I have a question about balance problems from visual vertigo and how they might differ from other balance problems. I hope I have explained it clearly below!
As I understand it, for a sense of balance the brain usually uses inputs from (1) earās vestibular apparatus, (2) vision and (3) proprioception of where the body is in space. In the case of visual vertigo the brain relies more than usual on visual input and this often turns out to be because the earās vestibular apparatus is not working properly.
From this I can understand how in a supermarket, the vision keeps seeing a large shifting field of information and relying on that would affect balance.
**The strange thing is that I sometimes get a sensation of walking on sponges when I am at home where I can not coordinate at what level my foot should be put down when I take a step. Surely this is not exactly the same thing is visual vertigo? **
This is my thinking. Firstly, I figure if you are at home and you are only moving your head slowly and there is nothing moving quickly in your field of vision, then the effect of your visual vertigo on balance should be small. Secondly, I figure that if I lost my balance (due to something like visual vertigo) then I might suddenly need to correct it by sticking a foot in a different place but that sort of act of suddenly re-balancing myself is surely not the same thing as being unable to put my foot down properly. I hope you can understand what I mean.
Would I be wrong to think that the sense of walking on sponges is the result of a second dysfunction in addition to the problem of relying on vision for balance? As an example of what else it could be (although this is just a wild suggestion) if someone has problems of blood insufficiency to the posterior circulation of the brain then one of their symptoms would be that they feel as if theyāre walking on sponges but they wouldnāt necessarily have visual vertigo.
I would be interested in any views on this as I am trying to collect my symptoms together in a letter to my neurologist and donāt want to start grouping together observations in a way which doesnāt help him.
What does your neurologist say? Have you had mood changes or memory problems, are your eyes difficult to move, especially down, and/or do you have double vision? Do you tend to tilt forward when you walk, grab things to balance, or have you fallen? Iām not a doctor, but what you described, to me, sounds more complicated than dizzinessā¦by that I mean motor neuron involvement??? (like PSP). What tests have you had?
I have heard a few people with dizziness problems mention āwalking on marshmallowsā but Iām not sure whether this is from an inner-ear disorder or some other problem. I guess if your inner ear isnāt functioning properly and your vision tries to compensate (thus causing the visual problems you mentioned), perhaps it could also disrupt your proprioception (i.e., where youāre putting your feet)?
But I agree this sounds like something you need to tell a neurologist about, if you havenāt already. I think it is some kind of proprioception problem.
I have thatā¦ canāt tell exactly where the floor is sometimes, causes problems with my knees from hitting the ground too hard (its higher than I think) or extending step but ground is lower than I thinkā¦
standing on uneven ground causes instant nausea and brain pressure. It is one of my worst triggers.
Iāll get that āwalking on marshmallowsā feeling regardless of whether Iām in my own home or a busy supermarket. Doesnāt seem to make a difference. Iāll also get a sensation of falling forward when sitting perfectly still in a comfortable chair, at home. Go figure!
I used to get the āwalking on spongesā or āmarshmallow floorā feeling an awful lot. And I must say, this is one symptom that has pretty much completely disappeared with the use of migraines meds, like Pizotifen and Topamax - indicating that the sensations were all down to the migraine mechanism in some way, rather than there being any lasting/permanent damage to my earās vestibular apparatus, or other āmechanicalā systemā¦?
Iāll also get a sensation of falling forward when sitting perfectly still in a comfortable chair, at home. Go figure!
Vic
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I used to get the imaginary falling quite a lot! But I went for a sideways fall rather than a forward fall, just to be a bit different from youā¦
And like Tony says, I found the marshmallow feeling went away with the use of medication (as did 99% of the imaginary falling gubbins). I also had particular problems walking down stairs for some reason. Felt like there was a mismatch between where my eyes were seeing the steps and where my feet were feeling they were. I remember my GP looking at me like I was a hypochondriac nutter when I told him about that.
Re standing or walking on uneven groudāthat bothers me too, though I donāt feel like falling. Not so much walking on CLEARLY uneven material, like rocks, but on a floor that has even the slightest unevenness that no one else notices.
I donāt get uncomfortable walking down stairs (with handrails), but I do when walking down RAMPS, for some reason. Walking UP them is fineābut walking down them makes me feel insecure, a bit unsteady.
I once walked down someoneās apartment hallway and said, āYour hallway floor slants slightly to the left.ā They looked at me like I was nuts. But later they called and said theyād taken a level to it, and by gum, I was right!
Maybe my proprioception (feet) got more sensitive, trying to compensate for the inner ear?
Iām curious about how it works for you to stand or walk with your eyes closed, perhaps with shoes off. (If you havenāt tried it, I suggest you start out with your hand on a railing.) It seems like a good way to separate out vestibular effects from any visual confusion. Also,I sometimes find it helpful just to let my eyes rest and rely more on proprioception.
Iām curious about how it works for you to stand or walk with your eyes closed, perhaps with shoes off. (If you havenāt tried it, I suggest you start out with your hand on a railing.) It seems like a good way to separate out vestibular effects from any visual confusion. Also,I sometimes find it helpful just to let my eyes rest and rely more on proprioception.
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David, thanks for the suggestion. I did a rough check on my vestibular function by standing one one foot with my eyes open and also closed. I used the values in Table 1 from this chart (which assumes arms folded) and saw my open eyes time was ok but my closed eyes times was very poor.
Thinking about this some more, my question wrongly assumes that people who suffer from MAV have acquired it as a consequence of visual vertigo. I think I overlooked the fact that some people will have MAV as a primary problem (which gives them a feeling of walking on sponges or stumbling). I didnāt stop to think that MAV sufferers may not necessarily have visual vertigo (and therefore lose balance in a supermarket).
Personally, I have both these problems although in my case the supermarket problem is much stronger. The walking on sponges feeling fluctuates a lot and presumable this is because it depends on whether migraine is occurring. On the other hand I find the the supermarket problem fluctuates less although, if I have observed correctly, I can improve my ability to cope with a supermarket if I take a long brisk walk immediately before going into the supermarket. I guess this may be something to do with increased function from improved cerebral blood flow.
I offer this hesitantly: āwritingā with your nose, which Iāll explain. I originally learned it as a remedy for eyestrain and stiff neck.
Perhaps others are familiar with it.
The exercise/meditation is one Iāve generally done sitting, with my eyes closed. Iāve known and used it for decades, donāt remember who taught it to me. I act as though the tip of my nose were the tip of a writing implementāpen, pencil, crayon, charcoal, . . . choose your weapon. Usually I āwriteā my name with it, but Iāve scribbled or sketch other things and written my name in different languages. If you want to be fussy about the metaphor, you might consider there to be a paper scroll or canvas moving slowly past the face as you scribble. Relaxes me; if it does the same for you, good; if not, donāt use it, right?
WexanāI just saw on your signature that you were originally dx with AD. What lead them to believe you had it? What testing was done to lead them to that conclusion?
WexanāI just saw on your signature that you were originally dx with AD. What lead them to believe you had it? What testing was done to lead them to that conclusion?
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Hi Teddypan, Iāll give you a detailed answer. You wonāt believe it but my erroneous assessment for Alzheimerās was done by a dedicated Young-Onset Alzheimerās team (who should know their stuff) which comprised a neurologist specialising in Young-Onset Alzheimerās , occupational therapist, psychiatrist and neuro-psychologist. My assessment involved about 6 or 7 visits and various brain scans. At the time the assessment was done last year I was almost continuously in states of confusion or severe confusion with only 30 minutes a day of relative lucidity. We protested strongly that even though we didnāt understand much about Alzheimerās or any of the other dementias, the team was obviously overlooking a lot of things; however they would not accept our input and they arranged for me to managed indefinitely by the Young-Onset Alzheimerās team and I will still see them for general support until I get a final diagnosis.
The team overlooked the fact that inattention is rarely found in Alzheimerās unless it is very advanced and that my fluctuations were too great to be the usual day-to-day or hour-to-hour fluctuations which people get.
I was referred to another neurologist specialising in Alzheimers for a second opinion and after some inconclusive brain scans, he was very interested that I had experienced inexplicable one-sided hearing loss about 10 years ago and, from my accounts of difficulty with balance in supermarkets, he deduced I had visual vertigo. This same neurologist also noticed I had been assessed for migraines many years ago but those migraines seemed to pass. In addition about 7 years ago I had received a diagnosis of ātension headacheā from another neurologist which is when I started my steep decline into confused states and headaches and inattention until I could no longer manage even the simplest of my own affairs like paying a bill. I am still being diagnosed but itās clear that visual vertigo and some sort of migranous headache are parts of my complicated picture.
What I still canāt understand is the fluctuating levels of consciousness I experience (which occur several times a day and are often very significantly debilitating) accompanied by marked confusion/inattention. You could probably call that āextreme brain fogā. I am typing this is a lucid interval because I would not be able to string words into sentence properly nor find it easy to use a keyboard. In addition I have a balance problem which varies depending on how overloaded I am. I have some degree of headache for over half the day and when it gets bad my head feels like it is bursting and ready to explode.
All this seems to get noticeably better for several hours following a 15 minute run. I still canāt work out if this improvement after running is due to (a) exercise reducing the headache or (b) improved blood flow to the brain which makes for overall better brain functioning.
I have some unexplained chest pains which are still being investigated. I wonder if I also get some intermittent impingement on the arteries carrying blood to the brain. I started along that line of thinking because calcium channel blockers helped me and I thought they were acting as a vasodilator of my chest arteries ā¦ but now I am beginning to wonder if the calcium channel blockers were helping with a migraine-type headache.
I find that ad-hoc benzodiazepines in the daytime are helpful with my headaches (and sometimes with my other pains). Perhaps the benzodiazepines are working to relax muscles in some part of my body which are giving me other troubles. I am now starting to experiment with triptans to see if they help.
Something Iāve often thought. Almost as often as Iāve blamed VRT for the same outcome.
Even now, highly medicated, I regularly share Nancyās experience. One sister-Iām-law has a very uneven ground floor throughout her terraced home. Always thickly carpeted and despite her decades of habituation Iām the only person ever to have noticed.
Iām the same. I have rather got used to it. Itās just an āacknowledgementā of the offending bump and a quickly passing sensation or so I thought until yesterday. Beautiful Autumn day decided to go blackberrying and the best hedge with the biggest and juiciest fruits was only accessible by crossing a wide patch of thick tussock grass which is notoriously spongey to walk over. Felt fine at the time. No problems with the warm bright Autumn sunshine and although the walking was difficult (it wasnāt much easier for Him Indoors and heās no vestibular issues) everything seemed fine. It was about six hours later I found myself rocking. So frustrating after weeks of being disequilibrium free. No visual vertigo involved here for me. Iām sure it was just the spongey ground. An unfamiliar feeling to the system.
āAll gait parameters on soft surfaces correlated significantly with functional reach. On the other hand, that on normal surface correlated significantly with leg strength. Gait properties on soft surfaces which changes in plantar aspect during foot contact differs from those on normal surfaces. Walking on soft surfaces may cause an unanticipated inverted pendulum sway supporting a foot contact point because of the disturbance by a sagging walkway; in short, requiring more effort to keep a body balanced. In conclusion, gait on the soft surfaces requires balance ability (functional reach) rather than legā.
So itās balance ability rather than leg strength that accounts for the difference.
