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Main symptoms: Woozy feeling light headed type of looking at…

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Main symptoms: Woozy feeling light...
Main symptoms: Woozy feeling light headed type of looking at both computer screens and trying to focus my eyes is tough and continues to get worse but once I do it slower it focuses easier quicker. (Said if earlier but best way to explain is when you bend over and then stand up quick that type of feeling but all that time I am sure you can imagine it’s uncomfortable looking around all the time like that) secondary symptoms: Muscle fasculations all over body been going on with the light headedness when it all started. Weakness swallowing and progressing with the upper three Symtoms but started happening a bit later. Third level symtoms: Tingling in feet and itchy skin 5 days of it now consistently of that. This has been going on for 6-7 years have done lots of tests looking for things outside the box at this point it continues to get worse.
Submitted: 1 month ago.Category: Neurology
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Answered in 1 day by:
3/19/2018
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago
Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 12,325
Experience: Neurosurgeon - Brain, spine, and peripheral nerve surgery
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Hello -

Since this has been going on for 7 years they probably have done all of these, but have you had:

EKG?

Holter monitor?

Blood pressure tests / orthostatic hypotension?

MRI brain?

Angiogram (CT or MRA) of the neck and brain?

Seen a neurologist? Seen an opthalmologist?

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Customer reply replied 1 month ago
all have done and all
Blood work. I am
Trying to think outside the box now
Customer reply replied 1 month ago
I just had a Tesla 3 MRA of neck and brain a Friday all were
Normal
Customer reply replied 1 month ago
2018.
TECHNIQUE: Multiplanar, multisequence MRA sequences of the neck were
performed. Other: None.. Post-processing: Multiplanar 3D MIP
reconstructions. IV Contrast: 8.6 cc Gadavist.
Evaluation of stenosis by NASCET criteria.
FINDINGS:
RIGHT
Common Carotid: Patent. No dissection or significant stenosis.
Internal Carotid: Patent. No dissection or significant stenosis.
External Carotid: Patent. No dissection or significant stenosis.
Vertebral: Patent. No dissection or significant stenosis.
LEFT
Common Carotid: Patent. No dissection or significant stenosis.
Internal Carotid: Patent. No dissection or significant stenosis.
External Carotid: Patent. No dissection or significant stenosis.
Vertebral: Patent. No dissection or significant stenosis.
Intracranial Circulation: No stenoses or aneurysms in the visualized
portion of the intracranial vasculature.
Other: The soft tissues, bones, and lung apices are within normal
limits.MRA:
COMPARISON: CT temporal bone 1/4/2016; status MR brain 12/2/2015
TECHNIQUE: Multiplanar, multisequence MRA sequences of the brain were
performed. Other: None. Post-processing: Multiplanar 3D MIP
reconstructionsIV Contrast: 8.6 cc Gadavist
Stenosis evaluated by NASCET criteria.
FINDINGS:
RIGHT
Internal Carotid (ICA): No aneurysm, stenosis or anomaly.
Middle Cerebral (MCA): No aneurysm, stenosis or anomaly.
Anterior Cerebral (ACA): No aneurysm, stenosis or anomaly.
Posterior Cerebral (PCA): No aneurysm, stenosis or anomaly.
Posterior Communicating (P-COM): No aneurysm, stenosis or anomaly.
Vertebral: No aneurysm, stenosis or anomaly in the visualized upper
vertebral artery.
LEFT
Internal Carotid (ICA): No aneurysm, stenosis or anomaly.
Middle Cerebral (MCA): No aneurysm, stenosis or anomaly.
Anterior Cerebral (ACA): No aneurysm, stenosis or anomaly.
Posterior Cerebral (PCA): Fetal PCA. No aneurysm.
Posterior Communicating (P-COM): No aneurysm, stenosis or anomaly.
Vertebral: No aneurysm, stenosis or anomaly in the visualized upper
vertebral artery.
MIDLINE
Anterior Communicating (A-COM): No aneurysm, stenosis or anomaly.
Basilar artery: No aneurysm, stenosis, or vascular malformation.
Other: None.
Customer reply replied 1 month ago
Also had ultra sound of neck of the arteries as well
But no angiogram.
Customer reply replied 1 month ago
Last MRI was 2015 Dec Tesla 3 with and without contrast of the brain
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

OK.

It appears that you have nothing wrong with the circulation to the brain.

Have you seen a neurologist? Had a lumbar puncture peformed? Had EMG and nerve conduction studies? MRI of the cervical spine?

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Customer reply replied 1 month ago
What would lumbar puncture do? And EMG yes in 2012
Customer reply replied 1 month ago
I am not weak except possibly swallowing
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

A lumbar puncture could look for increased pressure in the brain which could contribute to an issue with your vision and funny sensations in your head. They would also analyze the fluid for abnormalities. (It's probably unlikely that you have high pressure -- which generally causes headaches -- but if you've had everything else done already)

The EMG (a new one) can help to look at why you are having fasciculations in your body as well as look for evidence of progressive weakness, as well as the new symptoms of tingling in the feet (looking for neuropathy, muscle and nerve disorders)

But the main issue that seems to come to mind would be a blood pressure issue, such as orthostatic hypotension, which can cause a sudden lowering of blood pressure which can cause the feeling of lightheadedness (bend over and stand up quick like) and a constant low blood pressure to the brain can cause that kind of feeling. They would look for heart rhythm abnormalities and blood pressure readings --

https://www.mayoclinic.org/tests-procedures/tilt-table-test/about/pac-20395124

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Customer reply replied 1 month ago
Wouldn’t they seem the brain pressure in the MRI or in the MRA? Or in any other imaging? I really do not want to do a lumbar puncture I feel like they would have already caught that.
Customer reply replied 1 month ago
Blood pressure has been tested on my arm for the blood pressure as well
Customer reply replied 1 month ago
EMG you think should be done again even after 7 years and I’m gaining muscle at the gym these past years?
Customer reply replied 1 month ago
the brain pressure would have pressed on those arteries and shown obstruction or pressure on it right?
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

No, the intracranial pressure (ICP) cannot be measured on MRI or MRA.

They can see evidence of increased ICP if a neurologist or opthalmologist looked into your eyes, by looking for "optic nerve edema" or swelling of the nerve that goes to your eye.

The circulation itself is usually not affected by the increase in ICP (because the blood pressure is much higher pressure than the normal brain pressure). So even in cases of high ICP, it is not "pressing" on the arteries to cause obstruction.

The EMG can be helpful if you were feeling "weaker" -- but if you're gaining muscle and the fasciculations are not a problem, then it probably is not helpful. The nerve conduction testing can help to look for neuropathy for the tingling issues in your feet, however.

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Customer reply replied 1 month ago
Can they do a retinal fundus? Or is there anyway to confirm I do not have ICP without an invasive procedure like spinal tap and would this be plausible that this could go on for 6-7 years?
Customer reply replied 1 month ago
slowly get worse?
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

The neurologist can look in the eyes at the optic nerve, and they can do ultrasounds to look for evidence of optic nerve edema.

I agree, this is unlikely that this would be going on for 6-7 years at this point, but it would be one of the things that could possibly cause vision issues with "weird" sensations in your head.

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Customer reply replied 1 month ago
Would this confirm then without doing spinal tap? I am not getting to many headaches unless I stare at tv for a couple hours or could they look into my eyes for that as well?
Customer reply replied 1 month ago
It just slowly gets worse on a daily basis and I don’t know
If it would fall under this I don’t have high BP either or infections or anything.
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

Well, it could likely rule out a high ICP if there is no optic nerve swelling, but the confirmation comes with the lumbar puncture. But if there is no optic nerve swelling, then it's unlikely that they would do a lumbar puncture.

The concern would be for low blood pressure rather than high blood pressure for issues with your vision and woozy light headed feeling.

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Customer reply replied 1 month ago
I am 23 year old Male 194
Customer reply replied 1 month ago
190 lbs
Customer reply replied 1 month ago
Not much of a head ache but vision is as announced earlier I have normal BP I have been checked for that standing and sitting etc etc and this lasts all day everyday
Customer reply replied 1 month ago
Isn’t 90% of these cases women’s and obese women?
Customer reply replied 1 month ago
could this progress like this? Would this make sense?
Customer reply replied 1 month ago
Even though I do not get to many head aches I just get woozy type feeling light headed
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

For pseudotumor cerebri -- yes, it is most seen in young, larger women.

But "thinking outside the box" would include considering that in a young, not overweight man.

But it wouldn't typically progress like this, so it doesn't quite fit your symptoms.

The woozy type lightheaded symptom is much more consistent with a low blood pressure type of issue.

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Customer reply replied 1 month ago
Yeah I have an at home BP thing and it’s always normal.
Customer reply replied 1 month ago
Is it life threatening if it continues to get worse?
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

It does not sound like it is life threatening, considering you've had all these tests done to rule out the potential life threatening issues (MRIs, angiograms, etc).

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Customer reply replied 1 month ago
But if this is the benign version that keeps getting worse that itself is not life threatening right?
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

Correct -- not life threatening.

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Customer reply replied 1 month ago
Why is that?
Customer reply replied 1 month ago
Why are other versions life threatening but this one is not?
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

Pseudotumor is a condition where the ICP is elevated, but not elevated to the point where it can impair bloodflow, and cause strokes. Very high pressures could cause vision loss, and that is considered an emergency, but not life-threatening.

So it is simply annoying to most people.

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Customer reply replied 1 month ago
Okay impaired blood flow have showed on MRA of head and neck with contrast right?
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

Yes, it would have shown up on the MRA.

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Customer reply replied 1 month ago
Also sense I am gaining more muscle with this twitching all over my body the pst 6-7-8 years this is shows I don’t have a nerve degenerative disease?
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

If you are gaining more muscle -- you clearly don't have a degenerative disease.

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Customer reply replied 1 month ago
Okay that is weird what is causing it then hmmm
Customer reply replied 1 month ago
Could I be a drug baby? I was adopted?
Neurologist: Dr. Mark, Neurologist (MD) replied 1 month ago

Don't worry - this wouldn't have anything to do with being a "drug" baby.

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Customer reply replied 1 month ago
Okay hmmm do you think it could have something to do
With my liver not functioning properly all my enzyme are normal except high billirubin. One thing I will say you know when your head is dizzy from spinning around and your eyes try and focus on things but they can’t clearly that is kind of the feeling when I turn I get that dizzy feeling and my eyes don’t enable me to focus because my brain is saying I am dizzy so it’s a bit fuzzy that is what gets worse.
Customer reply replied 29 days ago
Hello?
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