[44F] Experiencing double vision, dizziness, and walking difficulties

Patient Description

A 44-year-old female presents with new-onset double vision, described as seeing images side by side, which sometimes persists when one eye is closed. She also reports dizziness and an unusual sensation of being pulled to one side while walking, with her top half moving faster than the bottom half. These symptoms have been occurring for approximately one week. She experiences significant fatigue but no severe headaches, slurred speech, or numbness. Her medical history includes anemia since 2016, anxiety, depression, and recently noted low protein levels. There is a family history of neurological conditions, including multiple sclerosis and Parkinson's disease. The patient is currently on Ajovy injections once a month, Topamax 50mg daily, Citalopram daily, Nexium 40mg daily, Lorazepam 0.5mg twice at night, and Slow FE for anemia. She has a food allergy to mango but no known drug allergies.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, several conditions could be considered:

  • Multiple Sclerosis (MS): This is a chronic disease that affects the central nervous system, particularly the brain and spinal cord. It can cause symptoms such as double vision, dizziness, and fatigue. Given your family history of MS, this could be a possibility.

    • Diagnosis usually involves a neurological exam, MRI, and sometimes a spinal tap. Treatment typically involves managing symptoms and slowing the progression of the disease with medication.
  • Vertigo: This is a sensation of feeling off balance, often described as a spinning sensation. It can be caused by issues in the brain or inner ear, and can lead to dizziness and problems with coordination or balance.

    • Treatment typically involves physical therapy exercises (vestibular rehabilitation) and medication to relieve symptoms.
  • Anemia: You've mentioned that you have a history of anemia. Severe or long-term anemia can cause fatigue and dizziness.

    • Treatment typically involves dietary changes, iron supplements, and in severe cases, blood transfusions.
  • Medication side effects: Some of the medications you're taking, such as Topamax, can cause side effects like dizziness and vision problems.

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

What you can do

You should definitely seek medical attention given your symptoms. In the meantime, here are some things you can do:

  1. Rest and hydrate: Make sure you're getting enough sleep and drinking plenty of fluids.
  2. Avoid triggers: If you notice certain activities or foods make your symptoms worse, try to avoid them.
  3. Safety measures: Given your balance issues, be careful when moving around to avoid falls. You might want to have someone stay with you until you can see a doctor.

What you should look out for

Seek immediate medical attention if you experience:

  • Sudden, severe headache
  • Difficulty speaking or understanding speech
  • Sudden numbness or weakness, especially on one side of the body
  • Sudden loss of balance or coordination
  • Sudden, severe dizziness or vomiting

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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1 yr ago

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People Also Ask


What are the common symptoms of Multiple Sclerosis (MS)?

Common symptoms of Multiple Sclerosis (MS) include fatigue, difficulty walking, numbness or tingling, muscle weakness, vision problems such as double vision, dizziness, and problems with coordination and balance.


How can vertigo be distinguished from other causes of dizziness?

Vertigo is often characterized by a spinning sensation, either of the person or the environment, and can be accompanied by nausea and balance issues. It is typically distinguished from other types of dizziness by its specific sensation of movement and is often related to inner ear problems.


What are the potential side effects of Topamax that could affect vision?

Topamax can cause side effects such as dizziness, vision problems including double vision, blurred vision, and eye pain. These side effects should be discussed with a healthcare provider, especially if they are severe or persistent.


How does anemia contribute to fatigue and dizziness?

Anemia can lead to fatigue and dizziness because it results in a reduced number of red blood cells or hemoglobin, which means less oxygen is delivered to the body's tissues. This can cause symptoms like tiredness, weakness, and lightheadedness.


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