Hello,
Thank you for your consult at DoctorSpring.com.
You had whiplash injury 1 month before. Now you are suffering from giddiness and blurred vision. as your MRI brain is normal , you don't have brain pathology.
Giddiness following trauma may be due to various reasons. Most common are positional vertigo or bppv which is inner ear condition. Other may be post traumatic stress etc.
To get correct diagnosis I need more information including
Description of 1st episode of vertigo in detail
Is it episodic, duration, interval
Any positional change, starts with turning head or lying down
Is it surrounding rotatoty or inside rotating
Associated with nausea or vomiting or headache or not
If it is getting better with exercise then can continue same.
Hearing test or audiogram is required
Positional test or dix- halpike menovuer can be done to rule out positional vertigo.
If all normal you can start tab. Betahistine 16 mg three times for 2 weeks
Hope this helps. Feel free to ask further queries
Regards
Dr. Sunil Jalan
Patient replied :
It all came on all of a sudden while eating dinner where I felt I was moving and almost a drunk, brain fog feeling and very sensitive to light. My neurologist said this is post traumatic concussion/dizziness. After about 2 weeks of the moving sensation I get dizzy when I change positions and can't lay on either sides when I sleep. I sleep propped up. The VNG picked up nystagmus with vision denied in all positions however I couldn't tolerate the calorics and the audiologist said along with the doctor this is not bppv. They thought maybe vestibular neurotis but can't seem to diagnose that either. They both think this had to do with the neck from whiplash and anxiety related. Can someone have nystagmus on the VNG and it not be related to inner ear issues and can he seen in normal people?
thank you so much for your feedback.
Hello.
Sorry for the exceptional delay in my reply.
Post-traumatic giddiness is most commonly due to BPPV. When it is associated with positional changes, then BPPV is all the more likely.
Please visit you ENT specialist again and ask him to repeat the position test (Dix-Halpike manouver).
You should stop all medication for vertigo for 72 hours before doing the positional test otherwise it may be false negative.
Vestibular neuronitis is unlikely as it usually occur following upper respiratory tract infection (common cold). There is not much of a positional component with it.
VNG is not a very specific test, but it helps in confirming certain diagnosis including Meneire's disease.
There are many inner ear condition associated with vertigo, we need to find out specific diagnosis.
BPPV too is one such inner ear condition. Since you have nystagmus with all positions in the VNG, it indicates some inner ear pathology. However, more information is required to get to a specific diagnosis.
So again I suggest that you to do a repeat Position test, as well as an audiogram.
If all of these turn out normal, you can start tablet. Betahistine 16 mg, three times daily, for 2 weeks.
Hope this helps. Feel free to ask further queries.
Regards,
Dr. Sunil Jalan,
ENT Specialist.
Patient replied :
Thank you so much! I should have mentioned that a week after the accident I did have a little bit of a head cold so that's why I think they thought that. My audiogram was normal. They really think this all has to do with my neck and they said it's not menieres. I just really feel at a loss right now bc I still have symptoms. And the most dizziness appears when i tilt either ear from side to side but if I only turn the dizziness has gotten better. So it's really when my head is tilted or when I move my head up and down and when I change positions I feel strange. My final question is can this all just be related to the neck? I also should mention that I had a computerized postpgraphy test done and my balance even in the vestiburlar section was all normal. Thank you and I will give you an excellent rating.
I also should mention that I've been anxious so perhaps that's making symptoms worse and when this sensation of movement first came on for the first week I couldn't watch TV and felt like I had a horrible case of the flu but the dizziness didnt get positional until a week or 2 later. My neurologist keeps saying it's due to a post concussion bc I was also very sensitive to light.
Hello.
Thank you for the detailed information.
As your audiogram is normal, it rules out many inner ear pathologies.
Vertigo related to neck doesn't present like this, so it is very unlikely or I will rather say it is not related to the neck.(Usually neck related vertigo is not acute. Other symptoms including neck or upper limb pain is also associated with it.)
Keeping in mind all the details, there is a possibility of only two diagnosis; one is BPPV and another is Vestibular Neuronitis.
Usually in BPPV vertigo is present on turning to one side only, but when it is severe mainly after trauma, it can be presented on turning to both sides. And giddiness can be quite severe causing the individual to panic. It can also be associated with nausea and vomiting. Vestibular neuronitis is less likely as it does not have positional changes, still it is a possibility.
Again, I suggest you to repeat the positional test if giddiness in not very severe. If it is severe, then control it with medication for 5 days, after that discontinue your medication for 72 hours and repeat positional test. Medication includes Betahistine 16 mg, three times daily. If the vertigo is very severe then, Cinnarazine 25 mg, three times daily or as and when required can be an alternate.(Use it if vertigo is not controlled with Betahistine.)
If these two do not work, then other medications, including sedatives, can be used after consultation with your ENT specialist.
Thank you very much for you kind words. Hope this was helpful.
Regards, Dr. Sunil Jalan,
ENT Specialist.