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Dr. Andrew Rynne

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Suffering from dizziness. ECG came normal. CT scan done. What could be the problem?

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Dr. Sudhir Kumar

Neurologist

Practicing since :1994

Answered : 5666 Questions

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Posted on Wed, 9 Jan 2013 in Sleep Disorders
Question: Hello Dr XXXXXXX

I am contacting you because of my dizziness i have been suffering for the past 7-8 months. This started 3 months after delivering a baby. I am in USA and couldn't see you personally.

Present Condition:
8 months back i suddenly started feeling dizzy and started sweating and later on shivering. The dizziness lasted for almost 30 mins. I rested , had some sugar water thinking my sugar levels were down. I felt nausea and had a bowel movement also. After 30 mins i was normal and since then i had this dizziness once in a while ( may be once a week) but it would go away in couple of minutes. I was nursing during that time. I had my physical checkup and EEG done bcoz of this dizziness and both were normal. A month ago, all of a sudden i felt dizzy again and it was very very severe. I couldnt get up , had jucie , sugar water but no improvement and it lasted for almost an hour. I had a bowel movement and vomited a lot. Then I went to emergency and i was told it could be vertigo and was referred to an ENT. CT scan was done in emergency and it was normal except that the calcium deposits were still there . ENT did the audiology tests and ENG and said everything is normal. I have my MRI scheduled for tomorrow. Since then i am feeling dizzy almost everyday and sometimes more than once in a day. But it would go away in few minutes.
doctor
Answered by Dr. Sudhir Kumar 1 hour later
Hi,

Thank you for contacting me for your current problem.

I am glad to note that you are seizure-free still.

Regarding your dizziness, there are two likely possibilities.

1. BPPV (benign paroxysmal positional vertigo)- in this condition, dizziness occurs in episodes, and symptoms get aggravated with change of head and neck position (with movements such as turning from side to side or getting up from lying down position, etc).

This is not a serious condition and responds well to treatment with betahistine and piracetam. Certain exercises such as vestibular rehabilitation exercises are also useful.

2. Vertiginous epilepsy- this is a remote second possibility. Very rarely, seizures can present in the form of dizziness. Once this is confirmed, treatment would be with anti epileptic drugs such as Tegrital.

For MRI, ask them to include epilepsy protocol, and also include MR venogram, as after pregnancy, we should exclude the possibility of clotting of blood in the brain veins.

Please let me know of the MRI reports, when ready.

There is no need to worry at present.

Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sudhir Kumar 12 days later
Hello Dr XXXXXXX

I got the MRI results , they included epilepsy protocol but couldnt do the MR Venogram. The doctor didnt order for that.

Everything came back normal except the old calcification which already exists.
As you said if it would be vertiginuos epilepsy shouldnt the EEG be abnormal?
My doctor here also ordered for thyroid test and that was normal too.

I am not sure what should be our next step. Do you suggest to consult a neurologist here? I also heard that in some types of migranes we dont have headaches but dizziness. Can that be the case?

Also can this be something to do with low BP levels?

Please suggest.
doctor
Answered by Dr. Sudhir Kumar 37 minutes later
Hi,

Thank you for getting back.

It is good to note that MRI brain came back as normal.

EEG may be normal in cases of vertiginous epilepsy (as in other cases of epilepsy), as abnormal electrical discharges occur in episodes.

It is possible to get migraines with predominant dizziness.

It may be worthwhile consulting a neurologist there.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 47 hours later
Hi Dr XXXXXXX

Thanks for your reply.

Are there any other tests to confirm it could be vertiginous epilepsy , so i could start the medication again with the help of a neurologist here.

Thank you!
doctor
Answered by Dr. Sudhir Kumar 4 hours later
Thank you for getting back.

Other tests are there, but not routinely performed. At Apollo Hyderabad, we would do PET CT scan of the brain, which is very helpful in localising the epileptic focus. However, I know that this facility is not available in many hospitals.

Also, vertiginous epilepsy can be diagnosed on the basis of description of symptoms, and starting treatment is easy, once the symptoms are highly suggestive.

You may discuss these with your neurologist.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 46 minutes later
So, based on my symptoms above do you feel it could be vertiginuos epilepsy only.
I will visit india in February, so I can consult you in person during that time.
Do you want to prescribe any medication based on my current symptomsand test results meantime.
doctor
Answered by Dr. Sudhir Kumar 6 minutes later
Hi,

Thank you for getting back.

I would not like to start anti epileptic medications till I see you and confirm that you have vertiginous epilepsy.

As of now, you can use symptomatic treatment with betahistine, as and when you feel dizzy.

Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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