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What Causes Persistent Unsteadiness, Eye Fatigue, Neck Pain And Leg Weakness?
Question: Hello,
I have a feeling of imbalance and unsteadiness when I am walking. Worse when I move my eye balls to the extreme left or right positions or even if I rotate my head to the left or the right.
It started about 7 weeks back and very first symptom I noticed was severe eye strain and eye fatigue after an evening walk. When this continued for a couple of days along with a sensation of unsteadiness while walking, I then approached an eye centre who did a check up and told me that my eyes were fine and that this is most likely an inner ear issue.
Unsteadiness - I realize its important to clarify what I mean by this. Its not a spinning sensation. but a sensation where my head, neck and eyes seem to be having a difficult time in providing me with a "balanced" view when I am walking and looking around. The first ENT doctor I visted suspected labrynthitis and put me on Stemitil which did not help and just made me feel drowsy. Stugeron made things worse for me after just 2 days and I stopped it. Vertin and other beta histamines did not help though I did not persist for them for more than 3 days
I was then advised to get an MRI done for the brain and the cervical spine. Both were reported to be fine with no relevant findings or issues.
One neurologist told me that this could be due to the neurotransmitter levels of norepinephrine and prescribed an antidepressant which I have not started the course for.
Another neurologist did an ENG test and a number of tests involving walking with one foot in front of the other etc and a few other tests and then told me that he did not think I have any disease that is getting progressively worse and that he would consider this an inner ear issue and that I should wait it out.
Also, I've been grappling with neck pain, stiff neck and shoulders and related eye strain for more than 3 years. Suspecting that this may be causing some of these symptoms of imbalance and unsteadiness, I went for 5 accupressure sessions which did not help to a noticeable extent. I approached another ENT doctor yesterday (i.e. 7 weeks later) who said he did not think I have inner ear issues and he concluded that I have anxiety.
Needless to say, this prolonged episode is causing me quite a bit of anxiety but I do not think that the anxiety caused these symptoms.
My thyroid levels are normal (though I am on thyroid medication - Thyronorm). Sugar levels are normal. Cholestorol is a little higher than borderline.
Current symptoms - the unsteadiness usually starts in the mornings once I start walking around. I also have eye strain and a stiff neck (occassionally). My legs muscles feel weak and tired most of time now.
Vision - I have both short sight and long sight glasses - one for normal wear and other for reading and working with computers etc. The back of my eye balls feel scratchy and if I blink rapidly my eyes become watery and strained. Things are better when I take off my glasses even while walking though I can't walk far without them and hence this is not an option. Eyes are very sensitive to bright lights.
I have been on an SSRI for the last 9 years Escitalopram 10mg a day. My psychiatrist does not think this is a side effect of the medication.
I am stumped as to what is going on with me and I haven't found anyone who can give me a diagnosis that makes sense to me.
I forgot to mention 2 things
1. I have tinnitus in my left ear. But I think I've always had tinnitus but may be its a little worse recently.
2. When I move my eye balls to the peripheries, i occassionally get a "shock" kind of sensation originating from the back of my eyes
My Vitamin B12 and D levels have also been checked and found to be within the optimal ranges
I have a feeling of imbalance and unsteadiness when I am walking. Worse when I move my eye balls to the extreme left or right positions or even if I rotate my head to the left or the right.
It started about 7 weeks back and very first symptom I noticed was severe eye strain and eye fatigue after an evening walk. When this continued for a couple of days along with a sensation of unsteadiness while walking, I then approached an eye centre who did a check up and told me that my eyes were fine and that this is most likely an inner ear issue.
Unsteadiness - I realize its important to clarify what I mean by this. Its not a spinning sensation. but a sensation where my head, neck and eyes seem to be having a difficult time in providing me with a "balanced" view when I am walking and looking around. The first ENT doctor I visted suspected labrynthitis and put me on Stemitil which did not help and just made me feel drowsy. Stugeron made things worse for me after just 2 days and I stopped it. Vertin and other beta histamines did not help though I did not persist for them for more than 3 days
I was then advised to get an MRI done for the brain and the cervical spine. Both were reported to be fine with no relevant findings or issues.
One neurologist told me that this could be due to the neurotransmitter levels of norepinephrine and prescribed an antidepressant which I have not started the course for.
Another neurologist did an ENG test and a number of tests involving walking with one foot in front of the other etc and a few other tests and then told me that he did not think I have any disease that is getting progressively worse and that he would consider this an inner ear issue and that I should wait it out.
Also, I've been grappling with neck pain, stiff neck and shoulders and related eye strain for more than 3 years. Suspecting that this may be causing some of these symptoms of imbalance and unsteadiness, I went for 5 accupressure sessions which did not help to a noticeable extent. I approached another ENT doctor yesterday (i.e. 7 weeks later) who said he did not think I have inner ear issues and he concluded that I have anxiety.
Needless to say, this prolonged episode is causing me quite a bit of anxiety but I do not think that the anxiety caused these symptoms.
My thyroid levels are normal (though I am on thyroid medication - Thyronorm). Sugar levels are normal. Cholestorol is a little higher than borderline.
Current symptoms - the unsteadiness usually starts in the mornings once I start walking around. I also have eye strain and a stiff neck (occassionally). My legs muscles feel weak and tired most of time now.
Vision - I have both short sight and long sight glasses - one for normal wear and other for reading and working with computers etc. The back of my eye balls feel scratchy and if I blink rapidly my eyes become watery and strained. Things are better when I take off my glasses even while walking though I can't walk far without them and hence this is not an option. Eyes are very sensitive to bright lights.
I have been on an SSRI for the last 9 years Escitalopram 10mg a day. My psychiatrist does not think this is a side effect of the medication.
I am stumped as to what is going on with me and I haven't found anyone who can give me a diagnosis that makes sense to me.
I forgot to mention 2 things
1. I have tinnitus in my left ear. But I think I've always had tinnitus but may be its a little worse recently.
2. When I move my eye balls to the peripheries, i occassionally get a "shock" kind of sensation originating from the back of my eyes
My Vitamin B12 and D levels have also been checked and found to be within the optimal ranges
Brief Answer:
seems to be electrolyte imbalance.
Detailed Answer:
Hi,
I had gone through your question and understand your concerns that you are having unsteadiness. I would like to ask you few more details.
Is there any head-ache or any episodes of loosing conciousness ?
Are you on any medications (hypertension or cardiac medications) ?
Kindly get back to me with the details.
Based on your clinical details, it appears to be electrolyte imbance or neck vessels compressions (unsteadiness during movements of head and eye symptoms).
I suggest you to do following investigations to rule out the cause.
1. Complete blood picture with peripheral smear (to see the status of blood parameters), serum electrolytes (sodium, potassinum and chloride) and color doppler of neck vessels ( to see any aneurysms or blocks).
2. (My legs muscles feel weak and tired most of time now). This could be due to hypokelemia secondary to inadequate intake or insensible loss( bp medications).
3. Kindly discuss with your treating physician about your medications history and investigations before doing these tests.
Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.
Wishing you good health.
seems to be electrolyte imbalance.
Detailed Answer:
Hi,
I had gone through your question and understand your concerns that you are having unsteadiness. I would like to ask you few more details.
Is there any head-ache or any episodes of loosing conciousness ?
Are you on any medications (hypertension or cardiac medications) ?
Kindly get back to me with the details.
Based on your clinical details, it appears to be electrolyte imbance or neck vessels compressions (unsteadiness during movements of head and eye symptoms).
I suggest you to do following investigations to rule out the cause.
1. Complete blood picture with peripheral smear (to see the status of blood parameters), serum electrolytes (sodium, potassinum and chloride) and color doppler of neck vessels ( to see any aneurysms or blocks).
2. (My legs muscles feel weak and tired most of time now). This could be due to hypokelemia secondary to inadequate intake or insensible loss( bp medications).
3. Kindly discuss with your treating physician about your medications history and investigations before doing these tests.
Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Prasad
Hi,
Thanks for your review and advice. In response to your 2 queries.
Is there any head-ache or any episodes of loosing conciousness ?
Answer> No headaches other than neck pain and stiff neck and eye strain
Are you on any medications (hypertension or cardiac medications) ?
Answer > Not taking any BP or cardiac medications. My BP is normal 120/80 - 130/80
By the way I am Male and of age 48
Thanks for your review and advice. In response to your 2 queries.
Is there any head-ache or any episodes of loosing conciousness ?
Answer> No headaches other than neck pain and stiff neck and eye strain
Are you on any medications (hypertension or cardiac medications) ?
Answer > Not taking any BP or cardiac medications. My BP is normal 120/80 - 130/80
By the way I am Male and of age 48
Brief Answer:
blood tests & doppler studies.
Detailed Answer:
Hello again,
Thanks for considering my answer and for your follow up.
Another possibilty is neuralgia (greater occipital nerve or Posterior occipital neuralgia) which involves both neck and eye. Anyway, Kindly go ahead above mentioned investigations to know the exact cause.
In the meantime, maintain good posture when reading, working, or doing other activities, Exercise the neck and shoulders frequently when working on computers, or doing other close work, Get plenty of sleep and rest and Massaging sore muscles may also help.
All the best. Take care.
blood tests & doppler studies.
Detailed Answer:
Hello again,
Thanks for considering my answer and for your follow up.
Another possibilty is neuralgia (greater occipital nerve or Posterior occipital neuralgia) which involves both neck and eye. Anyway, Kindly go ahead above mentioned investigations to know the exact cause.
In the meantime, maintain good posture when reading, working, or doing other activities, Exercise the neck and shoulders frequently when working on computers, or doing other close work, Get plenty of sleep and rest and Massaging sore muscles may also help.
All the best. Take care.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Hello,
I have done the blood tests that you recommended. Please find the results below.
I will need to schedule to find a centre that does the Doppler test and schedule it. Will this discussion remain open? If any additional payments are required to continue this consultation to a conclusion, please advise and I shall do the needful.
Also, please advise if there are any neuralgia related tests that can be done simultaneously
---------------------------------------------------------------------------
BIO CHEMISTRY
---------------------------------------------------------------------------
TESTS RESULTS NORMAL RANGE
----- ------- ------------
SODIUM : 137 mmol/L ( 133 - 146 )
POTASSIUM : 4.23 mmol/L ( 3.5 - 5.2 )
CHLORIDE : 98 mmol/I ( 96 - 106 )
BICARBONATE : 29 mmol/I ( 24 - 31 )
---------------------------------------------------------------------------
PERIPHERAL SMEAR STUDY
---------------------------------------------------------------------------
RBC SERIES : SHOWS NORMOCYTIC NORMOCHROMIC PICTURE
WBC SERIES : IS WITHIN NORMAL LIMITS
DIFF COUNT
NEUTROPHILS : 56 %
LYMPHOCYTES : 37 %
MONOCYTES : 02 %
EOSINOPHILS : 05 %
PLATELETS : ARE ADEQUATE IN NUMBER
: NO HAEMOPARASITES OR ABNORMALITY
: DETECTED
IMPRESSION : NO SIGNIFICANT OF HAEMATOLOGICAL
ABNORMALITY DETECTED
---------------------------------------------------------------------------
I have done the blood tests that you recommended. Please find the results below.
I will need to schedule to find a centre that does the Doppler test and schedule it. Will this discussion remain open? If any additional payments are required to continue this consultation to a conclusion, please advise and I shall do the needful.
Also, please advise if there are any neuralgia related tests that can be done simultaneously
---------------------------------------------------------------------------
BIO CHEMISTRY
---------------------------------------------------------------------------
TESTS RESULTS NORMAL RANGE
----- ------- ------------
SODIUM : 137 mmol/L ( 133 - 146 )
POTASSIUM : 4.23 mmol/L ( 3.5 - 5.2 )
CHLORIDE : 98 mmol/I ( 96 - 106 )
BICARBONATE : 29 mmol/I ( 24 - 31 )
---------------------------------------------------------------------------
PERIPHERAL SMEAR STUDY
---------------------------------------------------------------------------
RBC SERIES : SHOWS NORMOCYTIC NORMOCHROMIC PICTURE
WBC SERIES : IS WITHIN NORMAL LIMITS
DIFF COUNT
NEUTROPHILS : 56 %
LYMPHOCYTES : 37 %
MONOCYTES : 02 %
EOSINOPHILS : 05 %
PLATELETS : ARE ADEQUATE IN NUMBER
: NO HAEMOPARASITES OR ABNORMALITY
: DETECTED
IMPRESSION : NO SIGNIFICANT OF HAEMATOLOGICAL
ABNORMALITY DETECTED
---------------------------------------------------------------------------
Brief Answer:
top up
Detailed Answer:
Hello again,
Answers for your queries.
1. Your investigations reports are absolutely normal.
2. There are no specific tests for neuralgia, but the following tests may be done to find the cause of the pain. a). Nerve conduction study with electromyography b). lumber puncture.
3. I think, with this answer, this discussion will be closed. You can always top-up to ask another question.
Take care.
top up
Detailed Answer:
Hello again,
Answers for your queries.
1. Your investigations reports are absolutely normal.
2. There are no specific tests for neuralgia, but the following tests may be done to find the cause of the pain. a). Nerve conduction study with electromyography b). lumber puncture.
3. I think, with this answer, this discussion will be closed. You can always top-up to ask another question.
Take care.
Above answer was peer-reviewed by :
Dr. Yogesh D
Hi
Top up done
Doppler ultrasound of neck vessels done and nothing unusual or relevant found
What is the diagnosis for my issue?
Top up done
Doppler ultrasound of neck vessels done and nothing unusual or relevant found
What is the diagnosis for my issue?
Brief Answer:
stress induced.
Detailed Answer:
Hello again, Welcome back to HCM
From all the investigations and tests, everything seems to be normal (no organic dysfunction). Your problem looks more so like stress/anxiety neurosis/disorder.
Please try to change your life style, de-stress yourself and recreate yourself in the best possible ways.
Wishing for your speedy recovery by god's grace.
All the best. Take care.
stress induced.
Detailed Answer:
Hello again, Welcome back to HCM
From all the investigations and tests, everything seems to be normal (no organic dysfunction). Your problem looks more so like stress/anxiety neurosis/disorder.
Please try to change your life style, de-stress yourself and recreate yourself in the best possible ways.
Wishing for your speedy recovery by god's grace.
All the best. Take care.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Hello Doctor -
Thanks for your continued guidance and advice.
Could you please advise me if this issue of unsteadiness/imbalance is likely to be a prolonged episode of a vestibular dysfunction? As my tinnitus is still present all the time.
Is it possible for vestibular labrynthitis to take more than 2 months to resolve?
As this is impeding my smooth daily functioning, I am trying to decide if the presence of tinnitus along with balance issues would mean that I should continue to seek treatment from my ENT doctor or if I should visit a psychiatrist for further treatment .
Thanks
Thanks for your continued guidance and advice.
Could you please advise me if this issue of unsteadiness/imbalance is likely to be a prolonged episode of a vestibular dysfunction? As my tinnitus is still present all the time.
Is it possible for vestibular labrynthitis to take more than 2 months to resolve?
As this is impeding my smooth daily functioning, I am trying to decide if the presence of tinnitus along with balance issues would mean that I should continue to seek treatment from my ENT doctor or if I should visit a psychiatrist for further treatment .
Thanks
Brief Answer:
needs vestibular rehabilitation. exercises.
Detailed Answer:
Hello again,
Answers and solutions for your queries.
1. Yes. Prolonged symptoms seen in chronic phase of vestibular dysfunction. If symptoms of dizziness or imbalance are chronic and persist for several months, vestibular rehabilitation exercises (a form of physical therapy) may be suggested in order to evaluate and retrain the brain’s ability to adjust to the vestibular imbalance. Usually, the brain can adapt to the altered signals resulting from labyrinthitis or neuritis in a process known as compensation. Vestibular rehabilitation exercises facilitate this compensation.
2. Yes. vestibular labrynthitis, takes more time to resolve. The exercises may provide relief immediately, but a noticeable difference may not occur for several weeks. Many people find they must continue the exercises for years in order to maintain optimum inner ear function, while others can stop doing the exercises altogether without experiencing any further problems. A key component of successful adaptation is a dedicated effort to keep moving, despite the symptoms of dizziness and imbalance. Sitting or lying with the head still, while more comfortable, can prolong or even prevent the process of adaptation.
3. Related to exercises, you need regular follow ups from an ent surgeon.
All the best.
needs vestibular rehabilitation. exercises.
Detailed Answer:
Hello again,
Answers and solutions for your queries.
1. Yes. Prolonged symptoms seen in chronic phase of vestibular dysfunction. If symptoms of dizziness or imbalance are chronic and persist for several months, vestibular rehabilitation exercises (a form of physical therapy) may be suggested in order to evaluate and retrain the brain’s ability to adjust to the vestibular imbalance. Usually, the brain can adapt to the altered signals resulting from labyrinthitis or neuritis in a process known as compensation. Vestibular rehabilitation exercises facilitate this compensation.
2. Yes. vestibular labrynthitis, takes more time to resolve. The exercises may provide relief immediately, but a noticeable difference may not occur for several weeks. Many people find they must continue the exercises for years in order to maintain optimum inner ear function, while others can stop doing the exercises altogether without experiencing any further problems. A key component of successful adaptation is a dedicated effort to keep moving, despite the symptoms of dizziness and imbalance. Sitting or lying with the head still, while more comfortable, can prolong or even prevent the process of adaptation.
3. Related to exercises, you need regular follow ups from an ent surgeon.
All the best.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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