[24F] Experiencing dizziness, black vision, and ringing ears

Patient Description

A 24-year-old female has been experiencing episodes of dizziness, black vision, and severe ringing in the ears for the past two years. The episodes are unpredictable, and if not managed in time, lead to loss of consciousness. The patient has a history of a significant concussion at age 16, which has since been followed by depth perception issues and balance problems. Additionally, the patient was recently diagnosed with bipolar disorder and is currently on Wellbutrin 75mg immediate release and Lamotrigine 200mg daily, with recent adjustments to the dosages. The patient also takes fish oil and l-glutamate supplements. No known allergies or adverse reactions to medications have been reported. The patient experiences extreme fatigue post-episode, with heart palpitations during the episodes. There is no chest pain or shortness of breath, but there is a noted tendency to hold breath, which may contribute to dizziness.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are several possibilities:

  • Orthostatic Hypotension: This condition is characterized by a sudden drop in blood pressure when you stand up from a sitting or lying position, leading to dizziness or fainting. It can be caused by dehydration, certain medications, or underlying conditions.

    • Treatment typically involves lifestyle modifications like standing up slowly, staying hydrated, and wearing compression stockings. In some cases, medication may be prescribed.

  • Vestibular Migraine: This type of migraine is characterized by dizziness, problems with balance, and problems with vision. It can also cause ringing in the ears (tinnitus) and a feeling of pressure or fullness in the ears.

    • Treatment typically involves medications to prevent migraines or to relieve symptoms, as well as lifestyle changes like avoiding triggers.

  • Post-Concussion Syndrome: Since you've mentioned a significant concussion in your past, it's possible that some of your symptoms are related to this. Post-concussion syndrome can cause headaches, dizziness, and problems with concentration and memory.

    • Treatment typically involves rest, over-the-counter pain relievers for headaches, and sometimes cognitive therapy.

  • Side Effects of Medication: Some of your symptoms could be side effects of the medications you're taking. Both Wellbutrin and Lamotrigine can cause dizziness and other side effects.

    • If this is the case, your doctor may adjust your dosage or switch you to a different medication.

What you can do

  1. Make sure you're staying hydrated and eating regular, balanced meals.
  2. Stand up slowly from a sitting or lying position.
  3. Avoid triggers that you notice make your symptoms worse.
  4. Keep a symptom diary to track your symptoms and any potential triggers.
  5. Consult with your doctor or a specialist about your symptoms. They may want to adjust your medication or perform tests to rule out other conditions.

What you should look out for

If you experience any of the following, seek medical attention immediately:

  • A sudden, severe headache
  • A sudden, severe increase in the intensity of your symptoms
  • Loss of consciousness for a prolonged period
  • New neurological symptoms like weakness on one side of your body, difficulty speaking, or severe balance problems

Please remember that while I strive to provide accurate and helpful information, I'm not a doctor. Always consult with a healthcare professional for a formal diagnosis and treatment.

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9 mo ago

People Also Ask

What is orthostatic hypotension and how can it be managed?

Orthostatic hypotension is a condition where blood pressure drops significantly when standing up, causing dizziness or fainting. It can be managed by staying hydrated, standing up slowly, wearing compression stockings, and sometimes using medication.

Can a past concussion lead to long-term symptoms like dizziness and balance issues?

Yes, a past concussion can lead to long-term symptoms such as dizziness, balance issues, headaches, and cognitive difficulties, known as post-concussion syndrome. Treatment often involves rest, pain management, and sometimes cognitive therapy.

What are the potential side effects of Wellbutrin and Lamotrigine?

Wellbutrin and Lamotrigine can cause side effects such as dizziness, headaches, nausea, and in some cases, mood changes. It's important to discuss any side effects with a doctor, who may adjust the dosage or switch medications.

How can vestibular migraines be treated or managed?

Vestibular migraines can be managed with medications to prevent migraines or relieve symptoms, as well as lifestyle changes like avoiding known triggers, maintaining a regular sleep schedule, and managing stress.

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