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Heart Palpitations Forum >> Symptoms and other concerns >> Is there a link?
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Message started by beadbabe on Feb 14^th, 2007, 8:59am

Title: Is there a link?
Post by beadbabe on Feb 14^th, 2007, 8:59am

Hi there
I read with interest that you are a neurologist, RLR, so I wondered if you might know if there is any link between internuclear opthalmoplegia which I was diagnosed with nearly 10 years ago and still have as a residual problem, and dysfunction of the vagus nerve. Could this be why I have dizziness which was my starting symptom before all the heart palpitations came up and now over-ride everything else. I know that INOs are normally a result of demyelination (ie MS, especially as I got the INO aged about 28), but I have had two MRIs 10 years apart and both were 'normal', although obviously you can't imagine yourself an INO, or get one through anxiety :)
My GP said there is no such think as a vagus nerve becoming sensitised but I don't really believe that because a lot of what is on here makes sense to me.
RLR, if you can take the trouble to answer this - I am so grateful for all your help and you are a godsend to all these people on this site.
Beadbabe

Title: Re: Is there a link?
Post by RLR on Feb 14^th, 2007, 10:31am

Well, as you probably have been told, internuclear opthalmoplegia is the result of a lesion (injury) in the medial longitudinal fasciculus (MLF) which connects the sixth cranial nerve nuclei to the contralateral medial rectus muscle. The consequence is difficulty with adduction of the affected eye, which often lags behind when lateral gaze is conducted.

There is no known literature which would suggest a connection between this disorder and the onset of palpitations. It's also important to realize that when we speak of the Vagus nerve being sensitive, we are referring to it as part of the entire nervous system being sensitive due to elevated stress and anxiety. So your GP is correct if it was stated that the Vagus nerve alone could be subjected to greater sensitivity than the rest of the nervous system.

While MS would have been a good differential diagnosis, I would ask whether both eyes are affected because in most all cases of MS, INO is typically bilateral. Unilateral symptoms would make me think more of a vascular incident. Also, in the absence of rice-grain lesions typically evident on MRI in most cases of MS, I would have run MuSK antibody titres to make certain that Myesthenia Gravis was not of issue since it can mimic almost identically the motility patterns of true INO. The initial symptom of dizziness could have a number of origins and it would be difficult for me to suggest one over the other without medical historical information that certainly should not be posted on an open website forum.

Here would be a short list for thoughts when observing INO in patients - multiple sclerosis, brainstem infarction, brainstem and fourth ventricular tumor, viral infection, mechanical trauma, syphilis, Lyme disease, drug intoxication (phenothiazines and tricyclic antidepressants), subdural hematoma and in pseudo-INO the possibility of myesthenia gravis if other symptoms such as heat intolerance are evident along with positive lab results. Your age of onset would be typical of MS, but in the absence of symptoms beyond INO, I would be looking elsewhere particularly after nearly a decade.

Best regards and Good Health

Title: Re: Is there a link?
Post by beadbabe on Feb 19^th, 2007, 7:34am

RLR - thanks so much for your advice but of course I am now wondering when you say a vascular event - have I had a stroke and when am I going to expect another one?
I am having no luck coming to terms with these heartbeat problems. The atenolol isn't helping unfortunately.

Title: Re: Is there a link?
Post by RLR on Feb 19^th, 2007, 9:02am

Okay, no mention was made to suggest that you've suffered a cerebral vascular accident, or stroke. I was merely stating the more common presentation with symptoms as described in your posting and again, was not informed whether your INO is unilateral or bilateral.

I am certainly unable to examine or diagnose you via the Internet and it's very important for you to view my comments in response to readers as a form of medical information, not medical diagnosis.

In the absence of clear signs of MS or other known disease characteristically found to be responsible for INO, I would have suggested that a CT angiogram typically provides far more data about the prospect of vascular accidents. It's ability to discern such events does, however, wane as more time passes, certainly after 10 years or so, which I believe was the timeframe mentioned.

It's also worth inquiring here whether you are experiencing any type of GI problems, which can go a long way to creating the potential for this type of palpitation to occur.

Best regards and Good Health

Title: Re: Is there a link?
Post by beadbabe on Feb 19^th, 2007, 9:49am

Thanks again for info.
I'm not sure - the paralysis of the eye is in my left eye only but my vision doesn't work together as the right eye was a lazy eye from birth. What complications. Never mind - I don't expect you to diagnose without being able to see me. Thanks so much for all your helpfu advice.
sometimes I have a sort of upset tummy in the morning. Not really upset but just needing to go, so maybe it is related.