In 1988 I had a one vehicle motorcycle accident, which caused TBI/SCI. Yes, I wore a helmet and was going about 35 mph when I lost control in heavy sand on the road. Since then, I've had the following chronic conditions:
* Tinnitus: Continuous
* Dizziness; vertigo
* Headache, at two levels, one a feeling of pressure, generally at
the left temple & ear, also over the right eye; the other a "banging"
type of headache that immobilizes me.
* Parasthesias, in my extremities, but more noticable in my legs & feet.
* Circulation problems, in my extremities. My feet & hands will turn
bright red, but often my left foot will turn bluish.
* Loss of mobility in the pinky & ring fingers, both hands.
* Fatigue & loss of stamina. I am unable to do many of the physical
activities I once injoyed.
My biggest problem currently is the dizziness & vertigo, plus the continual pressure headache. I believe this the be a central nervous system/inner ear problem. I have had 2 back surgeries to decompress my spinal column, resulkting in 3 discs removed plus a 2 level fusion in the lumbar region and a single disc removed, plus a cervical fusion at C5/6. Neither surgery has alleviated my symptoms, although an MRI showed spinal cord flattening & bone spurs at C5/6. Conservative treatments presurgery did nothing to alleviate the symptom set.
An ENG given prior to the 2nd surgery of the cervical spine was abnormal, although I can get no clear information from the physician what the abnormalities were. Use of antivert and valium/librium did not alleviate the dizziness/vertigo/tinnitus. Nor did the surgery. In the morning, upon waking up, I tend to stumble. If I walk arounbd my office rapidly during the day, making a lot of turns & positional changes of my head, I get vertigo.
I suspect I have a medical problem that might be alleviated by additional surgery.
My question is how to direct my doctors regarding further testing & diagnosis?
Regards.
Answer -------
As I understand this, the primary question is concerning the diagnosis and treatment of dizziness that follows closed head trauma. I would assume that an initial evaluation has failed to identify any specific traumatic injury to the ear or skull such as a skull fracture, brain contusion, dislocation of an ear bone, trauma to ear drum, etc. In the absence of any obvious finding on either physical examination, or x-ray that might account for the dizziness a thorough ear, nose, throat as well as neurologic examination would be indicated.
An ear, nose, throat specialists approach to the evaluation of chronic dizziness of this nature would involve in addition to physical examination, an audiometric assessment including a standard hearing examination, as well as more sophisticated measurements to assess the integrity of the neural pathways of the inner ear. Such tests might include an acoustic reflex study or an auditory evoked response study. An ENG (electronystagmogram) is a common test used to evaluate dizziness and can provide information about the integrity of the balance portion of the inner ear. An ENG may also provide information about the more central (eg brain) related components of the balance system. However, it is not uncommon for abnormalities to be seen on an ENG that are not localizing - in other words they suggest dysfunction somewhere in the balance system, but can not indicate an anatomic location of dysfunction. A new investigation known as Dynamic Posturography has also been used recently to assist in the evaluation of dizziness, although it's availability is somewhat limited. A condition known as Benign Positional Vertigo is an inner ear condition that can usually be diagnosed on physical examination by a test known as a Hallpike manuever.
Unfortunately, despite the availability of several technologically sophisticated testing modalities for the evaluation of dizziness, it is often times the case that a straightforward diagnosis cannot be made. Fortunately, there is a treatment available that can often times be helpful even for these cases of disequilibrium. The treatment is known as Vestibular Adaptation Therapy. It involves a collection of physical therapy interventions designed to "retrain" the balance system as a whole. This therapy is available through most contemporary physical therapy departments.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
Click here to review
previous Ear, Nose and Throat Clinic consultations