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What Causes Dizziness And Metallic Taste In The Mouth Of An Elderly Patient?
Question: My 60 yr old mother here has a history of Hereditary Coproporphyria, scoliosis back, Ménière's disease, cough variant asthma, Tourette's syndrome, anxiety disorder and is white female 5 foot 6 inches tall and 220 pounds in weight.
Her symptoms are a wave of lightheadedness or slight dizziness followed by a metallic taste on the right side of tongue only several times per hour for weeks. It went away for two weeks then came back. It's been ongoing for months now. She has had EKG for 24 hour Holter, EEG, CT head scan, echo done, carotid done, tons of blood tests done and Mayo Clinic cannot figure it out.
The only slight odd thing was the audio test showed a very slight possibility of retrocochlear. What do you think is causing this as a diagnosis (and testing needed) and what would be the treatment plan?
Her symptoms are a wave of lightheadedness or slight dizziness followed by a metallic taste on the right side of tongue only several times per hour for weeks. It went away for two weeks then came back. It's been ongoing for months now. She has had EKG for 24 hour Holter, EEG, CT head scan, echo done, carotid done, tons of blood tests done and Mayo Clinic cannot figure it out.
The only slight odd thing was the audio test showed a very slight possibility of retrocochlear. What do you think is causing this as a diagnosis (and testing needed) and what would be the treatment plan?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Mayo Clinic is one of the best clinics not only in the US but also in the world, so obviously it is not an easy case. It might have been useful to know what were the blood tests which were done, however I am going to assume that they have been thorough in excluding metabolic alterations, nutritional deficiencies and toxins.
I am a little surprised that they did only a CT scan and not a MRI which can detect more subtle changes. So in terms of tests I would add only a MRI to the mentioned ones.
Based on that information one possible explanation for those episodes remain that of seizures. I know that EEG showed nothing, but that doesn't exclude epileptic seizures, outside of the moment of the seizure it can detect changes only in slightly over half percent of the patients. So since the rest seem to have been excluded I would still have a trial of antiepileptic medication.
The other possibility would be the episodes being of a psychological nature. It wouldn't be a typical manifestation those taste changes that must be said, but anxiety can mimic any neurological symptom, so when all tests result as normal it is included in the differential diagnosis.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Mayo Clinic is one of the best clinics not only in the US but also in the world, so obviously it is not an easy case. It might have been useful to know what were the blood tests which were done, however I am going to assume that they have been thorough in excluding metabolic alterations, nutritional deficiencies and toxins.
I am a little surprised that they did only a CT scan and not a MRI which can detect more subtle changes. So in terms of tests I would add only a MRI to the mentioned ones.
Based on that information one possible explanation for those episodes remain that of seizures. I know that EEG showed nothing, but that doesn't exclude epileptic seizures, outside of the moment of the seizure it can detect changes only in slightly over half percent of the patients. So since the rest seem to have been excluded I would still have a trial of antiepileptic medication.
The other possibility would be the episodes being of a psychological nature. It wouldn't be a typical manifestation those taste changes that must be said, but anxiety can mimic any neurological symptom, so when all tests result as normal it is included in the differential diagnosis.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
As you suggested I think that clinic should expand the blood testing to cover more. I agree an MRI would be a good idea. During the EEG those symptoms were present and showed nothing.
Would the scoliosis pinch a nerve or something painlessly hence causing this? Would a scoliosis series of xrays be a good idea to check on that?
Is the retrocholear possibility w/meniears disease or the porphyria a possible factor? Sometimes it gets triggered when moving or sucking a drink with a straw. But ears do not usually trigger a metallic taste on one side of the tongue, right? And for focal seizures to start it would seem to have a triggering cause? What diseases or imbalances needs to be ruled out from a neurologist point of view if it was your patient....exactly what battery of tests would you order to screen for what specificall?y
Would the scoliosis pinch a nerve or something painlessly hence causing this? Would a scoliosis series of xrays be a good idea to check on that?
Is the retrocholear possibility w/meniears disease or the porphyria a possible factor? Sometimes it gets triggered when moving or sucking a drink with a straw. But ears do not usually trigger a metallic taste on one side of the tongue, right? And for focal seizures to start it would seem to have a triggering cause? What diseases or imbalances needs to be ruled out from a neurologist point of view if it was your patient....exactly what battery of tests would you order to screen for what specificall?y
Brief Answer:
Read below.
Detailed Answer:
Scoliosis is not the cause of those symptoms, it is in no way anatomically related to the metallic taste. Any compression it could cause to the spinal cord or the nerve roots it would cause symptoms from that levels downwards, not upwards, that is how the nervous system is organised. So no tests are needed on that regard.
Meniere's disease is not that likely, it has a well described sensation of vertigo as well as tinnitus and hearing loss, not classically with these taste changes you describe. Porphyria can damage peripheral nerves but usually starts in the limbs and not the cranial nerves and not this isolated as in this case, so do not think it's the culprit either.
As for the possibility of ear issues being related to taste, that is actually real. That is because the branch of the facial nerve containing the taste runs along the middle ear and then with the facial nerve in the auditory canal. So tumors, inflammation, infection etc of the region can cause such symptom. That is why I think a MRI to be necessary.
As for the focal seizures having a cause that is generally true. However it can not be excluded by CT alone, subtle stuff need MRI to be captured.
So regarding the tests to be ordered it remains the MRI. Before I thought that perhaps there was some reason it was not performed (claustrophobia, metallic objects in the body) so didn't insist on it, but since you do not mention any I really think it to be the one necessary test.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Scoliosis is not the cause of those symptoms, it is in no way anatomically related to the metallic taste. Any compression it could cause to the spinal cord or the nerve roots it would cause symptoms from that levels downwards, not upwards, that is how the nervous system is organised. So no tests are needed on that regard.
Meniere's disease is not that likely, it has a well described sensation of vertigo as well as tinnitus and hearing loss, not classically with these taste changes you describe. Porphyria can damage peripheral nerves but usually starts in the limbs and not the cranial nerves and not this isolated as in this case, so do not think it's the culprit either.
As for the possibility of ear issues being related to taste, that is actually real. That is because the branch of the facial nerve containing the taste runs along the middle ear and then with the facial nerve in the auditory canal. So tumors, inflammation, infection etc of the region can cause such symptom. That is why I think a MRI to be necessary.
As for the focal seizures having a cause that is generally true. However it can not be excluded by CT alone, subtle stuff need MRI to be captured.
So regarding the tests to be ordered it remains the MRI. Before I thought that perhaps there was some reason it was not performed (claustrophobia, metallic objects in the body) so didn't insist on it, but since you do not mention any I really think it to be the one necessary test.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes we do have bad claustophobia but here they have upright OPEN MRI available in most major cities for those with claustophobia here. So, would it be an MRI brain and MRI ears and MRI sinus or what?
Also you mentioned metabolic, vitamins etc but all were nornal including the thyroid so are there any other blood tests or ear testing you would do? If so please list.
If the right side of tongue gets the bad taste would it be a left ear and left brain or right causing it? Is it a symptom of Multiple Sclerosis or any neuro brain disorder? If no, why not? If yes, why?
Why would the ENT say its a neuro problem when there is a history of menears disease( I had to spell it wrong so you would not get the odd symbols with the correct spelling) ....any ideas?
An antihistimine did not get rid of it and even stopping all medications and the very few vitamins did not make it stop.
Please advise as per the inquiries above.
Thank you!
Also you mentioned metabolic, vitamins etc but all were nornal including the thyroid so are there any other blood tests or ear testing you would do? If so please list.
If the right side of tongue gets the bad taste would it be a left ear and left brain or right causing it? Is it a symptom of Multiple Sclerosis or any neuro brain disorder? If no, why not? If yes, why?
Why would the ENT say its a neuro problem when there is a history of menears disease( I had to spell it wrong so you would not get the odd symbols with the correct spelling) ....any ideas?
An antihistimine did not get rid of it and even stopping all medications and the very few vitamins did not make it stop.
Please advise as per the inquiries above.
Thank you!
Brief Answer:
Read below.
Detailed Answer:
The MRI of the head is done on one exam, it contains many sequences among which sequences which afford a better view of the ear and tympanic bone along with those for the brain. I wouldn't ask other tests for the moment.
As for the location, if a peripheral nerve issue, such as compression of the taste nerve fibers and cochlear nerve, then it would be on the same side as the symptoms.
On the other hand in case of a seizure then the origin is in the brain and it would be on the opposite side.
I am not sure what do you mean by "ENT saying it's a neuro problem when there is a history of meniere's disease"....I didn't say it was meniere, on the contrary I said it was unlikely. And for the moment I am suggesting it could be a neuro problem, so kind of saying the same thing as the ENT.
I imagine the antihistamine and vitamins not making it stop, if there was no allergy or vitamin deficiency on testing why should they. As I said before, if I was to try something for the symptoms if the MRI results normal, I would try gabapentin as it works both for seizures as well as peripheral nerve damage sensitive symptoms.
I hope to have been of help.
Read below.
Detailed Answer:
The MRI of the head is done on one exam, it contains many sequences among which sequences which afford a better view of the ear and tympanic bone along with those for the brain. I wouldn't ask other tests for the moment.
As for the location, if a peripheral nerve issue, such as compression of the taste nerve fibers and cochlear nerve, then it would be on the same side as the symptoms.
On the other hand in case of a seizure then the origin is in the brain and it would be on the opposite side.
I am not sure what do you mean by "ENT saying it's a neuro problem when there is a history of meniere's disease"....I didn't say it was meniere, on the contrary I said it was unlikely. And for the moment I am suggesting it could be a neuro problem, so kind of saying the same thing as the ENT.
I imagine the antihistamine and vitamins not making it stop, if there was no allergy or vitamin deficiency on testing why should they. As I said before, if I was to try something for the symptoms if the MRI results normal, I would try gabapentin as it works both for seizures as well as peripheral nerve damage sensitive symptoms.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Taka, please know I have received more medical insights and articulated explanations from you on our issues than what we have gotten from major famous clinics! Dr. Taka, your expertise and caring to help was refreshing and amazing! Thank you!
If you have any additional insights for us to end with, please share in a response to this note.
If you have any additional insights for us to end with, please share in a response to this note.
Brief Answer:
Read below.
Detailed Answer:
Thank you for your kind words. In terms of diagnosis I do not have something else to suggest. I can only say that while I understand not having a clear explanation may be frustrating at times, you should try to look the glass half full and be relieved that the CT or other results have shown nothing serious.
Wishing you good health.
Read below.
Detailed Answer:
Thank you for your kind words. In terms of diagnosis I do not have something else to suggest. I can only say that while I understand not having a clear explanation may be frustrating at times, you should try to look the glass half full and be relieved that the CT or other results have shown nothing serious.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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