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What Causes Dizziness, Twitching In The Eyelid And Neck Stiffness?

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Posted on Sat, 15 Oct 2016
Question: Hi, i recently have been having complications with vertigo/dizziness, left eyelid twitching, nausea, head fullness, regular intermittent sharp stabbing pains toward the back of my head, neck stiffness, and sharp stabbing pains in my L1-L3 spinal region. The back pains are also intermittent and last for 30mins at a time, severe enough to make it difficult to walk. I have had the above symptoms for approx 4 weeks now, the dizziness has eased but now when the symptoms flare back up i become very irritable. 10 years ago i suffered a compression fracture to my L1 and L2. I have previously had glandular fever and toxoplasmosis. I was on medication, Escitalopram 10mg per day, this was stopped slowly approx 2+ months ago after i started feeling unwell. Currently my doctor recommends rest and ibuprofen for my back and headaches. Is there anything else that you think should be furher looked into? No medical tests have been done as doctor doesnt feel its necessary, although i havent got any better with their advice.
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Answered by Dr. Dariush Saghafi (3 hours later)
Brief Answer:
MRI of the back with gadolinium

Detailed Answer:
Good morning and thank you for your question.

As a neurologist this type of presentation of complaints always raises the specter in my mind of a possible compressive sort of entity upon the spinal cord or at least the sac encasing the spinal cord in the lumbar region. I am unable to easily tie the symptoms together of the head symptoms except to say that you may be experiencing some facets of atypical migraine types of headaches or what could also be an occipital neuralgia. But I don't see the relationship with what's going on in the back.

If you've suffered a compression fracture at L1 and L2 vertebrae in the past then, this sounds to be the most likely culprit for your ongoing pain and discomfort. If that is what it is then, I would agree with your doctor that rest and simple analgesics would be appropriate. I might add some physical activity specifically for improvement of strength and stamina of your lower back muscles which can definitely improve symptoms of pain by holding the spinal column more aligned. Aquatherapy would be something I would highly recommend.

However, again, as a neurologist worried about "worse" things.....my response to your picture in the U.S. would be to FIRST AND FOREMOST get you in for a good solid NEUROLOGICAL EXAMINATION of the lower extremities. If there are any abnormalities in the sensory or motor functions of your legs or if there were any signs of bowel/bladder compromise then, without a doubt I would get MRI images of the lumbar spine and add gadolinium contrast in order to rule out any mass lesion that could be causing these problems.

From your timeline of 4 weeks and the fact that these pains come and go intermittently at what I believe to be a pretty static intensity level of pain without other symptoms (at least you didn't mention any) my guess is that we probably won't find any type of growing mass....but there's nothing that says you couldn't have some type of benign lesion placing some compressive forces on the appropriate nerve roots to give you the pain symptoms either.

So again, in the face of neurological signs of some type of compromise of either sensory or motor symptoms I would not hesitate to get a high resolution imaging study of the back. Once its done you would not likely have to repeat any such study for an extremely long time because you'll know exactly what's there. At that point your doctors could turn their attention to pain management.

Headaches and other symptoms you mention could be looked at by a headache specialist as well to either rule out a form of atypical migraine headache or possible occipital neuralgia.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 15 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2473 Questions

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What Causes Dizziness, Twitching In The Eyelid And Neck Stiffness?

Brief Answer: MRI of the back with gadolinium Detailed Answer: Good morning and thank you for your question. As a neurologist this type of presentation of complaints always raises the specter in my mind of a possible compressive sort of entity upon the spinal cord or at least the sac encasing the spinal cord in the lumbar region. I am unable to easily tie the symptoms together of the head symptoms except to say that you may be experiencing some facets of atypical migraine types of headaches or what could also be an occipital neuralgia. But I don't see the relationship with what's going on in the back. If you've suffered a compression fracture at L1 and L2 vertebrae in the past then, this sounds to be the most likely culprit for your ongoing pain and discomfort. If that is what it is then, I would agree with your doctor that rest and simple analgesics would be appropriate. I might add some physical activity specifically for improvement of strength and stamina of your lower back muscles which can definitely improve symptoms of pain by holding the spinal column more aligned. Aquatherapy would be something I would highly recommend. However, again, as a neurologist worried about "worse" things.....my response to your picture in the U.S. would be to FIRST AND FOREMOST get you in for a good solid NEUROLOGICAL EXAMINATION of the lower extremities. If there are any abnormalities in the sensory or motor functions of your legs or if there were any signs of bowel/bladder compromise then, without a doubt I would get MRI images of the lumbar spine and add gadolinium contrast in order to rule out any mass lesion that could be causing these problems. From your timeline of 4 weeks and the fact that these pains come and go intermittently at what I believe to be a pretty static intensity level of pain without other symptoms (at least you didn't mention any) my guess is that we probably won't find any type of growing mass....but there's nothing that says you couldn't have some type of benign lesion placing some compressive forces on the appropriate nerve roots to give you the pain symptoms either. So again, in the face of neurological signs of some type of compromise of either sensory or motor symptoms I would not hesitate to get a high resolution imaging study of the back. Once its done you would not likely have to repeat any such study for an extremely long time because you'll know exactly what's there. At that point your doctors could turn their attention to pain management. Headaches and other symptoms you mention could be looked at by a headache specialist as well to either rule out a form of atypical migraine headache or possible occipital neuralgia. If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my answers/suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out. Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others. This query has utilized a total of 15 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.