?? * How are you feeling now? Has the problem reduced/disappeared/aggravated? * Medications being taken presently? I will revert back as soon as I hear from you. PLEASE HAVE FAITH in me: I will certainly get to the root cause of your problem. Fond regards, Dr. Rakesh Karanwal

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Brief Answer: Your problem is apparently hereditary (genetic) Detailed Answer: Hi Ma’am, Sorry for the delay, due to erratic internet connectivity. I have once again, gone through the entire thread of earlier discussion and summarized your problem as follows :- Your mother too had similar problem. Onset of your problem occurred at 45 years of age, starting with a mild attack, followed a week later, by a major attack of spinning sensation without associated vomiting. But you had a headache a day prior to it. There is also a history of ringing in the ears. All relevant tests have turned out to be normal. There is a gradual but steady improvement, though the feeling of being unsteady or rocking sensation still occurs while you are sitting steady and, on head movements. Having analyzed the entire information, sequence of events and also sifting through the available literature on the subject, I have conclusion that your problem is hereditary, due to defect of a gene, particularly as your case does not fit into any of the causative medical conditions. It can be broadly classified as Hereditary Vestibulopathy, which occurs at around 40 years of age and an episode lasts for 6-12 weeks. MAY I ASSURE YOU THAT IT HAS NO BEARING WHATSOEVER, ON THE LONGEVITY. Neither is there any likelihood of progression of the condition, though a recurrence may or may not occur in future. The other possible hereditary condition is called Vestibular Migraines, in which- instead of headaches- dizziness (feeling of unsteady state, rocking sensation) is the only manifestation. This condition too begins between 40-50 years of age. Hence, if I were your treating Neurologist, I would have prescribed daily calcium channel blockers (a type of blood pressure medication), OR an antidepressant selective serotonin reuptake inhibitors (SSRIs); increased the dose and frequency of Xanax; and, given you a short course of an over-the-counter motion-sickness medication such as meclizine or diphenhydramine. The treatment would have been continued till you became absolutely free from problems. So, please rest assured that there is nothing serious. Be happy, look after your small children and lead a normal social life. Lastly, I have seen hundreds of BPPV patients in my clinic : none of them continued to have problems for weeks/months. Hence, I beg to differ with your Neurologist. Take care and God Bless You, Fond regards, Col (Dr.) Rakesh Karanwal

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Brief Answer: Reports of both MRIs are normal Detailed Answer: Yes. I had seen both MRI reports (NECK and BRAIN) before giving my opinion. Both reports are normal. Your problem will just go away with time, with a rare possibility of recurrence (if at all). You will have a NORMAL life!! Take care

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Brief Answer: It has no relevance Detailed Answer: Oh Yes. the small fenestration at the origin of basilar artery has no relevance whatsoever. God Bless You

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Brief Answer: Heart check up not required Detailed Answer: There is no requirement of a heart check up!! Your heart is in perfect condition. But curbing your mental stress and anxiety is most important. Increase the dose of Xanax under your doctor's supervision/advice.

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Brief Answer: Your problem will eventually go away Detailed Answer: Yes Ma'am, it was plainly loud thinking of the most likely causes, based on the information provided: it was my duty as a professional man, sitting thousands of miles away, without examining you physically. I am really sorry for having scared you : It was NEVER my intention- TRUST ME. Your problem will eventually go away, just as it happened in your mother's case. You may close this chapter and look forward to the bright future. God Bless You Dr. Rakesh Karanwal

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Brief Answer: Wish you all the best Detailed Answer: you are most welcome. You have been my favorite patient

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Brief Answer: Fond regards Detailed Answer: Good Bye and wish you a healthy future.

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