Let's Play "Diagnose Me"

In My Humble Opinion
1

You all did such a great job diagnosing my pleurisy, I thought I’d give you another shot.

Symptoms:

Vertigo almost daily, to varying degrees. Not too strong that I fall over, but definitely a shifting, even when I’m just sitting at my desk at work. This has been happening over the last 6 months or so. At first I thought it was the Mirena IUD as whenever I would go on or off BC I would have periods of increasing vertigo, but this is getting worse instead of better.

Bouts of nausea, not daily, and can’t correspond it to eating as sometimes it’ll hit me as soon as I open my eyes in the morning. It definitely feels like a motion sickness nausea rather than an “I ate something icky” nausea if that makes any sense.

Three incidences in the last week of some weird “attack”. It starts off that I feel a little numb/tingly in the hands & feet, then my field of vision shrinks, I start to shake, break out in a sweat (not chills), and feel as though I may faint. I just ride it out. I have had these “attacks” on and off since I was around 19. I had a glucose tolerance test when they first started which turned up nothing. This was relayed to my doctor yesterday.

I had a physical in May and was proclaimed 100% perfectly healthy in every way. I had a yearly OBGYN/Mirena insertion check up in July and again - perfectly healthy.

Both doctors (PCP & GYN) state that the Mirena should not cause this. I went to the doctor (PCP) yesterday. I fully expected him to say “there’s nothing wrong with you; eat more vegetables” or something to that effect. Instead he expressed mild concern and said it could be any number of things:

Cardiac arrhythmia
Neurological
Inner ear

Blood pressure yesterday AM was low (even for me) at like 86/58, but tested a little higher by end of visit (94/62). Resting heart rate was bang on at 68-72 and my O2 level was 99%. He did a hearing test and middle ear pressure test (perfectly normal).

He did a few in office reflex and balance tests which I passed with flying colors, except for the last one. I had to stand with my feet together, hands raised palm up in front of me about shoulder high, tilt my head back and then close my eyes while he counted to 5. I would get to about 2.5/3 and then list badly to the right. Apparently, that’s not normal. But it did allow him to push cardiac issues to the bottom of the list and move up neurological.

He sent me off the lab for a battery of tests:

CBC with diff
Comprehensive Metabolic Panel
TSH
B12
CRP*

I should get the results tomorrow and depending on what they say will decide where he sends me next. Either ENT guy or Neurologist.

But in the meantime, let’s play Armchair Doctor.

What’s wrong with me? (besides the obvious)

*It’s never lupus

2

Lupus!

Oh wait…

Sounds like it could be an inner ear thing - my mom had something similar a few years ago which eventually resolved.

Of course, I know absolutely nothing, so it’s probably best to ignore my suggestion.

3

Vestibulopathy.

Likely to resolve spontaneously and ultimately discarded as idiopathic.

The fainty thing is a red herring.

The lab tests will be unhelpful in uncovering a cause.

This is not cardiac and highly unlikely to be central (ie, related to the brain, if that’s what you mean by “neurological”).

Read about some named types of vestibulopathy here. Try to stay away from having some of the more notorious ones.

But sure; if you insist is could be an atypical presentation of an atypical aneurysm in your vertebral or posterior arterial distribution and you are about to veggie out.

4

I’m not a doctor, and this advice is worth what you’re paying for it. Have you ever heard of Meniere’s disease? The random bouts of vertigo make me think Meniere’s. I can’t speak to the cause of your low blood pressure, because I don’t think that’s a hallmark of Meniere’s. But you could also have more than one condition.

5

Labyrinthitis

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002049/

6

That is what I’m hoping for, a simple inner ear thing that just goes away on its own with minimal fuss (and expense).

I think the fainty thing is unrelated also, but as it happened recently, I thought I’d toss that in there for the doctor (and you people here). My doctor mentioned some atypical migraine (I don’t headaches). I could deal with all of this being migraine related.

I hate idiopathic stuff - it usually winds up with too many invasive and costly tests that result in the doctor saying, “Fuck it - I don’t know what’s wrong with you, but here are meds to control the symptoms.”

Possible, but I have zero tinnitus or hearing loss. But maybe I’m in the beginning stages. I don’t like any disease that is only diagnosed by ruling everything else out though, so hopefully it’s not Meniere’s.

I don’t know what that is, but I totally want it because that’s a cool name! Though reading the risk factors, it’s unlikely because I don’t have any of them. And the only symptom I have is the vertigo.

7

My guess is ocular migraines.

Maybe Ménière’s (less likely, though, since your ears aren’t ringing).

It’d be helpful to know your demographic info.

8

I have had an optometrist diagnose me with ocular migraines when I told him about the field of vision loss that I get once or twice a year (without any numbness/fainting/sweats/etc). I thought that the addition of the other symptoms ruled out the ocular migraine, but maybe not.

Demographic info: 42 years old, female, in good health (apart of this weirdness), live in Phoenix, regular office job, play tennis 2-3 times a week. Anything else?

9

That was the initial diagnosis I received. Eventually it resolved, but I have had further bouts over the years. Full cardiac workup, CT of my head, ultrasound of my carotids, etc all normal.

10

Labyrinthitis is not really an appropriate diagnosis term for a symptom complex recurring over a period of 6 months.

The suffix “-itis” is generally used to denote an underlying inflammation of some kind. One of the putative causes of acute vertigo is inflammation secondary to viral or bacterial causes, especially when there is obvious evidence of such infection (associated URI symptoms, or perhaps direct evidence of inflammation of the middle ear, for example). For the most part, “labyrinthitis” should be reserved for those presentations.

The term “labyryinthitis” is often used casually and carelessly (including by clinicians and casual medical references) to refer to any vestibulopathy–especially an idiopathic one of acute onset–but when it’s used that way, it’s not really a diagnosis. It’s just another way of saying “vertigo.”

In this scenario it’s highly unlikely that an underlying inflammatory condition–infectious or otherwise–is the cause.

11

Strip to the waist. Post pics.

12

:dubious: I’m beginning to think you’re not a fake internet doctor after all…

13

OK, then. PM me the pics. HIPAA and all.

14

BPPV. Check the Wiki, it lists quite a few of your symptoms and is very common and very fixable. In my case the onset of episodes had a clear hormonal connection.

Although against internet directives I looked up the Epley maneuver and DIY’d which did help (luckily, because you can easily make it worse.) Finally I was professionally Epley’ed by a PT and the vertigo was immediately gone and remained gone for years. I am careful how I turn over now and have only had mild, easily fixable bouts since then.

15

BPPV is the first of the vestibulopathies listed in the link within my first post.

You’ll see a nice description and diagram of the Dix-Hallpike maneuver used to diagnosis it as well as a description of the Epley maneuver there.

16

It is possible the OP is as adverse to blind link-clicking as I am, but nice to know I agree with and narrow down your armchair diagnosis. In my research I never found documentation of a hormonal influence on BPPV but I am positive there is one.

17

I did check and I’m inclined to agree with your diagnosis based on the Wiki for BPPV and the absence of other symptoms with other issues that also list vertigo.

My blood work came back and I’m in perfect health as far as those results go. My PCP does want to me to see a neurologist anyway, so I’ll be doing that at the end of this month.