Dear Keephurting

I have to agree with some of the reasoning of alophysio. I will speak with respect to clients i have seen that have reported similar symptoms. I saw a lady approximately 8 months ago with a similar problem. She would fall to the ground with certain head movements. Alophysio is right in thinking that a VBI would need more sustained rotatory movements to cause dizziness/loss of balance/blackouts.However, this is usually what we see on assessment when things are controlled and in reality quick head rotations that are very rapid can totally obstruct an artery supplying the brain especially if the artery itself is already compromised.I say this because i have seen many patients who have had all the investigations in the world for inner ear problems all coming to not but still having drop attacks. A feeling of fuzziness and blurred vision makes me think the posterior part of the brain where vision is generally controlled is experiencing some compromise...which is why i still think a VBI is strongly the issue...most patients with inner ear problems do not describe a blurry vision, what they describe is a feeling of the room spinning, a feeling of the objects bouncing and they say if they do things a lot slower then they are fine...so the question is if you turn your head slowly do you feel alright?

VBI or verterbrobasilar insufficiency is a condition that occurs when the arteries that come from your neck to part of the arterial network that supply your brain are compromised. This can be as a result of a clot, vascular diseases or mechanical in origin. By mecahnical we mean movement causes it. because these arteries pass through the bones in your neck especially and at the upper part of the neck they change course in somewhat a turn, degenerative changes in the neck would mean they are vulnerable to blockage when the head is turned as the path they go through is smaller. So if you rotate and/or extend (look up) your neck the bones clip down on them and shut the blood supply to the brain...causing a feeling of wooziness, heaviness or tendency to black out...as soon as the pressure is taken off, everything back to normal, you fall because that is your bodies way of telling you "hey we cant pump blood up again to your brain, lie down and let gravity help us"

what you seem to be reporting is a "drop attack". certain conditions based on what clients have reported to me have this symptom, one is menneires disease, the other is cerebellar dysfunction/ataxia or posterior fossa lesions, veterbrobasilar insufficiency...

You report a feeling of fuzziness in your head and generally feeling weak after certain head movements. also your gait is unsteady, this still rules in either a cerebellar issue or a vascular problem. Musculoskeletal problems with the neck may cause a cord compression at the level of the brain stem...

you say you have been tested for BPPV and all tests prove negative...this means that positional effects do not influence your problem, do you get a feeling of fullness in your ear? do you have periods when you feel like you are fine and periods when you feel like the condition is just worse? i mean do your symptoms present at certain times during the year? when you lose balance due you feel nauseated like you want to vomit?

Do you experience vertigo? a feeling of the world spinning around you or oscillopsia, a feeling of objects bouncing up and down when you walk? these symptoms will mean you are unable to focus your eye on objects with head/body movements suggesting possibly an inner ear problem or CNS problem...slow pupil dilation really is not the test for a vestibular problem however it could mean a CNS problem sometimes originating from obstructions in the neck...

As alophysio said , testing you for BPPV only does not rule out an inner ear problem completely.

Are you able to keep your balance with your eyes closed? if you seriously lose balance, then you probably are looking at a central nervous system issue...this can happen when your with obstructions in the brain stem...

you need the following tests to help you make a suggestion for a diagnosis: Do them sitting down for safety,

NOTE:take care when doing these tests cause they can provoke neck pain and if you are unsure of what pain you would have or what effects they woul cause i strongly advise against doing them unless you are with a trained clinician!!!!

test one: can you focus on a stationary object in front of you? as your husband to watch you eyes, try to keep them still, if you eyes are bouncing up and down or side to side, and you start to feel dizzy...then your gaze stability is flawed...this points to a CNS problem...

test two: can you keep you eye steady on a stationary object while you move your head slowly left to right? these movements are just small rotations not extreme ones, again your husband can watch your eyes...do they bounce up and down or left to right? try to do this faster, again small rotations, if you eyes are not staying in focus...then your vestibuloocular reflex (VOR) cancellation is flawed...this means you may have a CNS problem or an inner ear problem...to be more precise would be looking for the gain of bounce, by gain we mean by how much the eye is bouncing out of focus and returning... this is a sign of nystagmus...

Do a similar test looking up and down, slowly then quickly...again small movements is all your need not extreme ones, if there is a bounce watch for the direction of bounce away from the ears if there is any, a horizontal bounce would mean a an inner ear problem...i.e your eyes keep bouncing away from the left ear towards the right..means the problem is problem is with the left ear...a bounce mainly in the vertical direction strongly suggests a CNS problem rather than an inner ear problem

test three: can you track an object moving in front of you smoothly with your head still? your husband can float a pen in front of you in different directions, try to follow the pen with your eyes... if you are having difficulty doing this... then the problem is likely to be CNS...it means you are unable to smoothly pursue an object, the vestibular issue is central

test four: can you follow an object moving your head and eyes smoothly...having trouble with this means your VOR, again this can be ponting towards an inner ear problem or CNS problem...

test five: can you stand still with your eyes closed? extreme sway or loss of balance strongly indicates a CNS problem...

test six: can you switch vision between two objects easily? put your hands about six inches away from the side your head but in front of you...keep your head still and switch vision between your two hands...do this for about a minute or two...if you are getting dizzy spells or are having trouble coordinating these movement then it is likely that you have a vestibular problem...maybe inner ear or CNS related...

No need to do BPPV tests as you have been through these before...

Now For what i really think is the problem...It is unusual to have pure inner ear troubles with headaches unless you have both problems...cervicogenic headeaches usually come from neck movements and as alophysio pointed out you would feel heaviness or a stabbing sensation in your eyes, however not all the time...you may experience pain at the top of your head or jaws..and these area in addition with your eyelids may feel tender...if your head ache is constant...then a cervicogenic headache is unlikely and CNS issues should be considered...

I think the problem is coming from your neck, and the degeneration you are having is probably causing some cord compression, i think you are displaying some symptoms of VBI, if you are not having a feeling of the room spinning and objects bouncing and your gait is just unsteady i would consider a cord compression/brainstem compression...you shouldnt have an unsteady gait with VBI alone...
In these case, i would consider looking at your coordination, sensation and muscle power in your arms and legs....

I would not attempt manipulating your neck until a good knowledge of how bad the degeneration is first, I may want to start of with exercises first to see what happens...