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What Causes Dizziness, Unsteady Gait, Right Vestibular Weakness And Blurry Eyes?
Question: Had vertigo 10 months ago 1 week following flu. Have dizziness/ feeling of imbalance while walking, eyes feel tight and blurry bi temporal headache in the beginning. Diagnosed at first of having BPPV. Undergone
Vestibular rehab and believed Epley' manuvre. Did not help. Had VNG and caloric test by ENT revealed right vestibular weakness 70 % less than the left, possibly due to right vestibular neuronitis. MRI, IAC MRI and MRA not significant. Follow up MRI not significant except a 6 mm right subcortical high signal on Flair ( poorly seen on 1st MRI as no Flair sequence done ). Symptoms persist. No neurological deficit.
Can the small focus on the MRI a significant finding and contributory ? Prognosis ? Further exam ? treatment ? Depressed by the ongoing illness . Please advise. Thanks.
Vestibular rehab and believed Epley' manuvre. Did not help. Had VNG and caloric test by ENT revealed right vestibular weakness 70 % less than the left, possibly due to right vestibular neuronitis. MRI, IAC MRI and MRA not significant. Follow up MRI not significant except a 6 mm right subcortical high signal on Flair ( poorly seen on 1st MRI as no Flair sequence done ). Symptoms persist. No neurological deficit.
Can the small focus on the MRI a significant finding and contributory ? Prognosis ? Further exam ? treatment ? Depressed by the ongoing illness . Please advise. Thanks.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern, I imagine how disabling vertigo can be.
I read that MRI report carefully. Regarding that lesion it is not mentioned the location of that small focus, different locations may cause different symptoms or none at all. However since it mentions it to be subcortical I can assume that it is in cerebral lobes and not a brainstem lesion at the area of the vestibular nuclei or the cerebellum which might cause such symptoms even when of small size.
So the answer is no, I do not believe that focus to be the reason of your vertigo, it does not justify it. It can be the remain of an old injury, or changes of the small vessels, actually with ageing in most persons some small signal changes are incidentally found with no symptoms at all.
Reading at your description the most likely cause to your situation, considering also its following a flu, would be a viral infection of the vestibular nerve, vestibular neuronitis, which often recovers completely over months but in same cases due to residual damage to the nerve like in your case can persist even more than a year, but improvement is seen, at least partial, the degree varies among patients. I do not think further exams are necessary really. Treatment consists in continuing vestibular rehabilitation and symptomatic antivertigo treatment (meclizine, dimenhydrinate) which unfortunately are not always completely effective.
I remain at your disposal for further questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern, I imagine how disabling vertigo can be.
I read that MRI report carefully. Regarding that lesion it is not mentioned the location of that small focus, different locations may cause different symptoms or none at all. However since it mentions it to be subcortical I can assume that it is in cerebral lobes and not a brainstem lesion at the area of the vestibular nuclei or the cerebellum which might cause such symptoms even when of small size.
So the answer is no, I do not believe that focus to be the reason of your vertigo, it does not justify it. It can be the remain of an old injury, or changes of the small vessels, actually with ageing in most persons some small signal changes are incidentally found with no symptoms at all.
Reading at your description the most likely cause to your situation, considering also its following a flu, would be a viral infection of the vestibular nerve, vestibular neuronitis, which often recovers completely over months but in same cases due to residual damage to the nerve like in your case can persist even more than a year, but improvement is seen, at least partial, the degree varies among patients. I do not think further exams are necessary really. Treatment consists in continuing vestibular rehabilitation and symptomatic antivertigo treatment (meclizine, dimenhydrinate) which unfortunately are not always completely effective.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Taka,
Thank you for your to the point and helpful answers. At this point can steroid be of
any benefit ? In fact I had taken a methylprednison pack at the 3rd month without any result.
Thank you for your to the point and helpful answers. At this point can steroid be of
any benefit ? In fact I had taken a methylprednison pack at the 3rd month without any result.
Brief Answer:
Too late I am afraid.
Detailed Answer:
In cases of vestibular neuritis steroids are used for their anti-inflammatory effect, but they are of use in the first weeks when there is active inflammation.
After 3 months or now they are unlikely to have any benefit as active inflammation has subsided by now, you are dealing with its residual aftermath.
So I do not recommend them, would only expose yourself to side effect.
I hope to have been of help.
Too late I am afraid.
Detailed Answer:
In cases of vestibular neuritis steroids are used for their anti-inflammatory effect, but they are of use in the first weeks when there is active inflammation.
After 3 months or now they are unlikely to have any benefit as active inflammation has subsided by now, you are dealing with its residual aftermath.
So I do not recommend them, would only expose yourself to side effect.
I hope to have been of help.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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