RESOLUTION OF CHRONIC DIZZINESS COMPLICATED BY AUTOIMMUNE THYROID WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION
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1
Independent researcher, United States
Background: a 29 year old female presented to a private clinic with a 10+ year history of chronic dizziness. She had been previously diagnosed with vestibular migraine. The patient described the dizziness as "debilitating" and as feeling like a "bouncy floor", "rocking", and "floating". The dizziness would frequently cause nausea and fatigue. The patient claims a history of migraines and autoimmune thyroid (Hashimoto's).
Methods: Neurological examination revealed a drop in blood pressure during tilt table testing upon standing. Gait analysis revealed a loss of arm swing during dual tasking. Finger to nose testing revealed dysmetria on the left. Alternating movements of the upper extremity were slow on the left. Pupillary reaction with light stimulation revealed fatigue on the left. Downward pursuits revealed saccadic intrusions. Rightward saccades were slowed to the right. Upward saccades were slow compared to downward saccades. Luria's sequence testing was abnormal on the left. Computerized Dynamic Posturography (CDP) revealed decreased stability on a normal surface with both eyes open and closed. With eyes closed and head to the right on a perturbed surface the patient's stability decreased abnormally. During head flexion on a perturbed surface with the eyes closed the stability score worsened. Saccodometry of 100 saccades revealed hypermetria bilaterally worse with leftward saccades. Leftward saccades were slow compared to the right. Palpation revealed several areas of aberrant spinal segmental movement in the cervical and thoracic spine. A program of multimodal neurorehabilitation included vestibular rehabilitation (VR), spinal manipulative therapy (SMT) and Low Level Laser Therapy (LLLT). VR included gaze stability exercises, laser guided visual feedback, repositioning maneuvers, balance exercises, passive and active vestibular canal stimulation, and eye movement exercises.
Results: Saccodometry revealed a resolution of the hypermetria and velocity normalized. CDP revealed an improvement in stability. Stability scores were in balance with the head in right and left rotation. Head in flexion with eyes closed on a perturbed surface produced an increase in stability. Gait analysis normalized with dual tasking. Left side alternating movements normalized. Finger to nose testing revealed no dysmetria. Downward pursuits normalized. The patient claimed a resolution of symptoms of dizziness with only occasional episodes that were stimulated by exposures to certain foods.
Conclusion: this author recommends further investigation into multimodal neurorehabilitation protocols that include VR, LLLT and SMT for the treatment of chronic dizziness.
Keywords:
Dizziness,
dizziness and vertigo,
Fatigue,
Autoimmune disease (AD),
Hypothyroid,
Hashimoto's,
Vestibular Rehabilitation,
Spinal manipulative therapy,
Balance rehabilitation,
Low level laser therapy ( LLLT),
saccodometry,
Computerized dynamic posturography (CDP),
Clinical Nutrition,
Luria alternating series test,
Dysmetria
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Schiller
D
(2019). RESOLUTION OF CHRONIC DIZZINESS COMPLICATED BY AUTOIMMUNE THYROID WITH A PROGRAM OF MULTIMODAL NEUROREHABILITATION AND CLINICAL NUTRITION.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00035
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Received:
02 Apr 2019;
Published Online:
27 Sep 2019.
*
Correspondence:
Dr. David Schiller, Independent researcher, Avon, Colorado, United States, drschiller@comcast.net