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Dr. Andrew Rynne

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Welcome to 'Ask a Doctor'. Please type your question here...hi

Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2385 Questions

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Posted on Fri, 1 Mar 2019 in Brain and Spine
Question: Welcome to 'Ask a Doctor'. Please type your question here...hi my name is XXXXXXX I’m a 31 year old female. I have been experiencing dizziness for a little over a month. Now over the past week or two my left leg is starting to get tingly as well as a little part of my lower jaw. I have seen a cardiologist to rule out anything cardiac wise. I have seen my doctor and have had blood work done with unremarkable results. Blood pressure and vitals are normal but I am very concerned it’s possibly something neurological. Should I be concerned??
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Follow up: Dr. Dariush Saghafi 0 minute later
Welcome to 'Ask a Doctor'. Please type your question here...hi my name is XXXXXXX I’m a 31 year old female. I have been experiencing dizziness for a little over a month. Now over the past week or two my left leg is starting to get tingly as well as a little part of my lower jaw. I have seen a cardiologist to rule out anything cardiac wise. I have seen my doctor and have had blood work done with unremarkable results. Blood pressure and vitals are normal but I am very concerned it’s possibly something neurological. Should I be concerned??
doctor
Answered by Dr. Dariush Saghafi 2 hours later
Brief Answer:
Good afternoon XXXXXXX

Detailed Answer:
Thank you for submitting your query XXXXXXX and I'm sorry you're not feeling well. I see you're from Toronto....not terribly far from Cleveland! I used to live in Montreal and XXXXXXX and Winnipeg....many, many, MANY moons ago....I was a kid during Expo 67....does that give you an idea? LOL....

Anyways young lady, let's take a look and see what we've got....you've been having "dizziness"....now do you mean a spinning sensation such as VERTIGO (movement, spinning, maybe even feeling nauseous from the perceived movement?) or are you more referring to a LIGHTHEADED sensation as if you were a little zoned, a little detached, a little buzzed (if that makes sense to you?), detached? Have you started taking any new medications in the past few months for depression, anxiety, or even motion sickness itself?

I saw that you had asked a colleague of mine something on your heart and so there is this shoulder pain as well in the background.

So, if a nice young lady such as yourself were to come right through the door of our office with the exact symptoms you were having I would do a thorough history of where's she's been, what medications she was on, what kind of work she does, and anything odd or even unpleasant that's been going on in her life for the past few months such as a lot of stress, anxiety, problems with family or a significant other, etc. I detect a bit of anxiety in the tone of what you write both to me as well as to the other doctor on the heart question. Has there been anything bad happening in your family or with a coworker, friend, etc.? Maybe someone's been diagnosed with something not so nice...or they are waiting for results and you're concerned for them as well....sometimes those feelings can translate into your feeling things as well.

So maybe that would be a bit of the history.

SECOND, I would perform a thorough and complete neurological examination (because I'm a neurologist) and see where things land in terms of your cranial nerves, motor functions of your muscles, sensory functions of your peripheral nervous system, reflexes, visual fields, gait/balance, and of course, a cognitive assessment.....For example, do you know how many islands there are in Hawaii? LOL.....tough question.....you see, I thought there were always 7...which are the ones that are actually inhabited.....but wanna hear something crazy? There are 135 Hawaiian islands, of which only 7 are inhabited! Isn't that wild? Do you think the U.S. government would put one of the other 128 up for sale? They might need it if they close the government again, oh lord! HAHA!

So then, once I completed your cognitive screening I would put the results together from a physical examination perspective and then, look to see what the history tells us on the evolution of these symptoms related to your life and what's going on.

Next step would be a good laboratory evaluation for something young and spry such as yourself meaning I would send you for the standard blood tests that all primary doctors love to get with the Chemistries and hematology profiles but I would augment for your symptoms with things such as Vit. B12, folate, Vit. D, homocysteine, methylmalonic acid, a urinalysis, and I think I would stop there for the time being with blood work and urine. Then, we'd see what all that shows. You said your doctor did bloodwork but you didn't mention the specific tests done nor their results......Often, your symptoms only prompt basic lab profiles and do not necessarily prompt looking at B12's, D's, or even something as simple as a urinalysis...but I actually look at all those things with careful eyes because things can be missed.

Finally, and again, depending on what we find with the rest of the workup I MIGHT consider getting an MRI of the brain with and without gadolinium contrast. If my index of suspicion were very high (based on NEGATIVE blood work and NEGATIVE physical examination) then, I'd throw the gadolinium contrast in....if not, I might just do the study without the contrast.

That would be the extent of my workup XXXXXXX ...and then, let's see what it shows.

So, should you be concerned? I would say, that being concerned before doing the organized and complete workup is counterproductive since there tend to be MANY MORE healthy 31 year old young ladies in the world than those with significant illnesses. Logical right? You don't want to excessively worry or contemplate things that don't exist.

But I would very much promote a complete and thorough workup before crossing the line of jumping to conclusions....what do you think? I will say that my experience in dealing with Canadian patients is that the degree of workups for symptoms such as these is variable and I've heard some patients saying that no way no how would they be able to get any type of head imaging study more than a CT scan.....and some say, not even.....so if there is going to be an imaging study then, I think it definitely it should be an MRI of the brain and gadolinium should be considered.

Also, I am always sure to send my patients for a renal clearance study of their bloodstream looking for what are referred to as the BUN (Blood Urea Nitrogen) and EGFR (Estimated Glomerular Filtration Rate) as a way of being absolutely certain your kidneys are as healthy as I believe you sound.... ;) In our hospital the EGFR needs to clear 60cc/min. in order for patients to get the green light to get the contrasted study. If it's going to be NON-contrasted then, you don't need to get that study.

Well XXXXXXX there you have it....the detail of what I would do for you if I were in your doctor's stead....along with a bit of a geography lesson on the Hawaiian Islands....can you believe? ONE HUNDRED THIRTY FIVE? Sheesh....as an XXXXXXX I feel wholly traitorous not knowing that basic bit of geography! HAHA! How about something interesting about Toronto if you'd like to share? I visited with our family (of course, now I have my own little rugrats and wife...HA!) back in 1998 when the XXXXXXX Association of Neurologists had their convention there....you were a kid then, so you won't remember when we descended upon your fair town.....it was a great time....weather wasn't terribly cooperative....but what a lovely city it was really, I've always promised that we'd go back....but shoot....now that the kids are out of college and doing their own things...it's so hard to schedule the time that everyone is free at once....

Soooo, If I've provided useful and helpful information to your question could you do me the HUGE favor of CLOSING THE QUERY along with some POSITIVE words of feedback and maybe even a 5 STAR rating?

And of course, N'oublie pas de me chercher at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. Don't you DARE press me by coming back with a whole treatise in French if should speak the tongue...because that is the best you're gonna get from me for the college French I took with my very grand and wonderful professor, Monsieur Aube...a real Frenchman to be sure! Ciao!

This query has utilized a total of 38 minutes of professional time in research, review, and synthesis for the purpose of formulating a return response.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
Good afternoon XXXXXXX

Detailed Answer:
Thank you for submitting your query XXXXXXX and I'm sorry you're not feeling well. I see you're from Toronto....not terribly far from Cleveland! I used to live in Montreal and XXXXXXX and Winnipeg....many, many, MANY moons ago....I was a kid during Expo 67....does that give you an idea? LOL....

Anyways young lady, let's take a look and see what we've got....you've been having "dizziness"....now do you mean a spinning sensation such as VERTIGO (movement, spinning, maybe even feeling nauseous from the perceived movement?) or are you more referring to a LIGHTHEADED sensation as if you were a little zoned, a little detached, a little buzzed (if that makes sense to you?), detached? Have you started taking any new medications in the past few months for depression, anxiety, or even motion sickness itself?

I saw that you had asked a colleague of mine something on your heart and so there is this shoulder pain as well in the background.

So, if a nice young lady such as yourself were to come right through the door of our office with the exact symptoms you were having I would do a thorough history of where's she's been, what medications she was on, what kind of work she does, and anything odd or even unpleasant that's been going on in her life for the past few months such as a lot of stress, anxiety, problems with family or a significant other, etc. I detect a bit of anxiety in the tone of what you write both to me as well as to the other doctor on the heart question. Has there been anything bad happening in your family or with a coworker, friend, etc.? Maybe someone's been diagnosed with something not so nice...or they are waiting for results and you're concerned for them as well....sometimes those feelings can translate into your feeling things as well.

So maybe that would be a bit of the history.

SECOND, I would perform a thorough and complete neurological examination (because I'm a neurologist) and see where things land in terms of your cranial nerves, motor functions of your muscles, sensory functions of your peripheral nervous system, reflexes, visual fields, gait/balance, and of course, a cognitive assessment.....For example, do you know how many islands there are in Hawaii? LOL.....tough question.....you see, I thought there were always 7...which are the ones that are actually inhabited.....but wanna hear something crazy? There are 135 Hawaiian islands, of which only 7 are inhabited! Isn't that wild? Do you think the U.S. government would put one of the other 128 up for sale? They might need it if they close the government again, oh lord! HAHA!

So then, once I completed your cognitive screening I would put the results together from a physical examination perspective and then, look to see what the history tells us on the evolution of these symptoms related to your life and what's going on.

Next step would be a good laboratory evaluation for something young and spry such as yourself meaning I would send you for the standard blood tests that all primary doctors love to get with the Chemistries and hematology profiles but I would augment for your symptoms with things such as Vit. B12, folate, Vit. D, homocysteine, methylmalonic acid, a urinalysis, and I think I would stop there for the time being with blood work and urine. Then, we'd see what all that shows. You said your doctor did bloodwork but you didn't mention the specific tests done nor their results......Often, your symptoms only prompt basic lab profiles and do not necessarily prompt looking at B12's, D's, or even something as simple as a urinalysis...but I actually look at all those things with careful eyes because things can be missed.

Finally, and again, depending on what we find with the rest of the workup I MIGHT consider getting an MRI of the brain with and without gadolinium contrast. If my index of suspicion were very high (based on NEGATIVE blood work and NEGATIVE physical examination) then, I'd throw the gadolinium contrast in....if not, I might just do the study without the contrast.

That would be the extent of my workup XXXXXXX ...and then, let's see what it shows.

So, should you be concerned? I would say, that being concerned before doing the organized and complete workup is counterproductive since there tend to be MANY MORE healthy 31 year old young ladies in the world than those with significant illnesses. Logical right? You don't want to excessively worry or contemplate things that don't exist.

But I would very much promote a complete and thorough workup before crossing the line of jumping to conclusions....what do you think? I will say that my experience in dealing with Canadian patients is that the degree of workups for symptoms such as these is variable and I've heard some patients saying that no way no how would they be able to get any type of head imaging study more than a CT scan.....and some say, not even.....so if there is going to be an imaging study then, I think it definitely it should be an MRI of the brain and gadolinium should be considered.

Also, I am always sure to send my patients for a renal clearance study of their bloodstream looking for what are referred to as the BUN (Blood Urea Nitrogen) and EGFR (Estimated Glomerular Filtration Rate) as a way of being absolutely certain your kidneys are as healthy as I believe you sound.... ;) In our hospital the EGFR needs to clear 60cc/min. in order for patients to get the green light to get the contrasted study. If it's going to be NON-contrasted then, you don't need to get that study.

Well XXXXXXX there you have it....the detail of what I would do for you if I were in your doctor's stead....along with a bit of a geography lesson on the Hawaiian Islands....can you believe? ONE HUNDRED THIRTY FIVE? Sheesh....as an XXXXXXX I feel wholly traitorous not knowing that basic bit of geography! HAHA! How about something interesting about Toronto if you'd like to share? I visited with our family (of course, now I have my own little rugrats and wife...HA!) back in 1998 when the XXXXXXX Association of Neurologists had their convention there....you were a kid then, so you won't remember when we descended upon your fair town.....it was a great time....weather wasn't terribly cooperative....but what a lovely city it was really, I've always promised that we'd go back....but shoot....now that the kids are out of college and doing their own things...it's so hard to schedule the time that everyone is free at once....

Soooo, If I've provided useful and helpful information to your question could you do me the HUGE favor of CLOSING THE QUERY along with some POSITIVE words of feedback and maybe even a 5 STAR rating?

And of course, N'oublie pas de me chercher at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. Don't you DARE press me by coming back with a whole treatise in French if should speak the tongue...because that is the best you're gonna get from me for the college French I took with my very grand and wonderful professor, Monsieur Aube...a real Frenchman to be sure! Ciao!

This query has utilized a total of 38 minutes of professional time in research, review, and synthesis for the purpose of formulating a return response.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 2 hours later
Thank you very much for answering me so promptly and thoroughly. I am actually from Windsor, ON, which borders XXXXXXX Michigan...so Toronto is like four hours away. I split my time between Windsor and XXXXXXX XXXXXXX where he lives. I also should've mentioned that I do fly every two weeks so I was also wondering if there's a possibility of an inner ear thing going on.

My anxiety definitely is getting the best of me and I know it is not wise to Dr.Google my symptoms but I keep thinking there is something serious going on like a tumor or MS based on my worst case scenario searches via the web.

I should also mention I did go see an optometrist back in the fall when I first started feeling like my focus was off. She did an exam and said everything was OK. Also at my family doctor they did tests that tested my reflexes, made me follow her light with my eyes, made me walk back and forth testing my motor skills with no reason to be concerned.

The sensation I would say I am feeling I guess if I had to describe it best would be almost a drunk feeling, or like someone spun me around twenty times then told me to walk. I have gotten it standing and sitting. The worst I had it was the other night when I was in my car and I was singing in the car. When I say singing I mean belting out singing HAHA. So I don't know if that is any usual information.

I also notice if I plug my nose and blow that makes the dizziness worse. I am trying not to freak myself out but I just want to get to the bottom of it. My diet definitely needs some improving and I do binge drink on weekends so I am sure that increases my anxiety and doesn't make me feel good.

Off topic..when you mentioned Hawaii I had to laugh because my husband and I went there in December for our honeymoon and we were told by everyone that there is seven islands!!! Totally didn't know there was that many!!!

I am going to go see my family doctor next Monday in XXXXXXX and I will mention to him what's going on. Hopefully I am feeling better. I am going to try and eat healthy and not drink this week and see if that makes me feel any better.

Is it possible there is an overstimulation of a nerve (Vagus)?? I feel like it is super sensitive. Anyways! I am going to stop self diagnosing myself for now.

Hopefully you have a great night. Thanks again
XXXXXXX Groulx RMT
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Follow up: Dr. Dariush Saghafi 0 minute later
Thank you very much for answering me so promptly and thoroughly. I am actually from Windsor, ON, which borders XXXXXXX Michigan...so Toronto is like four hours away. I split my time between Windsor and XXXXXXX XXXXXXX where he lives. I also should've mentioned that I do fly every two weeks so I was also wondering if there's a possibility of an inner ear thing going on.

My anxiety definitely is getting the best of me and I know it is not wise to Dr.Google my symptoms but I keep thinking there is something serious going on like a tumor or MS based on my worst case scenario searches via the web.

I should also mention I did go see an optometrist back in the fall when I first started feeling like my focus was off. She did an exam and said everything was OK. Also at my family doctor they did tests that tested my reflexes, made me follow her light with my eyes, made me walk back and forth testing my motor skills with no reason to be concerned.

The sensation I would say I am feeling I guess if I had to describe it best would be almost a drunk feeling, or like someone spun me around twenty times then told me to walk. I have gotten it standing and sitting. The worst I had it was the other night when I was in my car and I was singing in the car. When I say singing I mean belting out singing HAHA. So I don't know if that is any usual information.

I also notice if I plug my nose and blow that makes the dizziness worse. I am trying not to freak myself out but I just want to get to the bottom of it. My diet definitely needs some improving and I do binge drink on weekends so I am sure that increases my anxiety and doesn't make me feel good.

Off topic..when you mentioned Hawaii I had to laugh because my husband and I went there in December for our honeymoon and we were told by everyone that there is seven islands!!! Totally didn't know there was that many!!!

I am going to go see my family doctor next Monday in XXXXXXX and I will mention to him what's going on. Hopefully I am feeling better. I am going to try and eat healthy and not drink this week and see if that makes me feel any better.

Is it possible there is an overstimulation of a nerve (Vagus)?? I feel like it is super sensitive. Anyways! I am going to stop self diagnosing myself for now.

Hopefully you have a great night. Thanks again
XXXXXXX Groulx RMT
doctor
Answered by Dr. Dariush Saghafi 7 hours later
Brief Answer:
Thanks for the correction on that geographical location!

Detailed Answer:
So, once again, many thanks and hello again on your return question. Thanks for the clarification as to your location. I stand corrected. I didn't look carefully enough at the data supplied as to your place of origin. It says, TECUMSEH, ON.....is that more accurate? I'm sure Tecumseh is an XXXXXXX name of some sort....and I also know that TECUMSEH is the name of a truck engine....is there a Tecumseh Plant up there? Or is the town simply named in honor of Chief Tecumseh who was eventually killed in action during the War of 1812 while fighting on the side of the Brits who were busy burning the White House down! LOL..... That's when the famous portraits of XXXXXXX XXXXXXX and other historical paintings and artifacts were saved by Dolly XXXXXXX ....LOL.....

Windsor, ON is actually even closer to XXXXXXX than Toronto.....I remember crossing into Windsor on a couple of occasions when going to XXXXXXX over the years....you'll have to give me some travel tips of what to go and visit up there the next time I cross the bridge....can't remember the name....is it maybe the Windsor Bridge...oh no, I remember, it's the Ambassador Bridge? I just read about the Ambassador Bridge and learned of the newly approved Gordie Howe bridge which will be a 2nd connection bridge to connect XXXXXXX and Windsor....HOW COOL!! Did you know about this? HUGE project.....4.4 BILLION dollar price tag to be finished by 2024! Wow!!! Will be the largest cable-stayed bridge in North XXXXXXX with towers rivaling the height of the Renaissance Center. How cool is that???

And so your husband lives in XXXXXXX TX? How incredibly funny is that? Would you believe it if I told you our family (I was 5 years old at the time) lived in XXXXXXX My brother was born at XXXXXXX & White Memorial where my dad was doing his surgical residency training, I got my first LIONEL TRAIN SET for Xmas, my first TEXACO FIRE CHIEF'S HAT (complete with working microphone built into the hat), and I learned FIRST HAND about how nasty the red ant bite can be, let alone when you get covered in them if you sit on top of their ant hill and play with friends.....they come out and bite the CRAPOLA out of you! But I was so proud when I told my mom who was frantically trying to get these things off me...."Look mom, I'm not crying....she is though!"...It was my poor little friend..a girl in one of the apartments, and it was NOT good day for her at all! LOL....

Okkkk...so, let's see dizziness, inner ear? Mmmm...could be....but is it VERTIGO you have or LIGHTHEADEDNESS? How about hearing loss in one ear or the other? How about tinnitus (ringing in the ears)? The only way I think the flying could be tied to your symptom is if the problem literally started the day you started flying....or some time shortly thereafter....Furthermore, a quick Heigh Resolution IAC sequence of MRI with gadolinium contrast should show you any type of vascular malformation, cyst, dehiscence of the roof of the tectal plate within the cavernous sinus cavity....etc. etc....so just on the basis of the complexity of the diagnosis causing what sounds to be a relatively UNCOMPLICATED circumstance in the whole scheme of things....I'd say it was UNLIKELY.....

A quick audiometry session with a well trained technician and good interpretation by audiologist I think would be a reasonable thing to do as well as the HIGH RES MRI of the IAC (Internal Auditory Meatus). That will answer many questions immediately on the integrity of the inner ear on whichever side you're committed. I would recommend HIGHLY that you try avoiding any type of OTC or even prescription medication for the symptom of dizziness...for the time being until you get more information. You would be surprised how much junk MECLIZINE causes to happen and you don't want to miss the opportunity of finding out something that could be pathological if given the chance. So my vote (if I were your treating neurologist...."Pssstt....you're even closer to XXXXXXX than I thought....I can meet you in Toledo! ;)

Now, I understand that your family doctor has done a lot of physical examination sorts of tests on you....but have they done COMPLETE NEUROLOGICAL TESTING on your for your complaints and would they know what to look for if something were present but only very subtle? Nothing against your PMD...but honestly, nothing like a GOOD NEUROLOGICAL EXAMINATION done by a GOOD NEUROLOGIST! So, if you're still not feelilng quite convinced by your PMD that things are on the "up and up" would you feel convinced or better if a specialist (such as MOI...haha!) would put you through the paces?

But of course, you brought up the recognized fact that you could be letting your anxiety get the best of you....and if you've brought the topic up...then, I must say that my impression is slightly swayed (though no fault of your bringing it up....you are simply giving me as much information you feel I could use as possible) as to why your doctor is NOT sending you automatically to a neurologically....Is it because this sort of medical anxiety has happened in you before? That is usually the MO of someone who is facing a health concern of some sort but doesn't seem to be getting the proper or access to wide open testing.....I can understand why that would be the case and I can't say I disagree....in other words, at some point we must draw a line in the sand when it comes to testing, performing multiple visits in a short space of time, etc. etc. otherwise, as you can imagine, resources would become scarce for other patients who were not suffering necessarily from this terrible thing we call Health Anxiety.....

But if you've never been referred to a neurologist for a good solid set of relevant questions regarding your symptoms nor been fully tested with MRI's, etc. then, I as a naive physician to your circle would recommend taking your symptoms and really tracking them down thoroughly THEN, DOCUMENTING my findings so that they can be easily recovered and referred to if necessary. I know you said that you were worried about a tumor, MS, etc. I don't think your presentation is consistent with brain tumor since it doesn't APPEAR from what you've written that you're suffering from CRAZY PAINFUL migraines nor does it seem as if you were throwing up like a bandit, getting dehydrated, and completely unable to function due to the symptoms of the headache, speech/language problems, clear cut weakness on one side of the body compared to the other, yada yada yada.....make sense? At least that's my impression.

Are some of your symptoms consistent with a picture of MS...I ain't gonna lie...cuz Abe XXXXXXX didn't and boy did that take guts....for Heaven Sakes...the man was a LAWYER! LOLOLOL! But no, my dear...for you I will tell you the truth....some of your presented symptoms you mentioned could certainly mimic or look like things you might see in a patient presenting with MS as a first attack....I don't disagree with that.....however, this is EASY to figure out and RULE out with a simple MRI of the head and neck with gadolinium contrast after clearing the kidneys.....and you will have pretty much proof positive if there were any chance of this being MS. Next month's mortgage money is again that being a real diagnosis.....but I couldn't argue with anyone who puts that in their differential diagnosis.

But here's what I would say about your dilemma of looking everything up in Google Search......I tell my patients that I openly support and even ENCOURAGE to learn all they can about their symptoms and even what sorts of infirmities there could be associated with the symptoms, HOWEVER, I make my patients promise me that THOU SHALL NOT BECOME A DIAGNOSTICIAN ONLY BECAUSE ONE IS GOOD AT READING ABOUT SYMPTOMS AND THEIR ASSOCIATIONS."

I would fully support your right and talents at searching the Internet to your heart's content withi ONE CAVEAT.....ready? I don't mind you doing unlimited searching and looking for whatever you feel describes your symptoms BUT you must absolutely PROMISE not to DIAGNOSE YOURSELF WITH ANY TYPE OF CONDITION without running your investigated information by me first....DEAL??? You are only allowed to gather data to present (much as a Medical Student does in a clinic when working with an attending, right?). The medical student can spend 3 hrs. with the patient getting all the improtant and relevant information BUT the student is by far not in control of making the FINAL DIAGNOSIS or initiating beginning treatment UNLESS it is deemed OK by whomever is his primary treating physician. Make sense?

You are allowed to play DETECTIVE...or is it DETECTIVESS now in the M2 age......so long I am your DIAGNOSTICIAN...which means it's my call as to what you've got as much as being in charge of telling you what you DON'T have....Deal????

Binge drinking with these symptoms is definitely a NO NO NANETTE...if you catch my drift....it's only going to give you a magnification of what's going on, make it more difficult for you to regain a baseline state of functioning, and eventually, could worsen the baseline and make it more difficult to successfully treat if it in fact, DOES turn out to be a treatable condition...just because of the long term and toxic effects of alcohol.

You seem to be a very intelligent girl....so that's why I want to tell you point blank.....in my opinion, you must give up binge alcohol drinking and that's not something I've necessarily got a XXXXXXX answer for.....but you've got to really stop the alcohol consumption in order to get this figured out. Also, remember that medications you take for any of the conditions we've mentioned can be NEGATED in their actions in the presence of alcohol. And now with this little bit of additional history, even more reason to run several metabolic panels on you to be sure that your biochemical profiles are where they should be..

So, it sounds like you got this sudden onset of vertigo or imbalance as you described while driving and singing....ROCK STAR STYLE....anything I might know? Stairway to Heaven, Hotel California, Hello from Adele...or how about Sweet Caroline? I'm not sure whether the best explanation to that would be the fact you could've been hyperventilating in your excitement to be discovered by a Detroit/Motown Record Label Executive that may have just been passing you on the highway.....OR.....someone your cerebellar circuits decided to act up, or was it something in the INNER EAR.....did you have TINNITUS (ringing/buzzing in the ears when this happened? Any sudden loss of hearing?) Any pain inside the head.....maybe a headache....how about an unusually bad headache either 1-2 days before your Concert debut or AFTER? Anything there?

So based on that piece of information I would be interested in scanning you my dear...and that would mean an MRI of the brain (with fine cuts through the CEREBELLOPONTINE ANGLE) and of the CERVICAL SPINE because there are cerebellar circuits that go into the upper portions of the cervical spine that you may see better with a C-SPINE set of shots. Based on your plugging your nose and blowing against a closed trap door making things worse, I would also get an MRA of the head and neck looking for either a VASCULAR MALFORMATION SUCH AS AN AVM, or an aneurysm that could be in the brainstem or even cavernous sinus region. If your PMD didn't want to send you to see a neurologist for some crazy reason then, how about a NEURO-OTOLOGIST with the symptoms you're having.....they would be good as well to look into a problem such as this one....though truth be told any decent neurologist worth his salt should be licking his chops to work you up and either (preferably) give you a CLEAN XXXXXXX OF HEALTH....or solve the riddle.....

Not sure about the Vagus nerve question because my first question with that as a hypothesis is exactly what seems to be OVERSTIMULATING the nerve and what would the location of this overstimulation be in the body in order to fit the symptoms? You said that blood pressure and heart rates were normal right? I'm not getting the impression that you're passing out spontaneously or nearly passing out...there is the dizziness, which to some extent sounds like a vertigo..... The most common consequence of OVERSTIMULATING the vagus nerve is fainting or nearly fainting, really low blood pressure and low heart rate, low breathing, and very slow mentation...meaning mental faculties affected due to lack of blood flow to the brain.....

So bottom line is I don't really believe you're suffering from anything like that....but the sudden symptoms of what appear to be VERTIGO do interest me......I wholeheartedly approve your message to not drink this weekend and to eat real clean for the next week or 2.

I hope you have a terrific night (what's left of it at 1:15 am)....HAHA!! I'm hitting the hay now, my wife will probably ask me what I'm doing in bed so early! LOL.....and I look forward to your thoughts on things I've said....again, it's a little tough being in my position with you since I have so much of a desire to just implement the things that need to be done...but alas....no can do from THE LAND...unless you came here....;)

So, once again young lady....If I've provided useful and helpful information to your question and think I've hit the nails on the head.....could you be so awesome as to CLOSE THE QUERY with nice words of your thoughts on how I'm kickin' it with you and maybe even a 5 STAR rating? ;)

And of course, needless to say you, your friends and your family can always find me at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

Long live the GORDIE HOWE BRIDGE! See who gets a picture traveling on it first....Me or You! ROFLMAO!!

This query has utilized a total of 138 minutes of professional time in research, review, and synthesis for the purpose of formulating a return response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by Dr. Dariush Saghafi 0 minute later
Brief Answer:
Thanks for the correction on that geographical location!

Detailed Answer:
So, once again, many thanks and hello again on your return question. Thanks for the clarification as to your location. I stand corrected. I didn't look carefully enough at the data supplied as to your place of origin. It says, TECUMSEH, ON.....is that more accurate? I'm sure Tecumseh is an XXXXXXX name of some sort....and I also know that TECUMSEH is the name of a truck engine....is there a Tecumseh Plant up there? Or is the town simply named in honor of Chief Tecumseh who was eventually killed in action during the War of 1812 while fighting on the side of the Brits who were busy burning the White House down! LOL..... That's when the famous portraits of XXXXXXX XXXXXXX and other historical paintings and artifacts were saved by Dolly XXXXXXX ....LOL.....

Windsor, ON is actually even closer to XXXXXXX than Toronto.....I remember crossing into Windsor on a couple of occasions when going to XXXXXXX over the years....you'll have to give me some travel tips of what to go and visit up there the next time I cross the bridge....can't remember the name....is it maybe the Windsor Bridge...oh no, I remember, it's the Ambassador Bridge? I just read about the Ambassador Bridge and learned of the newly approved Gordie Howe bridge which will be a 2nd connection bridge to connect XXXXXXX and Windsor....HOW COOL!! Did you know about this? HUGE project.....4.4 BILLION dollar price tag to be finished by 2024! Wow!!! Will be the largest cable-stayed bridge in North XXXXXXX with towers rivaling the height of the Renaissance Center. How cool is that???

And so your husband lives in XXXXXXX TX? How incredibly funny is that? Would you believe it if I told you our family (I was 5 years old at the time) lived in XXXXXXX My brother was born at XXXXXXX & White Memorial where my dad was doing his surgical residency training, I got my first LIONEL TRAIN SET for Xmas, my first TEXACO FIRE CHIEF'S HAT (complete with working microphone built into the hat), and I learned FIRST HAND about how nasty the red ant bite can be, let alone when you get covered in them if you sit on top of their ant hill and play with friends.....they come out and bite the CRAPOLA out of you! But I was so proud when I told my mom who was frantically trying to get these things off me...."Look mom, I'm not crying....she is though!"...It was my poor little friend..a girl in one of the apartments, and it was NOT good day for her at all! LOL....

Okkkk...so, let's see dizziness, inner ear? Mmmm...could be....but is it VERTIGO you have or LIGHTHEADEDNESS? How about hearing loss in one ear or the other? How about tinnitus (ringing in the ears)? The only way I think the flying could be tied to your symptom is if the problem literally started the day you started flying....or some time shortly thereafter....Furthermore, a quick Heigh Resolution IAC sequence of MRI with gadolinium contrast should show you any type of vascular malformation, cyst, dehiscence of the roof of the tectal plate within the cavernous sinus cavity....etc. etc....so just on the basis of the complexity of the diagnosis causing what sounds to be a relatively UNCOMPLICATED circumstance in the whole scheme of things....I'd say it was UNLIKELY.....

A quick audiometry session with a well trained technician and good interpretation by audiologist I think would be a reasonable thing to do as well as the HIGH RES MRI of the IAC (Internal Auditory Meatus). That will answer many questions immediately on the integrity of the inner ear on whichever side you're committed. I would recommend HIGHLY that you try avoiding any type of OTC or even prescription medication for the symptom of dizziness...for the time being until you get more information. You would be surprised how much junk MECLIZINE causes to happen and you don't want to miss the opportunity of finding out something that could be pathological if given the chance. So my vote (if I were your treating neurologist...."Pssstt....you're even closer to XXXXXXX than I thought....I can meet you in Toledo! ;)

Now, I understand that your family doctor has done a lot of physical examination sorts of tests on you....but have they done COMPLETE NEUROLOGICAL TESTING on your for your complaints and would they know what to look for if something were present but only very subtle? Nothing against your PMD...but honestly, nothing like a GOOD NEUROLOGICAL EXAMINATION done by a GOOD NEUROLOGIST! So, if you're still not feelilng quite convinced by your PMD that things are on the "up and up" would you feel convinced or better if a specialist (such as MOI...haha!) would put you through the paces?

But of course, you brought up the recognized fact that you could be letting your anxiety get the best of you....and if you've brought the topic up...then, I must say that my impression is slightly swayed (though no fault of your bringing it up....you are simply giving me as much information you feel I could use as possible) as to why your doctor is NOT sending you automatically to a neurologically....Is it because this sort of medical anxiety has happened in you before? That is usually the MO of someone who is facing a health concern of some sort but doesn't seem to be getting the proper or access to wide open testing.....I can understand why that would be the case and I can't say I disagree....in other words, at some point we must draw a line in the sand when it comes to testing, performing multiple visits in a short space of time, etc. etc. otherwise, as you can imagine, resources would become scarce for other patients who were not suffering necessarily from this terrible thing we call Health Anxiety.....

But if you've never been referred to a neurologist for a good solid set of relevant questions regarding your symptoms nor been fully tested with MRI's, etc. then, I as a naive physician to your circle would recommend taking your symptoms and really tracking them down thoroughly THEN, DOCUMENTING my findings so that they can be easily recovered and referred to if necessary. I know you said that you were worried about a tumor, MS, etc. I don't think your presentation is consistent with brain tumor since it doesn't APPEAR from what you've written that you're suffering from CRAZY PAINFUL migraines nor does it seem as if you were throwing up like a bandit, getting dehydrated, and completely unable to function due to the symptoms of the headache, speech/language problems, clear cut weakness on one side of the body compared to the other, yada yada yada.....make sense? At least that's my impression.

Are some of your symptoms consistent with a picture of MS...I ain't gonna lie...cuz Abe XXXXXXX didn't and boy did that take guts....for Heaven Sakes...the man was a LAWYER! LOLOLOL! But no, my dear...for you I will tell you the truth....some of your presented symptoms you mentioned could certainly mimic or look like things you might see in a patient presenting with MS as a first attack....I don't disagree with that.....however, this is EASY to figure out and RULE out with a simple MRI of the head and neck with gadolinium contrast after clearing the kidneys.....and you will have pretty much proof positive if there were any chance of this being MS. Next month's mortgage money is again that being a real diagnosis.....but I couldn't argue with anyone who puts that in their differential diagnosis.

But here's what I would say about your dilemma of looking everything up in Google Search......I tell my patients that I openly support and even ENCOURAGE to learn all they can about their symptoms and even what sorts of infirmities there could be associated with the symptoms, HOWEVER, I make my patients promise me that THOU SHALL NOT BECOME A DIAGNOSTICIAN ONLY BECAUSE ONE IS GOOD AT READING ABOUT SYMPTOMS AND THEIR ASSOCIATIONS."

I would fully support your right and talents at searching the Internet to your heart's content withi ONE CAVEAT.....ready? I don't mind you doing unlimited searching and looking for whatever you feel describes your symptoms BUT you must absolutely PROMISE not to DIAGNOSE YOURSELF WITH ANY TYPE OF CONDITION without running your investigated information by me first....DEAL??? You are only allowed to gather data to present (much as a Medical Student does in a clinic when working with an attending, right?). The medical student can spend 3 hrs. with the patient getting all the improtant and relevant information BUT the student is by far not in control of making the FINAL DIAGNOSIS or initiating beginning treatment UNLESS it is deemed OK by whomever is his primary treating physician. Make sense?

You are allowed to play DETECTIVE...or is it DETECTIVESS now in the M2 age......so long I am your DIAGNOSTICIAN...which means it's my call as to what you've got as much as being in charge of telling you what you DON'T have....Deal????

Binge drinking with these symptoms is definitely a NO NO NANETTE...if you catch my drift....it's only going to give you a magnification of what's going on, make it more difficult for you to regain a baseline state of functioning, and eventually, could worsen the baseline and make it more difficult to successfully treat if it in fact, DOES turn out to be a treatable condition...just because of the long term and toxic effects of alcohol.

You seem to be a very intelligent girl....so that's why I want to tell you point blank.....in my opinion, you must give up binge alcohol drinking and that's not something I've necessarily got a XXXXXXX answer for.....but you've got to really stop the alcohol consumption in order to get this figured out. Also, remember that medications you take for any of the conditions we've mentioned can be NEGATED in their actions in the presence of alcohol. And now with this little bit of additional history, even more reason to run several metabolic panels on you to be sure that your biochemical profiles are where they should be..

So, it sounds like you got this sudden onset of vertigo or imbalance as you described while driving and singing....ROCK STAR STYLE....anything I might know? Stairway to Heaven, Hotel California, Hello from Adele...or how about Sweet Caroline? I'm not sure whether the best explanation to that would be the fact you could've been hyperventilating in your excitement to be discovered by a Detroit/Motown Record Label Executive that may have just been passing you on the highway.....OR.....someone your cerebellar circuits decided to act up, or was it something in the INNER EAR.....did you have TINNITUS (ringing/buzzing in the ears when this happened? Any sudden loss of hearing?) Any pain inside the head.....maybe a headache....how about an unusually bad headache either 1-2 days before your Concert debut or AFTER? Anything there?

So based on that piece of information I would be interested in scanning you my dear...and that would mean an MRI of the brain (with fine cuts through the CEREBELLOPONTINE ANGLE) and of the CERVICAL SPINE because there are cerebellar circuits that go into the upper portions of the cervical spine that you may see better with a C-SPINE set of shots. Based on your plugging your nose and blowing against a closed trap door making things worse, I would also get an MRA of the head and neck looking for either a VASCULAR MALFORMATION SUCH AS AN AVM, or an aneurysm that could be in the brainstem or even cavernous sinus region. If your PMD didn't want to send you to see a neurologist for some crazy reason then, how about a NEURO-OTOLOGIST with the symptoms you're having.....they would be good as well to look into a problem such as this one....though truth be told any decent neurologist worth his salt should be licking his chops to work you up and either (preferably) give you a CLEAN XXXXXXX OF HEALTH....or solve the riddle.....

Not sure about the Vagus nerve question because my first question with that as a hypothesis is exactly what seems to be OVERSTIMULATING the nerve and what would the location of this overstimulation be in the body in order to fit the symptoms? You said that blood pressure and heart rates were normal right? I'm not getting the impression that you're passing out spontaneously or nearly passing out...there is the dizziness, which to some extent sounds like a vertigo..... The most common consequence of OVERSTIMULATING the vagus nerve is fainting or nearly fainting, really low blood pressure and low heart rate, low breathing, and very slow mentation...meaning mental faculties affected due to lack of blood flow to the brain.....

So bottom line is I don't really believe you're suffering from anything like that....but the sudden symptoms of what appear to be VERTIGO do interest me......I wholeheartedly approve your message to not drink this weekend and to eat real clean for the next week or 2.

I hope you have a terrific night (what's left of it at 1:15 am)....HAHA!! I'm hitting the hay now, my wife will probably ask me what I'm doing in bed so early! LOL.....and I look forward to your thoughts on things I've said....again, it's a little tough being in my position with you since I have so much of a desire to just implement the things that need to be done...but alas....no can do from THE LAND...unless you came here....;)

So, once again young lady....If I've provided useful and helpful information to your question and think I've hit the nails on the head.....could you be so awesome as to CLOSE THE QUERY with nice words of your thoughts on how I'm kickin' it with you and maybe even a 5 STAR rating? ;)

And of course, needless to say you, your friends and your family can always find me at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

Long live the GORDIE HOWE BRIDGE! See who gets a picture traveling on it first....Me or You! ROFLMAO!!

This query has utilized a total of 138 minutes of professional time in research, review, and synthesis for the purpose of formulating a return response.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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