Functional neurological treatment approach for chronic dizziness in an adult female patient.
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1
LIFE UNIVERSITY, Campus Center for Health and Optimal Performance, United States
BACKGROUND:
The patient is forty-four years of age and female. She suffers from chronic dizziness which began in 1997. The mechanism of onset is unknown. The frequency and intensity of dizziness had increased over the past year. She experienced dizzy spells that lasted approximately 30 seconds and occurred at a frequency of 3 to 5 times per week. She rated the intensity at 8/10, with 10 being the worst. There is associated nausea and a “foggy” feeling.
Chiropractic spinal manipulative therapy (SMT), drinking water and myofascial release has helped decrease the intensity of the dizziness in the past. Sudden movements, bending over quickly, consuming caffeine or sugar, changes in air pressure, and seasonal allergies occasionally elicited or exacerbated symptoms. Nausea and incoordination would accompany the dizziness.
The patient reports feeling in overall poor health. She has had chronic pain and discomfort with her back. She suffers from allergic reactions to foods, adhesive products, and sulfa drugs. Reactions include welts, rashes, throat swelling and facial redness. The patient suffers from Hashimoto’s and emotional lability as well.
METHODS:
Examination found that the patient’s blood pressure was 132/86 on the right and 126/80 on the left. A left esotropia was observed. A thorough neurological examination revealed rightward square wave jerks on attempted left horizontal gaze fixation and the inability to fixate in the upper right field of vision. Rightward saccadic intrusions were observed upon horizontal pursuits bilaterally, worse towards the left. She had large saccadic intrusions past the target during vertical pursuit testing. Optokinetic (OPK) leftward stimulation revealed a slower and more erratic nystagmus than to the right. Pupillary response to light testing showed a very brisk constriction response with immediate pupillary re-dilation bilaterally.
Deep tendon reflexes were decreased on the right brachioradialis, biceps and patellar tendons compared with the left. Pendulum swinging of left leg during patellar reflex testing was greater than right. Increased flexor tone noted bilaterally in the upper and lower extremities. The patient exhibited a decreased right arm swing during gait. Increased tone in the left sternocleidomastoid muscle and decreased tone in the right sternocleidomastoid muscle was evident when palpated. Decreased palatal elevation was noted on the right during inspection with vocalization. Intention tremor was noted in the left hand on movement. She had a diminished vibration sense in the distal foot bilaterally.
Treatment in this case included right-sided spinal manipulative therapy (SMT), breathing exercises (3 sets of 10), and complex movement exercises for the upper and lower extremities (2 sets of 10) bilaterally. Patient specific gaze fixation exercises were prescribed and performed three times per day.
RESULTS:
After initiating treatment, dizziness frequency was reduced to once per week, and the intensity was reduced to 3-5/10. At the time of re-assessment, the patient had not had an episode of dizziness for 10 days. Tonicity in the sternocleidomastoid muscle was symmetrical. Pursuits and saccades had shown significant improvement in both the vertical and horizontal planes, but were still aberrant.
CONCLUSION:
While some improvements were realized in this case, not all symptoms were resolved. The positive outcome experienced by this patient promotes the need for further study of these treatment strategies, in cases of chronic dizziness in females.
Acknowledgements
Life Unviersity
Keywords:
functional neruology,
Dizziness,
Chronic Disease,
Chiropractic,
chronic dizziness
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
BORGES
B,
Rhodes
P and
Esposito
S
(2016). Functional neurological treatment approach for chronic dizziness in an adult female patient..
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00034
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Received:
31 Aug 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. BEATRICE BORGES, LIFE UNIVERSITY, Campus Center for Health and Optimal Performance, Marietta, GA, 30060, United States, DRBTAPIA@AOL.COM