I realize this is long. However, I wanted to give a full, more accurate picture of procedures done
I am 48 years old. Med Hx: WPW w/ ablation, PTSD, IBS, Gastroperesis, GERD, Anxiety, Depression.
Symptoms: Dizziness (no vertigo), dysequillibrium, fatigued/weak legs resulting in pain. Rare tingling, numbing & heat in L leg.
ORIGINALLY: Went to Physical therapy & Balance Center and given several tests: PT 2x/weak w/ no/to non significant improvement.
1. CALORIC (23% UW, L ear)
2. Nystagmus Tests: Dix-Hallpike L (L beating nystagmus - asymptomatic), Positional Head (Head R = left beating nystagmus. Head L = L beating nystagmus. OTHER results: Negative
3. Oculomotor Tests: Saccade-Random = NEG, PURSUIT = Abnormal CNS-Mild saccadic intrusions., OPK-Fixed = Abnormal CNS-Weak, low gain; soft sign of CNS.
FINDING & IMPRESSIONS: VNG indicated a MIXED(PNS+CNS) balance related impairment A significant hypofunctioning vestibular system was noted in the L inner ear. Oculomotor testing indicated a soft indication of a CNS impairment. These findings are supportive of a medical necessity for BRPT and further vestibular testing, as needed (Referred to neurologist).
Nerve Cell Biopsy: R lower thigh and R calf. Results: R lower thigh nerve fiber density was 6.5 (normal value >6.0/mm). My R calf showed a nerve fiber density of 1.4 (normal value >5.7/mm), morphology normal.
However, my ARS w/ QSART and Valsalva maneuver were normal w/ a comment of "blood pressure response to tilt showed a modest drop in blood pressure with inadequate heart rate increment."
CONCLUSION: "No evidence of autonomic failure...may be some degree of cardiovascular adrenergic instability (evidenced by reduction in blood pressure/head-up-tilt). This may suggest a predisposition to orthostatic intolerance or may indicate an early autonomic disorder. Repeat testing could be considered in 6-12 months if clinically indicated."
EMG (2nd one): Normal w/ comments: "Needle EMG examination revealed fibrillation potentials in the distal foot muscle, but were otherwise normal." INTERPRETATION: "This study is nearly normal. The fibrillation potentials in the foot muscles is not a diagnostic abnormality as this could be associated w/ a local process in the foot. If clinically indicated....6-12 mo repeat." .
EMG/NCV (1st EMG) Findings: "Eval. of R Sup Peron Anti Sensory nerve showed decreased conduction velocity (14cm-Ant Lat Mall, 30.3 m/s). Remaining nerves (normal limits). L vs. R side comparison for Tibial Motor nerve indicates abnormal L-R latency difference (2.0m/s). Remaining differences were w/in normal limits. All H Reflex L vs R latency differences w/in normal limits." INT: Normal
MRI W/WO contrast: normal (including vestibular apparatus, chochlea & otic capsules) w/ amall amount of T2/FLAIR/medial R temporal lobe. INT: Diagnostic consideraions: premature small vessel ischemic disease of aging or less likely demyelinating disease.
*Home Sleep Study: Normal
*Blood Work: RA, ANA, Sjogren's Ab's, serum protein electrophoresis, metals, Hep B/C - NORMAL
*IgG (normal), IgA (Low(74); RR(81-463), IgM (low(31);RR(48-271). NO IgE completed.
*Lumbar Puncture: Normal
*Carotid Ultrasound (EXT ART Bilateral): Normal w/ "minimal atheromatous plaque R&L carotid bifurcation
*EEG Awake/Sleep: Normal
*Neurological EVAL: Normal w/ "acrobatic contorsions w/ falling."
*CDP (ONLY): No report, but told "no evidence of vestibulopathy."
*Psychologist (Personality Assessment Inventory): High score- PTSD & increased anger (normal for me).
"DIAGNOSIS": 1. No objective evidence of neuropathy.
2. Somatization/conversion D/O
1. What do you think about test results/"diagnosis?"
2. Should I consider more tests for Vestibulopathy or other?
3. Allergy Panel makes sense to me too?