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General Health Conditions & Rare Disorders Discussions about general health conditions and undiagnosed conditions, including any disorders that may not be separately listed below. |
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08-13-2016, 07:58 PM | #1 | ||
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Back on 7 Dec, 2013 I woke up to find that I could not maintain my balance. I was not dizzy and had no vertigo. The day before I was perfectly fine. I've had two VNG (Videonystagmography) tests. The results of the first one showed
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Test results indicate abnormal tracking and fixation suppression which suggests a central lesion. Fixation suppression and tracking mechanisms share central pathways. Additionally significant down beating vertical nystagmus was noted in the head hanging position which is also indicative of a central lesion Code:
1. VNG Results- -Failure of fixation suppression indicates a central finding, often involving the cerebellar flocculus or the surrounding structures -Essentially normal oculomotor findings. 2. vHIT- testing indicated essentially normal results. The reduced gain in the LARP condition is likely a result of the limited range of motion and should be interpreted carefully. The Dizziness Handicap Inventory (DHI) was administered and indicated a severe (54+) handicap due to Veteran's dizziness. Functional: 22 (out of 36) Emotional: 14 (out of 36) Physical: 20 (out of 28) Total: 56 (out of 100) Another issue I have is where my legs will shake uncontrollably when I'm sitting in my recliner with the footrest up or especially at night when in bed trying to go to sleep. This has been going on for a couple of months and seems to be getting worse as time goes on. This starts happening either when I 1)flex the toes of either foot downwards a little bit or 2)bend either leg outwards from my groin. The flexing of the toes seems to make it worse. For instance last night it went on for a good 10+ minutes it seemed like with my left leg. I don't have an appointment with my VA Neurologist until Sept 8th to discuss the EEG results but I have contacted him and sent him a video I made of this happening. His only remarks were Code:
Thank you for the video. I cannot identify the nature of the shaking which moves from one leg to the other. It is no consistent with restless leg syndrome or seizure activity as I kn andow them Code:
11 May, 2015 Impression: 1. Multilevel cervical spondylosis. There may be a left foraminal disc protrusion at C4/C5. Consider MRI or CT myelography for further evaluation, as indicated. 2. Nonvisualization of the left lobe of the thyroid, possibly absent. Tiny hypodensities in the right lobe could be further evaluated by ultrasound. Primary Diagnostic Code: SIGNIFICANT ABNORMALITY, ATTN NEEDED Code:
FINDINGS: The ventricles are normal in size, shape and position without midline shift or mass effect. There is a small focus of lucency in the periventricular white matter on the left adjacent to the frontal horn of the lateral ventricle consistent with chronic ischemic change. There are no areas of acute hemorrhage and no mass lesions are identified. The visualized paranasal sinuses are clear with exception of a small mucous retention cyst in the sphenoid sinus on the right. The mild deformity of the skull table with relative flattening in the right parietal region is stable and probably developmental. Code:
PT has been seen for total of 11 visits for vestibular training and CDP testing on Neurocom. (age 65, ht 5'11".) Testing procedures reviewed pt and pt agreeable to testing. HArness applied and pt secured in machine. UNderwent 4 tests with the following results-- 1) Limits of Stability: tests ability of pt to move safely/quickly/smoothly through full limits of stability. abnormal findings-- (a) pt continues to demonstrates inability to reach set targets of this test in single, linear movements as well as reduced endpoint excursions (EPE) improvement-- pt's reaction time and movement velocity now within the norm for age 2) Adaptation test: objectively quantifies pt's ability to adapt or develop a balance response to varying support surfaces. abnormal findings-- (a) still has difficulty generating required force initially to overcome the induced postural instability posteriorly thus subsequently lost his balance with first trial. improvement-- in subsequent trials, pt was better able to consistently demosntrate ability to adapt to surface change. SUbsequent trials show slight improvement from initial testing results of 6-30-14. 3) Rhythmic weight shift: quantifies pt's ability to vary movement speeds while maintaining coordinated motor control. abnormal findings-- (a) pt demonstrated lack of coordination and control of movement(DCL) toward FORWARD position; but directional control(DCL) was within normal limits for LEFT/RIGHT. improvement-- demosntrated improvement in average speed of movement in BOTH directions to be within normal limits for age/ht. 4) Sensory organization test (SOT): isolates/quantifies abnormalities in pt's ability to make effective use of (or suppress inapproriate) input from three sensory systems that contribute to postural control as well as brain's central integration of these inputs- somatosensory/proprioceptive(SOM), visual(VIS), vestibular(VEST). abnormal findings-- (a) SOM score (condition 1&2) reflects NO CHANGE pt's inability to use cues from the somatosensory system to maintain balance- this is likley related to foot surgery pt underwent July 2013 from which he has continued to have numbness in (L)foot. (b) VEST score(condition 1&5) reflects NO CHANGE pt's inability to use cues from vestibular system to maintain balance. Pt again lost balance with every trial of condition #5. (c) pts composite score of all 6 conditions is 13 points below normative performance range (68). This is 4 points higher than previous test. (d) pt lost balance on all but one trial of conditions 2, 5, and 6 which are conditions dependent on somatosensory and vestibular systems. THese results are UNCHANGED from previous test. (e) COG position demostrates pt's tendency toward standing slightly posterior and to right side to center of base of support(again likley explained by issues with surgery/resultant numbness left foot) - UNCHANGED from previous test. (f) strategy analysis demonstrates ankle stretegy ONLY, hip strategy ONLY used when starting to step to avoid fall - UNCHANGED from previous test. PROGRESS TOWARD GOALS OF PHYSICAL THERAPY-- (1) will demonstrate improved ability by 10-15% improvement in ability to reach targets in the LEFT/FRONT quadrant - not met (2) independent with home program that encourages wieght shift/limits of stability into LEFT/FRONT quadrant - MET (3)demosntrate working knowledge of safety issues with gait on outside uneven surfaces/terrain - MET Patient Plan/Comments: Essentially results of pre and post-CDP reveal NO CHANGE in pt's ability to maintain balance after 10 weeks of vestibular retraining. Will discontinue PT at this time however pt encouraged to continue use of cane when walking in community and to continue home program. Code:
ASSESSMENT: Dysequilibrium problem is likely of central origin. I strongly doubt an inner ear issue, with normal hearing and the videonystagmography (VNG) pointing towards a central lesion. I really have no further suggestions at the present time. Code:
Be advised that damage to the organ of balance is the most common cause of imbalance. stroke MAY have such a symptom but is the rare, unusual, atypical cause for imbalance. but, as they say , it is possible it could relate to a stroke so small that it cannot be seen on CT scanning but this is unusual, and a stroke so small you cannot see it should have correspondingly minimal symptoms, which is not your case. I'm constantly trying to find answers to this and wondering if anyone else has experienced something like this? Chris Last edited by chris1948; 08-14-2016 at 09:52 AM. Reason: Add more information |
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08-14-2016, 12:37 AM | #2 | |||
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It might help if you include as much information as possible in a single thread like this one, for best replies. Just easier early on when all info is in one place..
You can copy/paste your info from your posts on New Members if you would like to.
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"Thanks for this!" says: | chris1948 (08-14-2016) |
08-14-2016, 08:44 AM | #3 | ||
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Thanks, I'll do that. Appreciate the help
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08-14-2016, 08:30 PM | #4 | |||
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I can tell you from personal experience that VNGs are not always accurate. I have facial neuropathy in my trigeminal nerve chain that stretches from my throat to eye....and also in my ear. At the peak of my symptoms, I lost my hearing, experienced hyperacusis, and had loud ringing in my ear for over a year. My appointment with the ENT happened almost a year after my symptoms started. My VNG didn't show anything and I was told that my disequilibrium was of a central origin. This is a bunch of nonsense. I'm not even sure why I wasted hundreds of dollars on this appointment.
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"Thanks for this!" says: | chris1948 (08-14-2016) |
08-14-2016, 08:49 PM | #5 | ||
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I really don't have much faith in my VA Neurologist even after seeing him for over 2 1/2yrs. I recently asked my Primary Care doctor at the VA what I need to do to get a 2nd opinion, she has no idea. Maybe when I have my EEG on the 23rd something will show up since I have so many other seemingly neurological issues.
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