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How long should i continue B-12 shots for oscillopsia?

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Posted on Mon, 25 May 2015
Question: Two years ago, after a flight from east coast to west coast, I came home with severe jet lag (so I thought) and was unable to hold a standing pose in my yoga class. Was diagnosed with orthostatic hypotension w/syncope after numberous trips to the ER (currently on fludrocortisone). I then developed vertical double vision, oscillopsia ( the fast jumping movement) with rotational nygstamus-diagnosed with BPPV. After maneuver, nygstamus gone but not oscillopsia. Actually, lost my job because I was not able to walk/drive for a few months. Any movement (including chewing food!) brought on attacks of oscillopsia and vertigo..finally figured out to close my eyes while eating. I also developed thyroiditis (slightly enlarged for a year!) but all thyroid tests were normal--back & forth between hyper/hypo. And developed muscle twitching. Neurologist ran nerve conduction tests and MRI, but all normal. The oscillopsia is now the "bobbing" vision and my brain has started to compensate but I have photosensitivity. Grocery stores send me into another whirly world! Am driving now but not at night because it seems as though every driver has his brights on!! I was referred to Chapel Hill to a neuroENT for possible Meneires. Negative test results and was told he could not help, unless I developed some hearing loss. However, his PA mentioned that maybe I had a slow cerebral spinal fluid leak during that coast to coast flight that was affecting my cranial nerves. My doctor doesn't believe there is any connection with the flight and my problems. He thinks just a coincidence. Am being tested next week for cognitive decline due to brainstem damage (?) and starting PT for balance issues (oscillopsia, double vision, fasciculations, and vertigo). My life was normal 2 years ago and now each day is different for me. I have a history of b12 deficiency-level was immeasurable when initially diagnosed but that was 5 years ago. I do monthly injections. Also diagnosed with carotid artery disease but has remained at stable level since starting b12 shots. Take Maxalt for migraines with aura--they decreased once I started b12 shots. Any THOUGHTS would be appreciated!!
doctor
Answered by Dr. Goswami Debopom (2 hours later)
Brief Answer:
Not to worry.

Detailed Answer:
Welcome to Health care Magic. Thank you for posting your query.
I can understand your concern.

Oscillopsia is caused either by a loss of the vestibulo-ocular reflex or by involuntary eye movements (spontaneous or positional nystagmus). These in turn are caused by damage to the inner ear, the nerves that connect the inner ear to the brain, or the brain structures to which the inner ear is connected.

The damage to the nerves can be due to subacute degeneration owing to the lack of Vitamin B12 . So you need to continue the Vitamin B12 shots.

I would suggest you to

- Expose yourself cautiously and incrementally to provoking environments or activities can speed the adaptation process. This will help to overcome the increased photosensitivity

-Wear dark glasses.

- Practice some relaxation or breathing exercises.


Yes . I too feel there is no correlation between the flight and your symptoms.
Visit an ENT surgeon and an ophthalmologist. They can examine you and correlate clinically.

Hope this helps.
Write back to us.
Regards.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Goswami Debopom (3 hours later)
Thank you for your reply. The biggest issue for me has been "why?". I felt great while I was in San XXXXXXX then five days later after arriving back to NC, I'm unable to stand to even brush my teeth and the scenery is jumping around. So frustrating because I've been told so many different things. I did see an ENT surgeon and an ophthamologist. The ENT gave me the referral to Chapel Hill but he felt it was due to my low blood pressure (60/40) The ophthamologist suggested a MRA. My neurologist does not feel it's related to the b12 since my levels have been good. (BTW-b12 shots are for the rest of my life). He thinks it's metabolic because of the thyroiditis. But I don't have that anymore. My frustration is beyond imaginable at this point. I do yoga with modifications and as stated earlier, will begin physical therapy this week and I also wear sunglasses at night. I am more concerned about a neurodegenerative disease as I have been told that oscillopsia can be a sign. I will keep you posted when I receive test results in 2 weeks. Thanks again for your thoughts.
doctor
Answered by Dr. Goswami Debopom (7 hours later)
Brief Answer:
You are welcome

Detailed Answer:
Do not worry much.

It is actually difficult to comment without actually examining you and seeing the reports.
Yes oscillopsia can be a manifestation of neurodegenerative diseases like multiple sclerosis ,vasculitis , Wernicke's disease. But wait for the reports to arrive.


Kindly write back to us once you get the reports.
We will be happy to help.

Regards.
Dr. XXXXXXX
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Goswami Debopom (13 days later)
Blood work was flagged for low white blood cell count and low vitamin D (so taking my 5000 supplements for that). Dr. said WBC not low enough for leukopenia. Meanwhile, I developed carotidnyia on right side-swelling, pain, and constant cough (also nose very stuffy!). Again, was told not to worry and take 800mg of Motrin. He did hear bruits but I have carotid artery disease. I have an ultrasound each year and levels have remained stable at 59%. Annual ultrasound scheduled for September. Coincidentally, I developed palmar erythema. Again, told not to worry. The past few nights I have had night sweats and a constant headache(not severe). I am post menopausal. I appreciate your thoughts on any connection with low WBC. Thanks!

PS. Since taking the 800 mg of Motrin, I have gone 5 days WITHOUT oscillopsia!!!-inflammatory disease??
doctor
Answered by Dr. Goswami Debopom (26 minutes later)
Brief Answer:
Yes carotidynia is an inflammatory disease.

Detailed Answer:
Carotidynia is a defined inflammatory condition of the carotid.

Carotidynia is usually self limiting, spontaneously resolving within 2 weeks. Resolution can be expedited with non-steroidal anti-inflammatory drugs(Motrin) or steroids . Not to worry indeed.

The most common cause of carotidynia may be migraine, and then it is usually self-correcting. So the headache could possibly be due to it.

May I ask you a few questions.
1. Do you have fever?
2. Has there been a recent reduction in your bodyweight?

I would suggest you to continue the Vitamin D supplements and Motrin as advised by your doctor.

Get your ultrasound done .

Get back to us.
Regards.


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Goswami Debopom (18 minutes later)
Yes, I have had a low grade fever which occurs only in the evening. The swelling has greatly diminished in the past week though. I am always trying to gain weight! Five years ago I weighed 106 lbs and now I can't get up to 100. I am a petitie person though.
doctor
Answered by Dr. Goswami Debopom (36 minutes later)
Brief Answer:
Not to worry.

Detailed Answer:
Do you have any lumps in any part of your body like armpit or groin or in the neck? I mean to say have you noticed any lymph node swelling?

About the weight loss , is the loss around 10% of body weight in the last 6 months?

It would have been great had I examined you on my own.

Write back to us.
Regards.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Goswami Debopom (6 hours later)
I don't see my reply. Should I re-submit?
doctor
Answered by Dr. Goswami Debopom (6 hours later)
Brief Answer:
Need clarification.

Detailed Answer:
I am sorry, I needed more clarity before I provide my opinion. I can see that you do have fever and seems to have lost weight.
I would like to know:
1. Have you noticed any swelling/lump in your neck,groin or armpit?
2. Have you lost weight rapidly over the last few months (say the last 6 months). If yes, how much weight have you lost - it is 10% or more?

Write back to us.
Regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Goswami Debopom (7 hours later)
I apologize. I had replied but my answer obviously didn't go through..I was having computer problems yesterday! No swelling (except the carotidnyia) or lumps. Weight loss was 10% but I have actually gained weight past few 2 months. I feel it is due to the fludrocortisone AND I am attending yoga classes on a regular basis.
When my daughter was 4, she tested high positive (speckled) ANA with low C3 & C4 levels, inflammatory anemia, low WBC. A punch biopsy of her urticaria came back neg for lupus. At that time, I had an ANA too but mine was negative. Should I consider another ANA for myself? (That was 12 years ago)
Admittedly, I am an interesting case! Thank you so much for your input.

doctor
Answered by Dr. Goswami Debopom (2 hours later)
Brief Answer:
At present I would not consider an ANA test.

Detailed Answer:
Thank you for replying.

Actually I was ruling out the possibility of a lymphoma considering you had fever , night sweats and weight loss. But since you do not have enlarged lymph nodes, chances are less.

For lupus there are criteria like
1. Butterfly rash over face
2. Oral ulcers
3. Alopecia
4. Blood in urine
5. Seizures or neuropathies
6. Hemolytic anemia
7. low WBC , Low platelet
- to name a few

So having a low WBC , I won't consider an ANA.


Do not worry.
COntinue with the current medications and yoga.

Write back to us with any developments or new reports.
We will be happy to help.
Regards.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
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Dr. Goswami Debopom

General & Family Physician

Practicing since :2013

Answered : 484 Questions

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How long should i continue B-12 shots for oscillopsia?

Brief Answer: Not to worry. Detailed Answer: Welcome to Health care Magic. Thank you for posting your query. I can understand your concern. Oscillopsia is caused either by a loss of the vestibulo-ocular reflex or by involuntary eye movements (spontaneous or positional nystagmus). These in turn are caused by damage to the inner ear, the nerves that connect the inner ear to the brain, or the brain structures to which the inner ear is connected. The damage to the nerves can be due to subacute degeneration owing to the lack of Vitamin B12 . So you need to continue the Vitamin B12 shots. I would suggest you to - Expose yourself cautiously and incrementally to provoking environments or activities can speed the adaptation process. This will help to overcome the increased photosensitivity -Wear dark glasses. - Practice some relaxation or breathing exercises. Yes . I too feel there is no correlation between the flight and your symptoms. Visit an ENT surgeon and an ophthalmologist. They can examine you and correlate clinically. Hope this helps. Write back to us. Regards.