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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Neurology
Satisfied Customers: 45226
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I have had severe dizziness in past from neck issues (

Customer Question

I have had severe dizziness in past from neck issues ( vestibular migraine) that were resolved a couple of years ago. Now again I am having numbness in my right arm and again dizziness. Last night my bloodpressure went very high even though it is normal usually . Can this mean a heart issue /stroke
JA: The Neurologist can help. Just a couple quick questions before I transfer you. Is the headache episodic or daily? And what about nausea?
Customer: rarely. Today I have nausea
JA: Anything else in your medical history you think the Doctor should know?
Customer: I had polymyalgia a few years ago. Resolved with homeopathy.
Submitted: 2 months ago.
Category: Neurology
Expert:  Dr. Arun Phophalia replied 2 months ago.

I am writing the answer for you and will get back to you in 5 minutes. If you get a phone call request, you may ignore it as that is an automated site trigger. Thank you.

Customer: replied 2 months ago.
Ok
Customer: replied 2 months ago.
Expert:  Dr. Arun Phophalia replied 2 months ago.

You may need to get an ultrasound of the neck arteries and MRI of the brain with your medical history. This may not be due to stroke or heart issues, but these symptoms need a thorough evaluation.

The dizziness with the neck issues can be explained on the basis of what we term as cervical spondylosis. This predisposes to lightheadedness or vertigo which can originate from a condition called cervicogenic vertigo. This is because of the degenerative changes in the cervical spine and hardening of the carotid arteries (neck vessels that supply blood to the brain). Read about cervicogenic vertigo;

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2484651

http://www.chiroweb.com/archives/13/02/03.html

You should consult either a physical therapist or MD in physical medicine and rehabilitation. They would teach you specific exercises for neck and shoulder girdle and may consider traction to the neck.

Cervicogenic vertigo (other references):

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2484651

http://www.chiroweb.com/mpacms/dc/article.php?id=40024

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Customer: replied 2 months ago.
i have not received an answer by email!! just said i will get a response in 5 minutes.. I do not want to talk on the phone.
Expert:  Dr. Arun Phophalia replied 2 months ago.

Could you please see the answer above?

Expert:  Dr. Arun Phophalia replied 2 months ago.

If you wish, I can copy-paste the answer.

Customer: replied 2 months ago.
Not helpful at all! I know about physio therapy. Nothing about danger!!
Customer: replied 2 months ago.
I want my money back
Expert:  Dr. Arun Phophalia replied 2 months ago.

Numbness in the right arm is due to pinched nerves in the neck.

Following investigations would be required;

1) X-ray of the neck spine

2) MRI of the neck

3) Nerve conduction velocity (NCV) study

4) Electromyography (EMG)

Following measures would be helpful;

1) Neck care in the activities of daily living.

a) No working on the computer for more than half an hour in a single stretch. Same for TV.

b) Monitors and televisions exactly in front (180 degrees).

c) Contour pillow: Should fill the hollow when lying on back or straight. Available over the counter.

2) Cervical Collar or Brace

3) Cervical traction

4) Anti-inflammatory analgesics like Ibuprofen

5) Some physicians do give oral steroids in severe radiculopathy cases, in which numbness is quite significant.

6) Physical therapy: gradually increasing exercises from passive stretching to active against resistance regime.

7) Electrotherapy in the form of TENS, interferential and laser and ultrasound.

8) Hot fomentation

9) Local analgesic patch / ointment / spray.

Customer: replied 2 months ago.
Thank you
Expert:  Dr. Arun Phophalia replied 2 months ago.

The causes of dizziness according to the decreasing incidence are;

1) Benign paroxysmal positional vertigo (BPPV) 20%

2) Vestibular 15%

3) Migraine and motion sensitivity 15%

4) Anxiety and depression 10%

5) Meniere's disease 7%

6) Cerebellar disease 6%

7) Transient ischemic attacks 5%

8) Orthostatic hypotension 4%

9) Other.

Your primary care physician should refer you to a neurologist, cardiologist and ENT specialist for evaluation as the causes can be divided on the system, which is involved;

1) Inner ear or internal ear disease

2) Central nervous system

3) Cardiovascular, or

4) Systemic diseases.

Dizziness and imbalance are amongst the most common complaints in your age.

Although the causes of dizziness are multifactorial, peripheral vestibular dysfunction is one of the most frequent causes. Benign paroxysmal positional vertigo is the most frequent form of vestibular dysfunction, followed by Meniere’s disease. Every factor associated with the maintenance of postural stability deteriorates during aging.

The underlying cause of dizziness can be complex and multi-factorial in your age group.

Dizziness and imbalance can be caused by changes in any of the factors associated with the balance system, be they of sensory, visual, vestibular (internal ear), neurologic, and muscular origin.

Since the causes of dizziness in older people are multi-factorial, management of this disease should be customized according to the etiology of dizziness in each individual. Management of dizziness includes various approaches, including medical and rehabilitative ones as well as the use of prosthetic devices.

Vestibular rehabilitation includes;

1) VOR adaptation exercises to assist the central nervous system to adapt to a change or loss in inputs to the vestibular system,

2) habituation exercises to reduce pathologic responses to a provoking stimulus, and

3) substitution exercises to promote the use of the remaining sensory system.

You may consider consulting an MD in physical medicine and rehabilitation.

Currently, these exercises are found to be effective in treating people with dizziness caused by vestibular dysfunction, anxiety, cerebellar dysfunction, or Parkinson’s disease. Several studies have provided evidence that vestibular rehabilitation exercises are effective in improving postural control, dizziness symptoms, and emotional status in dizzy patients with nonspecific causes.

But I would again like to say here; the anxiety of something serious may be the underlying factor for your dizziness/imbalance/instability etc.

If you have fear of falling:

Various prosthetic devices have been developed to improve postural balance in the elderly. Vibrotactile feedback devices, which fit around the waist and provide augmented feedback about body tilt thorough vibration, have been shown to improve postural balance during quiet standing and walking. Vibrating insoles that enhance sensory input from the lower extremities have been reported to improve postural performance in the elderly.

Oral supplementation with antioxidants such as alpha-lipoic acid and coenzyme Q10 has been shown to reduce age-dependent hair cell loss in the inner ear.

Expert:  Dr. Arun Phophalia replied 2 months ago.

Wishing you a speedy resolution and all the very best in life.

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