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What Causes Headache, Anxiety And Fatigue?
Question: I have fatigue, headaches, anxiety but the main thing that is new is tremors, it feels like the earth is moving under my feet, it first happened when I was sitting down in a chair, but now it happens often while I try to sleep, one night it felt like the bed was moving. I also lose my grip on objects and they just fall out of my hand for no reason. I also have mental confusion, and anxiety, not sure what this could be, but I am fear it might be a neurological condition. Also insomnia
Brief Answer:
Cause of tremors and imbalance
Detailed Answer:
Hi xxxxxxxxxxxxxxxxxxxx thanks for asking from HealthcareMagic.
I can understand your concern. You are having resting and intentional tremors. You are also having some imbalance problem as you feel like ground is moving. Such symptoms could be due to
- Anxiety - I am mentioning it first as you are already suffering from it. It can cause all the above symptoms. Along with it, you will also feel palpitations, mental stress, dryness of mouth, sweating in palms and soles. Te diagnosis is made by ruling out other causes and based on your symptoms only.
- Cerebellar disease - Cerebellar hemispheric disease can cause above symptoms. But the tremors are only intentional. No resting tremors. It also causes incoordination like not able to hold glass, not able to reach glass, not able to button/unbutton shirts. There will be no palpitation.
It can be ruled out by cerebellar system examination, MRI brain, B12 level, angiography of brain vessels.
- Red nucleus lesion - It is a region in brainstem. It can be damaged by ischemia or mass lesion. It can cause both types of tremors and imbalance. There will no anxiety like symptoms or incoordination. MRI brain is a good investigation to confirm the site.
My advise is to consult a neurologist and get yourself examined. Your nervous system examination is needed to suspect something. Based on that, further investigation like B12 level, MRI brain and angiography might be needed to confirm the cause. Further treatment will depend upon the diagnosis.
Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
Dr Ishu Bishnoi
Cause of tremors and imbalance
Detailed Answer:
Hi xxxxxxxxxxxxxxxxxxxx thanks for asking from HealthcareMagic.
I can understand your concern. You are having resting and intentional tremors. You are also having some imbalance problem as you feel like ground is moving. Such symptoms could be due to
- Anxiety - I am mentioning it first as you are already suffering from it. It can cause all the above symptoms. Along with it, you will also feel palpitations, mental stress, dryness of mouth, sweating in palms and soles. Te diagnosis is made by ruling out other causes and based on your symptoms only.
- Cerebellar disease - Cerebellar hemispheric disease can cause above symptoms. But the tremors are only intentional. No resting tremors. It also causes incoordination like not able to hold glass, not able to reach glass, not able to button/unbutton shirts. There will be no palpitation.
It can be ruled out by cerebellar system examination, MRI brain, B12 level, angiography of brain vessels.
- Red nucleus lesion - It is a region in brainstem. It can be damaged by ischemia or mass lesion. It can cause both types of tremors and imbalance. There will no anxiety like symptoms or incoordination. MRI brain is a good investigation to confirm the site.
My advise is to consult a neurologist and get yourself examined. Your nervous system examination is needed to suspect something. Based on that, further investigation like B12 level, MRI brain and angiography might be needed to confirm the cause. Further treatment will depend upon the diagnosis.
Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
Dr Ishu Bishnoi
Above answer was peer-reviewed by :
Dr. Kampana
I kindly thank you for your thorough and thoughtful answer. I will be 62 in October. I am scared but I have always faced anything in life head-on and straightforward and I want to know as much facts as possible, then I find a solution usually through prayer. I was wondering what your opinion is of the following information I found on internet? ?
Multiple System Atrophy Overview
Multiple system atrophy, or MSA, is a rare, degenerative neurologic condition that affects both men and women, usually starting in the 50’s or early 60’s1. MSA is considered a type of parkinsonism but with more widespread effects on the brain and body. The condition was first identified in 1962 and named Shy-Drager syndrome for two physicians who reported patients showing a combination of Parkinson-like movement disorders and problems with the autonomic, or body-regulating division of the nervous system2.
Common and Distinguishing Features
•Similarities to Parkinsonism: Both Parkinson’s disease and MSA are characterized by deposits of a type of protein known as alpha-synuclein in the nervous system. Both conditions also specifically affect cells that produce dopamine,4, a neurotransmitter that controls motor commands. As a result, many of the same motor dysfunctions occur in the two conditions.
•Unique Features: Important differences distinguish the symptoms and course of MSA from Parkinson’s disease and other conditions of the nervous system, such as cerebellar ataxia or pure autonomic failure (PAF). Notably, MSA affects several areas of the brain, including the cerebellum, your brain’s balance and coordination centers, and the autonomic nervous system, which controls your body’s automatic, or regulating functions, such as blood pressure, digestion and temperature.
•Another distinguishing feature of MSA is the types of cells involved. While Parkinson’s disease affects the dopamine-producing neurons of a motor-controlling portion of the brain known as the nigro-striatial area, MSA affects both neurons and glial cells – support cells that maintain the health of neurons and which out number neurons by 10:15. Additionally, some of the glial cells affected in MSA produce myelin, the fatty substance that insulates neurons6.
Multiple System Atrophy Overview
Multiple system atrophy, or MSA, is a rare, degenerative neurologic condition that affects both men and women, usually starting in the 50’s or early 60’s1. MSA is considered a type of parkinsonism but with more widespread effects on the brain and body. The condition was first identified in 1962 and named Shy-Drager syndrome for two physicians who reported patients showing a combination of Parkinson-like movement disorders and problems with the autonomic, or body-regulating division of the nervous system2.
Common and Distinguishing Features
•Similarities to Parkinsonism: Both Parkinson’s disease and MSA are characterized by deposits of a type of protein known as alpha-synuclein in the nervous system. Both conditions also specifically affect cells that produce dopamine,4, a neurotransmitter that controls motor commands. As a result, many of the same motor dysfunctions occur in the two conditions.
•Unique Features: Important differences distinguish the symptoms and course of MSA from Parkinson’s disease and other conditions of the nervous system, such as cerebellar ataxia or pure autonomic failure (PAF). Notably, MSA affects several areas of the brain, including the cerebellum, your brain’s balance and coordination centers, and the autonomic nervous system, which controls your body’s automatic, or regulating functions, such as blood pressure, digestion and temperature.
•Another distinguishing feature of MSA is the types of cells involved. While Parkinson’s disease affects the dopamine-producing neurons of a motor-controlling portion of the brain known as the nigro-striatial area, MSA affects both neurons and glial cells – support cells that maintain the health of neurons and which out number neurons by 10:15. Additionally, some of the glial cells affected in MSA produce myelin, the fatty substance that insulates neurons6.
Brief Answer:
Multiple system atrophy diagnosis and treatment
Detailed Answer:
Hi xxxxxxxxxxx, welcome back.
I got your point. I did not consider "MSA (multiple system atrophy)" as your differential diagnosis, because it is rare. But I agree you do have some features like it. So I will give some valuable information about it that will help you.
As you are already aware of its symptoms and pathology, I will briefly describe few things and then tell you how to approach it. The unique thing in MSA is cerebellar involvement and autonomic dysfunction. It is because of these features, it is called "multiple system (cerebellar, autonomic, cerebral functions).
It is difficult to diagnose. The diagnosis is based on examination of cerebral, cerebellar functions like coordination/tremors/balance, autonomic function like change in BP with posture/sweat test/cardiac rhythm with respiration/urodynamic studies/Sphincter electromyography (EMG) of the detrusor.
MRI brain and PET scan features are confusing and non specific. MRI may show olivopontocerebellar atrophy (OPCA), cerebellar atrophy and the putaminal lesions of striatonigral degeneration. Dopamine trace (MRI brain with DWI with Dopamine trace) uptake is increased in cerebellum, putamen.
Another confirmatory method is brain biopsy which is not used now.
Thats how the MSA is confirmed. Its diagnosis is mostly exclusion based.
Now coming to the treatment, it is managed symptomatically. It can not be reversed.
- For tremors, usually tablet propranolol and if anxiety, tablet clonazepam are given. Surgically, Deep brain stimulation can also help.
- For autonomic symptoms like constipation, fiber diet, plenty of fluids and mobilisation. Syrup lactulose may be given after prescription.
There are variety of medication of different symptoms that can be used to treat symptoms. Let me know any other symptoms of yours, I will tell you how to manage it. You can consult all about it with your doctor. MRI brain might rule out anything serious.
Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
Dr Ishu Bishnoi
Multiple system atrophy diagnosis and treatment
Detailed Answer:
Hi xxxxxxxxxxx, welcome back.
I got your point. I did not consider "MSA (multiple system atrophy)" as your differential diagnosis, because it is rare. But I agree you do have some features like it. So I will give some valuable information about it that will help you.
As you are already aware of its symptoms and pathology, I will briefly describe few things and then tell you how to approach it. The unique thing in MSA is cerebellar involvement and autonomic dysfunction. It is because of these features, it is called "multiple system (cerebellar, autonomic, cerebral functions).
It is difficult to diagnose. The diagnosis is based on examination of cerebral, cerebellar functions like coordination/tremors/balance, autonomic function like change in BP with posture/sweat test/cardiac rhythm with respiration/urodynamic studies/Sphincter electromyography (EMG) of the detrusor.
MRI brain and PET scan features are confusing and non specific. MRI may show olivopontocerebellar atrophy (OPCA), cerebellar atrophy and the putaminal lesions of striatonigral degeneration. Dopamine trace (MRI brain with DWI with Dopamine trace) uptake is increased in cerebellum, putamen.
Another confirmatory method is brain biopsy which is not used now.
Thats how the MSA is confirmed. Its diagnosis is mostly exclusion based.
Now coming to the treatment, it is managed symptomatically. It can not be reversed.
- For tremors, usually tablet propranolol and if anxiety, tablet clonazepam are given. Surgically, Deep brain stimulation can also help.
- For autonomic symptoms like constipation, fiber diet, plenty of fluids and mobilisation. Syrup lactulose may be given after prescription.
There are variety of medication of different symptoms that can be used to treat symptoms. Let me know any other symptoms of yours, I will tell you how to manage it. You can consult all about it with your doctor. MRI brain might rule out anything serious.
Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
Dr Ishu Bishnoi
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thank you very much. My hope is that you have something positive in your day today to make you smile, the song of a bird, the wind in the leaves, the soft sunlight on your face, God Bless you.
Brief Answer:
Thanks a lot
Detailed Answer:
Hi xxxxxxxxxxxx, thanks a lot for your appreciation.
I really liked your words. Your blessings mean a lot to me.
Hope you will get better soon. Take care.
Thanks a lot
Detailed Answer:
Hi xxxxxxxxxxxx, thanks a lot for your appreciation.
I really liked your words. Your blessings mean a lot to me.
Hope you will get better soon. Take care.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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