Balance Problems

[Ellbell]

Hi,
I have had low back and hip pain since I was a child (over 40 years now). To make a long story short, I ended up at a chiropractor who did wonders for me and kept me going for many, many years. It turned out that I had a curvature, several bulging discs, several compressed ones, plus a few other little goodies. All the result, of what they referred to as, a "congenital anomaly".
Anyway, about 10 or 12 years ago, I started having what I thought were dizzy spells while I was walking. The funny thing about it was that I felt a dizzy/tingling sensation in my head and in my shins at the same time. It only lasted a few seconds at a time and I always had the feeling that it was related to my back problems so I never pursued it.
Two years ago my low back and hip pain got much worse and so did the dizzy spells. The chiropractor wasn't really helping anymore and I had to quit my job (in a bank) because I just couldn't endure the pain and do my job at the same time. My neurologist did a couple of  MRIs (of my spine - for the pain and my brain - for the dizzy spells). He said that I have numerous "crushed" dics and fractures in the surrounding vertebrae which are putting pressure on my nerve roots. My brain MR. came out normal so now I am scheduled to have an evoked potentials test to see if there is nerve damage that is interfering with the nerve impulses between my brain and my legs. He thinks that my dizzy spells are in actuality a balance problem, possibly from the sensation loss that I have in my legs. Does this sound like a possibility?

[Ephraim]

Thanks for your question.  I have suffered from a similar phenomena for the past two years.  The Doctor's answer was very helpful.  I also suggest you try to learn the Alexander technique.  It has been helpful for me.
Ephraim

[CCFNeuroMD JT, MD]

Dear Ellbell:

Thank you very much for your question. I am happy to address the issues that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a replacement for an office visit with a neurologist.  Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.

Dizziness is a fairly non-specific symptom and requires further testing to determine the underlying problem.  Problems can range to very benign conditions such as Benign Paroxysmal Positional Vertigo (BPPV) to more serious conditions such as blockage of brain blood vessels.  Given the story you provide me with, I do agree that there is a possibility that a peripheral neuropathy (i.e. senosry problem) may be a contributing factor, although other more serious conditions should be evaluated and ruled out.  Because  you do have what sounds to be fairly severe degenerative disease in your L-spine, I would not be surprised to find that you have some sensory loss.  

Balance is one of those things that is dependent on a number of factors.  Inner ear problems can produce balance problems as can problems with peripheral position receptors.  These receptors allow us to perceive where our body parts are in space and loss of this sense may lead to a feeling of dizziness.  However, given that sensory loss is a fixed deficit, one would expect for this to be a permanent problem and not to occur in spells.

The history you give is such that you are experiencing intermittent spells of dizziness.  Dizziness means many things to different people- some people say "dizzy" when they are lightheaded, others mean that the room is spinning around them.  Because these are episodic, I would suspect other possible diagnoses such as a migraine variant (not all migraine headache cause pain), a narrowing of the basilar artery which supplies the cerebellum (responsible for balance) with blood flow, seizure (less likely), or some congenital abnormality such as a Chiari Malformation (where part of the cerebellum is a little bit low-lying), Menier's disease (inner ear problem), or BPPV.  Additional considerations include postural orthostatic tachycardia syndrome which can be evaluated by checking your blkood pressure and heart rate in various positions. Unfortunately, I am unable to offer you a diagnosis based on your posting, especially wothout examining you and reviewing your films.

If  you have not yet sought out a neurologist, I would advise you to do so.  He or she may opt to check an MRA (magnetic resonance angiogram) or an ultrasound of your brain blood vessels to ensure that there is no vascular problem.  Other possible tests to consider include EEG and carotid ultrasound.

Thanks for your question, and good luck.
JBT, MD