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Suggest remedy for balancing problem when walking

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Posted on Wed, 13 May 2015
Question: Hello Doctor,
My mother has below said condition.
She has a dis-balancing problem as in, whenever she gets up to walk she feels that she is going to fall as her feet feels heavy and her head starts to spin however when she is sitting she's feels a bit ok but the head still seems to be very heavy.
This kind of attach could even happen when she is sitting and then she would have speech problems and very rarely the face also get dis-shaped or so.
This happens 3-4 times a day. This problem has started since last 3 years now.
Some doctors say that a nerve or her small brain in her head the blood is not flowing properly.
Could you please look at the reports and my explanation of the problem and suggest as to what exactly is this issue and what could be the possible medication for it.
Have shown mum to tons of doctors but some say that research is going on this issue and so far no one is able to give any proper medication apart from some vitamin tablets / Asprin, Some Doctors also say that their is a cerebral attack.
doctor
Answered by Dr. Dariush Saghafi (2 hours later)
Brief Answer:
MRI shows normal anatomy except for mild diffuse atrophy

Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am a neurologist from XXXXXXX OH.

I would be happy to comment on this case to the extent possible based on your description of things that are going on and the MRI report of the brain.

First of all, let's take the report of the brain. The report states that she is suffering from ATAXIA AND DIZZINESS. I do not see where the brain is being called "small" by any means. The report does not use this term but does say there is MILD atrophy which could possibly be slightly ahead of what I normally expect for a person of 58 years of age although the MRI reports her as 60 years of age. No reference is being made to abnormalities in the cerebellum which is considered to be the main control center as far as balance is considered.
The report also fails to mention anything abnormal about her brain-stem which is where DIZZINESS or what seems to be more like a description of VERTIGO (spinning sensation) comes from.

Also, this report does not say anything about the blood supply to the brain. In other words, what they did was an MRI of the brain. I would've likely recommended an MRA study in order to assess the vascular beds and circulatory patterns but this was not done. I would also recommend doing a study with GADOLINIUM CONTRAST since this may show something present in the brain such as a plaque or small tumor hidden deep within the PONTOCEREBELLAR region called a Schwannoma or acoustic neuroma that explain these symptoms.

You haven't said anything about blood-work or her cognitive abilities. Has she had her thyroid gland function checked? B12, folate, ANA markers, Heavy Metal Screening?"

Is your mom becoming more forgetful? Is she having trouble with holding her bladder at all over the past few years. Is her voice getting softer/quieter when she speaks....does she have a tougher time raising her voice loudly? Are there times she isn't making sense when she speaks? Does she repeat the same questions in a short amount of time...forget important appointments?

Do her feet shuffle when she walks or do they appear "stuck" to the ground as if they were magnetized?

Based upon your description of things and the MRI report at hand there is not likely to be any medication that is going to solve this problem. We have to first discover the root cause of what's going on.

I haven't a clue what the doctor means when he says "cerebral attack" unless he is suggesting some type of seizure disorder but I haven't heard anything in your story that suggests that's really happening.

Bottom line is we need a better diagnosis than ATAXIA/DIZZINESS.

I would recommend an MRI of the brain with GADOLINIUM CONTRAST as well as an MRA of the head. I would specify to the radiologist that we are looking to rule out an ACOUSTIC NEUROMA.

I would also consider doing a hearing test on your mom just in the event there is some as of yet undetected hearing loss that could be associated with this whole problem. Perhaps, when she arises to move and gets terribly dizzy and vertiginous she is suffering from an attack of Meniere's. Again, a bit of a long shot based on what you're describing but I think it fits in to the realm of possibility of you're talking about.

Then, there are several lab analyses which I've mentioned above that I would check including: TSH, FT4, ANA, ESR, CRP, Vit. B12, Vit. D, serum Magnesium, serum Heavy Metal Screen, Urine Heavy Metal Screen and Toxicology screen.

If can videotape your mother walking or having one of her dizzy spells with audio sounds I'd be interested in seeing it.....perhaps, you can either post it somewhere where I could go and see it...such as your own personal website or a secure site that is password protected or something.

If this answer satisfactorily addresses your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback on your part.

Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived expeditiously for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your mum's situation by writing me at: bit.ly/drdariushsaghafi

All the best

The query has required a total of 113 minutes of physician specific time to read, research, and compile a return envoy to the patient.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (5 days later)
Thanks a lot for your well explained reply, and i shall try to send you a video taped of her situation to you as soon as, is it possible to upload it on this site itself, if not i shall try and do that on may be some youtube link or so.
Regards,
XXXX
doctor
Answered by Dr. Dariush Saghafi (53 minutes later)
Brief Answer:
Thank you for your follow-up and all the best to your mother

Detailed Answer:
Thank you for your follow up and I look forward to seeing a video of her in action. You may also wish to upload results of any of the lab tests that I recommended if they have not been done and I will be happy to comment on those as well.

Until then, please do not forget to post your opinion of my service as I hope it met with your favor. A HIGH STAR GRADE and positive feedback would be most appreciated as well as CLOSING THE QUERY at this time so that the transaction can be expedited and material archived for future reference by colleagues as necessary in their patients.

Also, when you are ready to re-open with the next query you may DIRECT THE QUESTION to my attention by going to my website at: bit.ly/drdariushsaghafi and I will be very happy to do my best at giving further suggestions as to what can be done or thought of to help your mother's situation.

All the best.

The query has required a total of 120 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Suggest remedy for balancing problem when walking

Brief Answer: MRI shows normal anatomy except for mild diffuse atrophy Detailed Answer: Good afternoon. My name is Dr. Saghafi and I am a neurologist from XXXXXXX OH. I would be happy to comment on this case to the extent possible based on your description of things that are going on and the MRI report of the brain. First of all, let's take the report of the brain. The report states that she is suffering from ATAXIA AND DIZZINESS. I do not see where the brain is being called "small" by any means. The report does not use this term but does say there is MILD atrophy which could possibly be slightly ahead of what I normally expect for a person of 58 years of age although the MRI reports her as 60 years of age. No reference is being made to abnormalities in the cerebellum which is considered to be the main control center as far as balance is considered. The report also fails to mention anything abnormal about her brain-stem which is where DIZZINESS or what seems to be more like a description of VERTIGO (spinning sensation) comes from. Also, this report does not say anything about the blood supply to the brain. In other words, what they did was an MRI of the brain. I would've likely recommended an MRA study in order to assess the vascular beds and circulatory patterns but this was not done. I would also recommend doing a study with GADOLINIUM CONTRAST since this may show something present in the brain such as a plaque or small tumor hidden deep within the PONTOCEREBELLAR region called a Schwannoma or acoustic neuroma that explain these symptoms. You haven't said anything about blood-work or her cognitive abilities. Has she had her thyroid gland function checked? B12, folate, ANA markers, Heavy Metal Screening?" Is your mom becoming more forgetful? Is she having trouble with holding her bladder at all over the past few years. Is her voice getting softer/quieter when she speaks....does she have a tougher time raising her voice loudly? Are there times she isn't making sense when she speaks? Does she repeat the same questions in a short amount of time...forget important appointments? Do her feet shuffle when she walks or do they appear "stuck" to the ground as if they were magnetized? Based upon your description of things and the MRI report at hand there is not likely to be any medication that is going to solve this problem. We have to first discover the root cause of what's going on. I haven't a clue what the doctor means when he says "cerebral attack" unless he is suggesting some type of seizure disorder but I haven't heard anything in your story that suggests that's really happening. Bottom line is we need a better diagnosis than ATAXIA/DIZZINESS. I would recommend an MRI of the brain with GADOLINIUM CONTRAST as well as an MRA of the head. I would specify to the radiologist that we are looking to rule out an ACOUSTIC NEUROMA. I would also consider doing a hearing test on your mom just in the event there is some as of yet undetected hearing loss that could be associated with this whole problem. Perhaps, when she arises to move and gets terribly dizzy and vertiginous she is suffering from an attack of Meniere's. Again, a bit of a long shot based on what you're describing but I think it fits in to the realm of possibility of you're talking about. Then, there are several lab analyses which I've mentioned above that I would check including: TSH, FT4, ANA, ESR, CRP, Vit. B12, Vit. D, serum Magnesium, serum Heavy Metal Screen, Urine Heavy Metal Screen and Toxicology screen. If can videotape your mother walking or having one of her dizzy spells with audio sounds I'd be interested in seeing it.....perhaps, you can either post it somewhere where I could go and see it...such as your own personal website or a secure site that is password protected or something. If this answer satisfactorily addresses your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback on your part. Also, CLOSING THE QUERY on your end (if there are no further comments) will be most helpful and appreciated so that this question can be transacted and archived expeditiously for further reference by colleagues as necessary. Please keep me informed as to the outcome of your mum's situation by writing me at: bit.ly/drdariushsaghafi All the best The query has required a total of 113 minutes of physician specific time to read, research, and compile a return envoy to the patient.