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Suggest Treatment For Dizziness, Heart Palpitations And Tingling Hands
Question: my mother has been having these symptoms of something for about eight months. they started as migraines and progressed to severe dizziness with heart palpitations and periods of tingling hands and feet. after many visits to the ER and doctors several CT scans have been done plus ECG's and no issues of the heart have been found. She is still experiencing up to twenty episodes a day of waves of dizziness that occure suddenly and can last for a few minutes up to a half hour. accompanied with the dizziness is extreme nausea but no vomitting and plusing behind the left eye with fluttering in the chest.
Brief Answer:
Please define dizziness
Detailed Answer:
Good afternoon. My name is Dr. Dariush Saghafi and I am a neurologist as well as a headache specialist in the XXXXXXX OH area of the world. Greetings to wherever you are at. Am I assuming correctly that the author of this vignette is the daughter of the patient and that the patient is 51 years old? Is she currently on Nortriptyline and metoprolol? Anything else? And is it true that prior 8 months the patient was absolutely in tip top shape? In other words, there were no headaches, no dizzy spells, no palpitations, no tingling in the hands/feet, basically, perfectly healthy? Or were there some issues going on even back then? When you say migraine headaches could you please define some of the symptoms of that headache she had and if she was ever treated specifically for the headaches themselves?
Now, define for me what you mean by DIZZINESS. Do you mean VERTIGO with spinning or a whirling feeling or a feeling of movement of the body or of the room where she is? Or is it more like a lightheaded feeling of disconnected, zoning sensation when you say dizziness? Do any of these waves of dizziness KNOCK HER TO THE GROUND due to the intensity of the episode? Do they get any better or worse if she were to lie down vs. stand up or walk? What are eyes doing during these dizzy spells? Have you seen them? Does the fluttering of the chest come on before these spells or during/after these spells?
Does she get woken up from a dead sleep with any of these spells? Are there headaches accompanying these dizzy spells when they occur? Do headaches occur when she IS NOT HAVING the dizzy spells?
Is she totally with it when she has these spells. In other words do you get the impression that while in any of these spells she is zoned out to the point of not knowing what's going on around her, not directly recognizing people or things around her, no knowing the day of the week, or where she is....just being really confused.....just that ever happen during any of these episodes?
What dose of nortriptyline and metoprolol is she on?
Has she seen anybody other than ER docs? Has she seen either ENT or Neurology?
So after the million questions let me just give you some general thoughts because until I get more information back this is not going to be that easy to nail down without at least some additional information
There are a couple of things that come to mind with this type of story:
1. Migrainous vertigo (needs Headache Specialist)
2. Complex partial seizures (possibly something called tornado seizures)- Neurologist or epileptologist
3. Atypical Meniere's disease (hydrops)- ENT specialist
4. coronary vessel or valvular disease (least likely)- cardiologist
Get back to me with some of the answers to these questions and then, we'll go from there.
I'd also like to alert you to the fact that you can always look me up specifically on this network to send medical questions to at the following URL:
http://doctor.healthcaremagic.com/doctors/dr-dariush-saghafi/68474
You may also consult with me in private by webcam, audio, or real time texting by setting up an account and then, an appointment for us to meet online but going to:
www.healthtap.com/drsaghafi
following the instructions to set up an account and then, having us set up time and date to meet on camera.
If you feel I've provided you with useful information to address your concerns then, I'd appreciate greatly your written feedback and a STAR RATING on this response. Also, if you have no further questions or comments to make on what I've written then, please CLOSE THE QUERY on your end so that the system can process, archive, and credit this conversation for future reference.
Wishing you all the best...and hoping we can keep the conversation going a bit to see if we can't figure this out....maybe even by camera. I already 1 appointment tonight at 10p. I could see your mom at 11p (Eastern Standard Time). or another day if more convenient and if you have a webcam or good audio connection to the internet.
This query required 36 min. of physician specific time for review, research, and final draft documentation for envoy.
Please define dizziness
Detailed Answer:
Good afternoon. My name is Dr. Dariush Saghafi and I am a neurologist as well as a headache specialist in the XXXXXXX OH area of the world. Greetings to wherever you are at. Am I assuming correctly that the author of this vignette is the daughter of the patient and that the patient is 51 years old? Is she currently on Nortriptyline and metoprolol? Anything else? And is it true that prior 8 months the patient was absolutely in tip top shape? In other words, there were no headaches, no dizzy spells, no palpitations, no tingling in the hands/feet, basically, perfectly healthy? Or were there some issues going on even back then? When you say migraine headaches could you please define some of the symptoms of that headache she had and if she was ever treated specifically for the headaches themselves?
Now, define for me what you mean by DIZZINESS. Do you mean VERTIGO with spinning or a whirling feeling or a feeling of movement of the body or of the room where she is? Or is it more like a lightheaded feeling of disconnected, zoning sensation when you say dizziness? Do any of these waves of dizziness KNOCK HER TO THE GROUND due to the intensity of the episode? Do they get any better or worse if she were to lie down vs. stand up or walk? What are eyes doing during these dizzy spells? Have you seen them? Does the fluttering of the chest come on before these spells or during/after these spells?
Does she get woken up from a dead sleep with any of these spells? Are there headaches accompanying these dizzy spells when they occur? Do headaches occur when she IS NOT HAVING the dizzy spells?
Is she totally with it when she has these spells. In other words do you get the impression that while in any of these spells she is zoned out to the point of not knowing what's going on around her, not directly recognizing people or things around her, no knowing the day of the week, or where she is....just being really confused.....just that ever happen during any of these episodes?
What dose of nortriptyline and metoprolol is she on?
Has she seen anybody other than ER docs? Has she seen either ENT or Neurology?
So after the million questions let me just give you some general thoughts because until I get more information back this is not going to be that easy to nail down without at least some additional information
There are a couple of things that come to mind with this type of story:
1. Migrainous vertigo (needs Headache Specialist)
2. Complex partial seizures (possibly something called tornado seizures)- Neurologist or epileptologist
3. Atypical Meniere's disease (hydrops)- ENT specialist
4. coronary vessel or valvular disease (least likely)- cardiologist
Get back to me with some of the answers to these questions and then, we'll go from there.
I'd also like to alert you to the fact that you can always look me up specifically on this network to send medical questions to at the following URL:
http://doctor.healthcaremagic.com/doctors/dr-dariush-saghafi/68474
You may also consult with me in private by webcam, audio, or real time texting by setting up an account and then, an appointment for us to meet online but going to:
www.healthtap.com/drsaghafi
following the instructions to set up an account and then, having us set up time and date to meet on camera.
If you feel I've provided you with useful information to address your concerns then, I'd appreciate greatly your written feedback and a STAR RATING on this response. Also, if you have no further questions or comments to make on what I've written then, please CLOSE THE QUERY on your end so that the system can process, archive, and credit this conversation for future reference.
Wishing you all the best...and hoping we can keep the conversation going a bit to see if we can't figure this out....maybe even by camera. I already 1 appointment tonight at 10p. I could see your mom at 11p (Eastern Standard Time). or another day if more convenient and if you have a webcam or good audio connection to the internet.
This query required 36 min. of physician specific time for review, research, and final draft documentation for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. Saghafi, thank you for getting back to me. Yes I am her daughter and my mother will be 51 in October. She is currently taking Nortriptyline HCL 75MG, Metoprolol Tartrate 25MG, Gabapentin 300MG and Indomethacin ER 75MG as prescribed by her GP and Neurologist. She was taking Propaneral for about 2 years to help with her migraines. These migraines always start and stay contained to the left side of here head. She describes them as a single punch like sensation to the back of there head and a dull pain behind her left eye. In the course of this treatment she started having these symptoms. Her migraines would be fine but then she would have episdoes of extreme lighheadedness where she felt like she was going to pass out. These episodes progressed for the next few months and continued to where they now include chest palpitations and nausea (without vomitting, lightheadedness/dizziness (without passing out). The dizziness is more an overwhelming sensation of feeling like you are going to pass out. She gets that rush of feeling to her head and the warm sensation of fainting without actually fainting. She attempts to stand perfectly still if she can't immediately sit down when one of these episodes occur. She has never actually fainted during one of these episodes but has said she sometimes will have a blurry vision because of it. These episodes happen suddenly and occur whether she is standing up or laying down. If she is lying down the episodes seem to be more intense when they occur than if she were standing or sitting. I have witnessed these episodes and no her eyes do not roll into the back of her head and she is completely aware of who is around her. what's going on and where she is at. Her response to one of these episodes is to close her eyes and put her head in her hands and try to breathe her way out of it until it passes. If it is the few minute episode she can continue with what she was doing. If it is the closer to half hour type of episode she tries to get to a quiter location and partially lay down until it passes.
The fluttering in her chest is during the spells and worse when laying down. Yes, she says the nighttime is worse for when the attacks occur. Many nights she can not sleep at all because she is being woken up by these episodes. Sometimes there is a headache and sometimes there is not. IF there are any headaches its always on the left side and behind the left eye where the pain is located. Yes, sometimes she can have a small headache without having a spell of heart fluttering and the feeling of passing out.
She was admitted into the hospital for having a low heart rate and these episodes. During her stay she saw a neurologist (the same one who had placed her on the propaneral) and a cardiologist. She had several radiation tests done and stress tests and some ECG's or EKG's and the results were that nothing was wrong with the heart. She has also been to see and ENT for potential Meniere's Diseases due to the pain behind the left eye but nothing was amiss there either. Currently she is seeing her GP once a week to moniter her progress with the meds but I am talking to you because they are not working and episodes are just a frequent as before and increasing with intensity.
as far as your references of what they might be. She was tested for Meniere's Disease and the ENT said no. Also, while in the hospital they did several tests with radiation and some other chemicals that are supposed to blow open your veins to check for any blockage and the reported that she had none. I'm sorry I don't know the names of them.
Thank you so much.
her neurologist has diagnosed with "Jolts and Jabs Syndrome" this giving her the meds for that
The fluttering in her chest is during the spells and worse when laying down. Yes, she says the nighttime is worse for when the attacks occur. Many nights she can not sleep at all because she is being woken up by these episodes. Sometimes there is a headache and sometimes there is not. IF there are any headaches its always on the left side and behind the left eye where the pain is located. Yes, sometimes she can have a small headache without having a spell of heart fluttering and the feeling of passing out.
She was admitted into the hospital for having a low heart rate and these episodes. During her stay she saw a neurologist (the same one who had placed her on the propaneral) and a cardiologist. She had several radiation tests done and stress tests and some ECG's or EKG's and the results were that nothing was wrong with the heart. She has also been to see and ENT for potential Meniere's Diseases due to the pain behind the left eye but nothing was amiss there either. Currently she is seeing her GP once a week to moniter her progress with the meds but I am talking to you because they are not working and episodes are just a frequent as before and increasing with intensity.
as far as your references of what they might be. She was tested for Meniere's Disease and the ENT said no. Also, while in the hospital they did several tests with radiation and some other chemicals that are supposed to blow open your veins to check for any blockage and the reported that she had none. I'm sorry I don't know the names of them.
Thank you so much.
her neurologist has diagnosed with "Jolts and Jabs Syndrome" this giving her the meds for that
Brief Answer:
Jabs and Jolts doesn't fit YOUR description
Detailed Answer:
Hi there again. Thanks for the extra information. At least by your description of your mom's description my interpretation of things is that the predominant and most debilitating of her problem is this overwhelming feeling of "dizziness" as opposed to painful headache attacks or facial pain attacks. It is the dizziness that comes on multiple times daily not headaches. At least that's my interpretation of things. Jabs and Jolts syndrome or Icepick Headaches are predominantly a PAINFUL type of headache that does not typically include as part of its description or symptomatology the sensation of wooziness, dizziness, near fainting, dysequilibrium, rushing sensation of warmth to the head. They are literally JABS and JOLTS to the head and facial region and can happen up to uncountable times per day. Read this description of JABS and JOLTS and see if it fits with what's going on in your mom:
http://www.ncbi.nlm.nih.gov/pubmed/0000
I think some type of pathology in a region of the brain referred to as the Cerebropontine Angle (CPA territory) such as the presence of an Acoustic Neuroma or Schwannoma could be going on. Against that diagnosis would be the fact that I haven't heard more symptoms of true vertigo, tinnitus (ringing in the ears), dysequilibrium and hearing loss. However, perhaps this is an atypical form of it in some respects and therefore, in my opinion we shouldn't miss an opportunity to catch a weird case of it and get her an MRI with contrast (if her kidneys are healthy) of the brain.
I would also throw in an MRA of the head and neck since she could also be demonstrating the effects of lack of good blood flow to the back of the brain region and this is referred to as VERTEBROBASILAR INSUFFICIENCY which can be due to a blockage in one of the arteries traversing up the neck and to the parts of the brain responsible for feelings of nauseousness/vomiting, balance and equilibrium, and which can cause severe headaches. Other strange things can happen when you reduce blood flow to this part of the brain such as alterations in heart rate and rhythm, lessened levels of energy and alertness, increased sleepiness and tiredness. Again, perhaps this is not the case but it never hurts to get a scan and check it out. If we miss it and it's really there she is at high risk for a fatal stroke.
BTW, I would also get a HIGH RESOLUTION MRI of the IAC (Internal Auditory Canal) with contrast. We are looking for the anatomy of 4 nerves that run through that area (facial, cochlear, superior vestibular, inferior vestibular. I know you said the ENT said "All Clear" but without imaging certainty and with the fact, I believe I would get the MRI in your mother for other reasons this study should be done for completeness. If it's clean then, the ENT guy gets a Flourless Chocolate Cookie from Starbuck's (My daughter's favorite)!
Finally, I believe that if this does turn out to be some type of a headache syndrome (and that's altogether very possible given the story) then, as a headache specialist my "AND THE SURVEY SAID" answer would be something called Migrainous Vertigo as I call it or Vestibular Migraine or Migraine associated Vertigo has the following description. The important thing in the following description that I'd like to focus your attention on is the fact that the headache and the vertigo (or dizziness in this case) typically happen at separate times which makes it very hard for even neurologists to some times to recognize and it is misdiagnosed as all sorts of other things:
http://emedicine.medscape.com/article/884136-overview
I believe this description better fits your mother's case as you've presented it as opposed to anything else.
If you feel this information has answered some more of your questions I'd appreciate your highest marks possible on a STAR RATING and some written feedback-- I only scored a 4/5 on your last consult-- :( -- oh well, whatever the Coach wants is what we do for the team, right?
Also, if you've no further questions or comments your CLOSING THE QUERY will help start the processing of this conversation so that we can archive and credit the answers appropriately for future reference.
I do hope you'll let me know, however, how things go. Don't forget that you can always address me directly on this website at:
http://doctor.healthcaremagic.com/doctors/dr-dariush-saghafi/68474
or search by name (DARIUSH SAGHAFI, MD). I am located in the XXXXXXX OH area of the world (USA- in case you're from outside- GO BROWNS!).
Alternatively, I also give full webcam based consultations (which can be adapted to just audio or texting as well) at: XXXXXX
We can meet by prior arrangements after you've set up an account and signed on or you can also visit me during my normal operating hours on Wed-Sat's 3a-6a (ET- New York City Time) or Sundays 11p-3a. I picked the weird hours so I'd have more time to look up really bad jokes and try them out on unsuspecting patients! LOL!
I wish you and your well and hope to hear from you soon.
This query required 40 min. of physician specific time for review, research, and final draft documentation for envoy.
Jabs and Jolts doesn't fit YOUR description
Detailed Answer:
Hi there again. Thanks for the extra information. At least by your description of your mom's description my interpretation of things is that the predominant and most debilitating of her problem is this overwhelming feeling of "dizziness" as opposed to painful headache attacks or facial pain attacks. It is the dizziness that comes on multiple times daily not headaches. At least that's my interpretation of things. Jabs and Jolts syndrome or Icepick Headaches are predominantly a PAINFUL type of headache that does not typically include as part of its description or symptomatology the sensation of wooziness, dizziness, near fainting, dysequilibrium, rushing sensation of warmth to the head. They are literally JABS and JOLTS to the head and facial region and can happen up to uncountable times per day. Read this description of JABS and JOLTS and see if it fits with what's going on in your mom:
http://www.ncbi.nlm.nih.gov/pubmed/0000
I think some type of pathology in a region of the brain referred to as the Cerebropontine Angle (CPA territory) such as the presence of an Acoustic Neuroma or Schwannoma could be going on. Against that diagnosis would be the fact that I haven't heard more symptoms of true vertigo, tinnitus (ringing in the ears), dysequilibrium and hearing loss. However, perhaps this is an atypical form of it in some respects and therefore, in my opinion we shouldn't miss an opportunity to catch a weird case of it and get her an MRI with contrast (if her kidneys are healthy) of the brain.
I would also throw in an MRA of the head and neck since she could also be demonstrating the effects of lack of good blood flow to the back of the brain region and this is referred to as VERTEBROBASILAR INSUFFICIENCY which can be due to a blockage in one of the arteries traversing up the neck and to the parts of the brain responsible for feelings of nauseousness/vomiting, balance and equilibrium, and which can cause severe headaches. Other strange things can happen when you reduce blood flow to this part of the brain such as alterations in heart rate and rhythm, lessened levels of energy and alertness, increased sleepiness and tiredness. Again, perhaps this is not the case but it never hurts to get a scan and check it out. If we miss it and it's really there she is at high risk for a fatal stroke.
BTW, I would also get a HIGH RESOLUTION MRI of the IAC (Internal Auditory Canal) with contrast. We are looking for the anatomy of 4 nerves that run through that area (facial, cochlear, superior vestibular, inferior vestibular. I know you said the ENT said "All Clear" but without imaging certainty and with the fact, I believe I would get the MRI in your mother for other reasons this study should be done for completeness. If it's clean then, the ENT guy gets a Flourless Chocolate Cookie from Starbuck's (My daughter's favorite)!
Finally, I believe that if this does turn out to be some type of a headache syndrome (and that's altogether very possible given the story) then, as a headache specialist my "AND THE SURVEY SAID" answer would be something called Migrainous Vertigo as I call it or Vestibular Migraine or Migraine associated Vertigo has the following description. The important thing in the following description that I'd like to focus your attention on is the fact that the headache and the vertigo (or dizziness in this case) typically happen at separate times which makes it very hard for even neurologists to some times to recognize and it is misdiagnosed as all sorts of other things:
http://emedicine.medscape.com/article/884136-overview
I believe this description better fits your mother's case as you've presented it as opposed to anything else.
If you feel this information has answered some more of your questions I'd appreciate your highest marks possible on a STAR RATING and some written feedback-- I only scored a 4/5 on your last consult-- :( -- oh well, whatever the Coach wants is what we do for the team, right?
Also, if you've no further questions or comments your CLOSING THE QUERY will help start the processing of this conversation so that we can archive and credit the answers appropriately for future reference.
I do hope you'll let me know, however, how things go. Don't forget that you can always address me directly on this website at:
http://doctor.healthcaremagic.com/doctors/dr-dariush-saghafi/68474
or search by name (DARIUSH SAGHAFI, MD). I am located in the XXXXXXX OH area of the world (USA- in case you're from outside- GO BROWNS!).
Alternatively, I also give full webcam based consultations (which can be adapted to just audio or texting as well) at: XXXXXX
We can meet by prior arrangements after you've set up an account and signed on or you can also visit me during my normal operating hours on Wed-Sat's 3a-6a (ET- New York City Time) or Sundays 11p-3a. I picked the weird hours so I'd have more time to look up really bad jokes and try them out on unsuspecting patients! LOL!
I wish you and your well and hope to hear from you soon.
This query required 40 min. of physician specific time for review, research, and final draft documentation for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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