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Long Shot - Virtigo Like Symptoms

3,054 Views | 42 Replies | Last: 7 mo ago by bigtruckguy3500
Ragoo
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4:00p, 4/22/25
AG
Sunday afternoon about 1:30 I felt/heard a crackle like sound in my right ear. Immediately I felt like my balance was gone. A wave came over my head and I became to feel like I was listing hard left.

Laid down and took advil as I thought maybe it was a migraine coming on.

Didn't help

Could not walk upright without support at all.

Went to a clinic. Ears showed signs of fluid and infection so go an antibiotic and steroid shot. Movement caused me to expelled all food and water from the day. Movement caused same sensation through yesterday about 1:30 and has since gone away. I can now eat and drink without concern.

Got out of the car took a step and a half and immediately hit the ground falling to my left.

Went to sleep.

Woke up slightly better. Worked some. Had boughts of motion like sickness until a little after noon

Went to ENT. Did a full hearing test, checked for ear cyst all alignments and dizzyness. No smoking guns.

Went to ER last night and had a CT on head and neck that all returned negative. I thought I may have had a stroke or some other neurological issues internal to my brain.

Have a PCP appointment tomorrow and an MRI scheduled for tomorrow after noon.

As of this typing I am able to get up and move around, slower than is typical for me, slight imbalance feeling. But I can recognize and self correct. I do feel like I have a tension type headache around the temples of my head.

I feel like I have a fog around my head that just needs to clear for things to go back to normal.
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88planoAg
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4:38p, 4/22/25
AG
Did anyone discuss positional vertigo with you?
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Ragoo
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In reply to 88planoAg • 4:41p, 4/22/25
AG
What do you mean by that? The ENT made my tilt my head to a 45 each way and all the way back to see if that would cause dizzyness. Nothing happened.

Edit: the test I described it this positional vertigo you mentioned
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Pahdz
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4:51p, 4/22/25
Had some similar but not nearly as severe experiences about 6-7 years ago. My doc told me to use Flonase to help congestion and get the ear crystals or whatever back aligned by clearing things up.

I have used it daily since and never had those moments again, and also can't recall having anything close to resembling a sinus infection or something of the like since either.
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andrago94
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5:13p, 4/22/25
AG
I had dizziness a year ago and cured it with the Epley maneuver. Google it, might help.
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True Anomaly
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In reply to andrago94 • 5:30p, 4/22/25
AG
andrago94 said:
I had dizziness a year ago and cured it with the Epley maneuver. Google it, might help.
If the Dix-Hallpike maneuver didn't elicit symptoms (as he alluded to in a previous post), then the Epley maneuver won't work
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Beckdiesel03
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6:53p, 4/22/25
AG
Was Mieneres disease brought up by the ENT? Allergies really can set mine off and the vertigo is impossible to deal with. Are you feeling like your ear with "fulll and it's hard to hear?
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Ragoo
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In reply to Beckdiesel03 • 7:00p, 4/22/25
AG
Nope. Only issue with the ear was to quick 15-20 second episode at the start and really slow think that was something internal or n that side that my ear just picked up on. Fully audio and panel at the ENT ruled out any ear issues.
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Kool
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7:08p, 4/22/25
AG
You 100% need to get that MRI done if you are still having dizziness. You are definitely not describing BPPV, that lasts only seconds. A vertiginous migraine is very common, the symptoms can be terrible and last for hours but it isn't so common to go on for days. Same with Meniere's. I'm sure the ENT did an audiogram, which would tend to show if Meniere's was a concern or not, but it can be normal if you either had a bout of vestibular Meniere's or if the hearing recovered between the start of symptoms and your visit. Viral labyrinthitis sounds like what it is, and in a way it is a diagnosis of exclusion. Regardless, a CT head, even if done with contrast, isn't sensitive enough to detect a lot of the neurological causes that need to be ruled out. The MRI is the way to go. Often an MRA of the head and neck needs to be done if symptoms persist and the diagnosis remains in doubt. If it ends up being viral labyrinthitis (or vestibular neuronitis, more appropriately), it can take a long time to get better and often seeing a vestibular therapist will help accelerate your healing. All the best and keep us posted.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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Ragoo
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In reply to Kool • 7:14p, 4/22/25
AG
Thanks. Plan on doing the MRI tomorrow. The CT was with contrast. I am not so much dizzy. I can see clearly. More tunneled Vision than anything. Hard to explain.
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Kool
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In reply to Ragoo • 7:30p, 4/22/25
AG
Ragoo said:
Thanks. Plan on doing the MRI tomorrow. The CT was with contrast. I am not so much dizzy. I can see clearly. More tunneled Vision than anything. Hard to explain.

If I recall correctly, you are a triathlete. No? Did this occur after a hard bout of training or maybe dehydration? That could certainly trigger a migraine or maybe Meniere's attack. Again, the length of symptoms is not very consistent with either of those.
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Ragoo
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In reply to Kool • 7:40p, 4/22/25
AG
Kool said:
Ragoo said:
Thanks. Plan on doing the MRI tomorrow. The CT was with contrast. I am not so much dizzy. I can see clearly. More tunneled Vision than anything. Hard to explain.

If I recall correctly, you are a triathlete. No? Did this occur after a hard bout of training or maybe dehydration? That could certainly trigger a migraine or maybe Mnire's attack. Again, the length of symptoms is not very consistent with either of those.
I am. This happened Sunday afternoon. Hadn't done any training since Saturday. Had just ate brunch with the fam and did cascarones in the front yard.

My gut tells me sudden hypertension which is why I thought minor stroke. CT was negative but again doing the MRI to hopefully get more information. I can feel a little throbbing in my temples right now.
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Dr. Not Yet Dr. Ag
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In reply to Ragoo • 2:41a, 4/23/25
Nah, hypertension generally takes months to years to cause issues. There is a study where they measured Olympic weightlifters arterial BPs during their lifts and the highest recorded was 480 systolic. The human body can handle extremely high BPs for very long periods of time without significant issues. I have patients in the ER that have been living in the 200s systolics for YEARS.

Viral labyrinthitis vs vestibular neuritis vs vestibular migraines is probably the most likely etiology based on everything stated, but as Kool said, those are diagnoses of exclusion. I've seen vestibular migraines last for a few days, although it is atypical.

Given your age and good health, my first thing to rule out would've been a vertebral dissection, which it sounds like they did with a CTA. Posterior circulation stroke could still be a possibility, but rare in your age group without a vertebral dissection or additional neuro deficits besides vertiginous symptoms, as well as waxing and waning symptoms which are atypical for central vertigo etiologies. The MRI is a good idea, but don't be shocked if it comes back completely normal and you get a shrug from your doc saying "could be this, could be that…"
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Kool
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In reply to Ragoo • 12:18p, 4/25/25
AG
Ragoo said:
Thanks. Plan on doing the MRI tomorrow. The CT was with contrast. I am not so much dizzy. I can see clearly. More tunneled Vision than anything. Hard to explain.
More better now??
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txags92
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12:44p, 4/25/25
AG
I get similar episodes from time to time that can last a few hours to a couple of days and best I have been able to figure out is vestibular migraines like has been posted above. When I first had the hearing loss that eventually got me diagnosed with MS, the ENT's gut feel was that it was meniere's disease. But at the time, I was not having any vertigo or nausea to go with the hearing loss.

I did find out during that time that the inner ear can be very sensitive to sodium and potassium levels in the fluid in the ear and having one or the other getting too high or too low can cause issues. I have found that when I feel an episode coming on, I can sometimes head it off or blunt the severity by making sure I am getting enough potassium and not overdoing sodium intake.

Mine usually start with that kind of tension headache/fogged over woozy feeling before eventually the vertigo and nausea get worse and worse over a few hours.

One other thing that can cause similar issues that your ENT probably would have noted is sinus pressure. Excess pressure in your sinuses can sometimes compress the facial nerves or the inner ear and cause vertigo, nausea, motion sickness, etc. It is probably worth trying a little Afrin just to see if it clears out your sinuses and relieves the symptoms. It is the time of year for allergies, so if you were out training saturday, it might have given you an extra dose of allergens.
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Ragoo
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1:46p, 4/25/25
AG
I had a minor stroke in the back left of my head. Been in the hospital since Wednesday evening. They just did a TEE to confirm for a hole in my heart. Should be released soon to tackle next steps at home and if confirmed a follow up procedure to close.
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Kool
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In reply to Ragoo • 1:59p, 4/25/25
AG
Ragoo said:
I had a minor stroke in the back left of my head. Been in the hospital since Wednesday evening. They just did a TEE to confirm for a hole in my heart. Should be released soon to tackle next steps at home and if confirmed a follow up procedure to close.
Ugh, I am sorry to hear that. I didn't want to suggest that but wanted to make sure you got the MRI done. As I said, a CT head, even with contrast, can miss quite a lot. I am glad that you did follow through and glad that you are very healthy otherwise. All the best to you.
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Ragoo
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In reply to Kool • 2:00p, 4/25/25
AG
Yeah thanks. The MRI is the only thing that points to the stroke. All other effects are minimal or non existent.
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Kool
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In reply to Ragoo • 2:14p, 4/25/25
AG
Ragoo said:
Yeah thanks. The MRI is the only thing that points to the stroke. All other effects are minimal or non existent.
Must have gone through the vertebral arteries, the posterior circulation. Explains the visual and vestibular disturbances. Hopefully your vessels are nice and open because of your exercise and ? have a young age. Just like COVID showed (some of) us, it's REALLY important to keep your vessels open by keeping your blood pressure and your blood sugars and cholesterol (and weight) low.
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Dr. Not Yet Dr. Ag
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In reply to Ragoo • 2:30p, 4/25/25
Damn, I'm sorry, bud. I'm glad that it sounds like you're doing better, at least.

Vertigo symptoms is probably the thing that gives me the most stress when discharging a patient from the ER because of exactly what Kool said, CT scans are going to miss posterior circulation strokes nearly every time. Also, it's almost impossible to get MRIs done without keeping someone in the hospital for a few days, and even then MRIs still miss a sizeable percentage of posterior circulation strokes if presenting within 24 hours of symptom onset.
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txags92
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In reply to Ragoo • 3:42p, 4/25/25
AG
Wow, glad you got that checked out and are hopefully going to be on the road to recovery.
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OasisMan
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9:11p, 4/25/25
AG
Would consider a Loop recorder
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Ragoo
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In reply to OasisMan • 9:17p, 4/25/25
AG
Likely going to get an external to track afib, with insurance it sounds like you start 7 days then 2 weeks and then maybe long term based on the data.
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Kool
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In reply to Dr. Not Yet Dr. Ag • 12:50p, 4/26/25
AG
Dr. Not Yet Dr. Ag said:
Damn, I'm sorry, bud. I'm glad that it sounds like you're doing better, at least.

Vertigo symptoms is probably the thing that gives me the most stress when discharging a patient from the ER because of exactly what Kool said, CT scans are going to miss posterior circulation strokes nearly every time. Also, it's almost impossible to get MRIs done without keeping someone in the hospital for a few days, and even then MRIs still miss a sizeable percentage of posterior circulation strokes if presenting within 24 hours of symptom onset.
I don't envy your job, and I don't think most people understand how difficult and stressful it is to see patients in an acute setting and try to figure out what's going wrong with them. Yesterday, I had a really difficult sinus case which was making me rethink some of my life choices. All the landmarks had been destroyed by nasal polyposis, and the image guidance system wasnt giving me the accuracy I wanted. That being said, I knew I could just be patient and I would find my landmarks and get through it. Working in the ER is different. Some of my worst nights ever were the nights after I was Pit Boss in the Parkland ER back in the 90s. I would often lie awake, unable to go to sleep, even though I was exhausted, and sometimes had nightmares wondering what I might have missed on a patient.
Getting back to the OP, every week, I will see someone who went to a CVS minute clinic or similar, who was misdiagnosed. I can stop the patient as they're telling me how the visit went. The provider always says they see fluid, slight redness, slight infection in the ear, whatever. They are given Amoxicillin or a Z-Pak, plus or minus steroids if the provider really wanted to go out on a limb. Some of it is because the providers aren't well trained in urgent care, some of it is because they don't have the equipment needed to really get a good exam.Nobody wants to say (myself included), or hear, "I don't know what's wrong with you". And the patient wants to leave with an Rx. Ragoo persisted, took the next step, and got the MRI. If anything, that's the lesson here.
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Ragoo
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In reply to Kool • 12:09p, 4/27/25
AG
100% need to be your own advocate

Here is a timeline of my last week

Sunday afternoon: grinding clicking sound in right ear followed immediately by sudden loss of balance. Tried to rest. Went to clinic and was said to have ear infection. Shot of antibiotic and steroid, referred to ENT. Couldnt walk or stand on own, anything consumed was almost immediately rejected.


Monday: ENT appointment. Full audio panel and check for vertigo. All passed to confirm not the source. Balance slowly improved through day. nausea ceases midday. After ENT figured the source was more neuro so drive to ER on way home to get a CT.

Tuesday: CT report negative but encouraged to follow up with Neuro. Tried to make appointment but wouldn't let me without a PCP visit. Made PCP appointment for Wednesday. MRI scheduled for Wednesday.

Wednesday: ENT had ordered the MRI. PCP actually didn't think an MRI was necessary based on the CT and how I was presenting physically in their office. Nonetheless it was scheduled and the $670 seemed like small potatoes to get more information. Note here: the ER plus PCP was all Houston Methodist. The ENT was not. So the ultimate MRI report was back to ordering ENT not to Houston Methodist who was ultimately handling my comprehensive care by this point. Posed a challenge and something the medical community needs to fix. My opinion. But once home the ENT called almost immediately and encouraged me to return to the ER. Back at ER had blood drawn, had EKG on heart which immediately gave the nurse pause. MD said it was okay. Nurse confessed what he saw was cardiac arrest in process. Did ultra sound of both legs to look for clotting. All clear. Admitted to hospital for observation and further testing. Met with neuro. Basically said at this point based on likely sources of stroke a cardio was going to take over. Likely heart related.

Overnight into Thursday: lots of blood draws and medicine to course correct the out of balance markers. All came back inline following. Midday did Echo to look at heart performance, afib, hole. Hole showed present. TEE ordered for Friday to confirm and gauge size etc.

Friday: midday did TEE. MD who performs closure procedures did the TEE so felt good about that. Discharged a couple hours later.

Medication:
81mg asprin a day basically forever now.
Lipitor for about 3 months
Clopidogrel for 3 weeks, believe 1-2 prior to closure then another week following.
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Kool
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1:05p, 4/27/25
AG
Aye caramba, what a week! Having both A-fib and a perforation in your heart is a bad mix, in a way you are lucky that you didn't throw a much bigger clot into your carotids and have a worse stroke. Glad it is all moving towards resolution. Are you still in A-fib, or has that resolved?
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Ragoo
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In reply to Kool • 1:08p, 4/27/25
AG
Sorry, don't believe I am in afib. Didn't intend to imply that. Agreed on the impact. My understanding is afib would have compound the issue.
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MaxPower
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In reply to Ragoo • 1:31p, 4/27/25
Did they say root cause on the hole? I thought that was typically congenital so seems odd it would not show any symptoms until later in life, especially if you have already been doing heavy exercise for awhile.
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Ragoo
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In reply to MaxPower • 2:13p, 4/27/25
AG
MaxPower said:
Did they say root cause on the hole? I thought that was typically congenital so seems odd it would not show any symptoms until later in life, especially if you have already been doing heavy exercise for awhile.
it is congenital and 25% of the global population still have theirs open. Usually not an issue and the body adapts to the condition.

I am hoping after closure I get an uptick in athletic performance since my oxygenated blood has been diluted with post depleted blood!
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bigtruckguy3500
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2:44p, 4/27/25
Wow. Glad you found your answer.

Did anyone get an EKG on you before the second ED visit? I suspect the first ED probably got one, but perhaps you weren't in afib at the time. Or did you have a smart watch that showed your heart rate bouncing around a lot? Or did you feel your heart doing irregular things? Afib can present very differently, some people feel instantly lightheaded, out of breath, and can feel their heart being weird, while others walk around for days or weeks or longer never realizing it.

Appreciate Kool recognizing the challenges of the ER. I think more residents these days need at least one month in the ED. And I agree with Dr. Not a doc - "dizzy" and "vertigo" and a bunch of similar complaints are always frustrating thing to work up in the ER. Everyone needs to remember that the ED looks at a snapshot in time, and has a very limited time to do a workup, and determine if you stay or go. And if you don't meet clear admission criteria (set forth mostly by insurance), it is often a fight to get a further workup as an inpatient. And yes, getting medical records between healthcare systems is extremely frustrating for us as well.

Maybe when MRIs can be done at the speed of CT scans (another 20+ years?), things will be better.


Is the hole they see an ASD? Did anyone do a HINTS exam on you while in the ED or at the ENT? Basically they hold your head, ask you to look straight ahead, then rapidly turn it left and right, then they cover one eye, then the other, and have you look far left/right/up/down. There's some debate on how good it is, but it's supposed to be one of the better physical exam tools to help figure out peripheral(ear) vs central (brain) vertigo.

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Ragoo
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In reply to bigtruckguy3500 • 2:48p, 4/27/25
AG
The duration of the CT and MRI were not different enough that the MRI should have been first. I did it offsite at an imaging site. Took 36 hrs to schedule and 25 min to complete.
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Dr. Not Yet Dr. Ag
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In reply to Ragoo • 9:23p, 4/27/25
CT head and CT angio head/neck take 5 minutes to perform, MRI/MRA head/neck takes 25-30. It's a big difference when thinking about it from a population standpoint. A CT tech can perform 10 in an hour. A MRI tech can only perform 2. Also, we are more concerned with ruling out bleeds and large intra-arterial clots in the emergent setting, as those are potentially rapidly correctable issues and/or issues that require immediate intervention.

Also, most hospitals are unable to get MRIs performed emergently. I can do it on rare occasions when the stars align, but typically I'm waiting 8-10 hours for it to get completed, and more commonly just admitting someone so it can get done in the next 1-3 days.

As for the HINTS exam, it's only useful if the patient has active nystagmus, which I'd say the large majority of my posterior stroke patients don't have on exam. Also, it seems to be taught poorly to my ER bretheren as I frequently see my colleagues trying to perform it in people that don't have active nystagmus, which is an obvious requirement.

I'd say in the ER it's useful if you actually know how to perform it properly, but can be dangerous if implemented by someone that doesn't really know what they are doing. Keep in mind the original study that demonstrated 100% sensitivity 96% specificity was performed by neuro-ophthalmologists and not ER docs, and I'd imagine in the average ER docs hands is going to have poorer test characteristics, even for those that know what they are doing. This is an exam that I hammer into my residents and med students heads that they need to get perfect and can't half *ss it or come in with an incomplete understanding.

And I'm a fellow UTSW grad, as well, Kool. Parkland is just a different animal from just the shear volume of patients. Can't imagine how nerve racking it was back then pre-EM residency program, especially without much attending oversight like they have now.
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bigtruckguy3500
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In reply to Dr. Not Yet Dr. Ag • 11:28p, 4/27/25
Yeah, I think one study showed that the sensitivity among ER docs is only about 83%. While it's either 96 or higher in neurologists. Agree, it's a difficult test to understand and perform.

Just curious if it was done, as he seemed to be having vertigo during one of his visits. I often hear "HINTS exam is negative," but when you prompt an explanation of what "negative" means you get whole array of responses.
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Ragoo
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5:59p, 4/29/25
AG
Complaints

Now that I am discharged I feel like advocacy is now zero. I called the cardiologist office for my follow per the discharge instructions - 3 weeks. When I met with the cardiologist at the hospital 2 weeks was the timeline for the procedure. I can't speak direct with the doctor. I can't ask for advice in the interim. I am already going stir crazy without physical activity. Like really bad.
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Kool
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In reply to Ragoo • 7:49p, 4/29/25
AG
That is a really crappy way to do things. I don't know why their system is that way. Trust me, I get pounded all day with questions from patients that I have to answer. Even if I don't pick up the phone and call the patient, they are answered by the end of day through my medical assistants. Even when I'm out of the office. It's one of the least enjoyable parts of my job, feeling I can never get away from work, but it needs to be done. I'd persist, though, in trying to get your questions answered.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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