Question
QUESTION: Hello,
I have 2 cervical herniated discs at c4-c5 and c5-c6 with cord compression.  I have been experiencing lightheadedness, not really dizziness, just a spacey, lightheaded feeling, mostly with neck movement.  I had one episode of true dizziness with neck movement to the right.  I had another episode where I was resting with my neck back, got up, and within a few minutes was feeling lightheaded.  My neck muscles have been tight, and I am currently seeing a chiropractor.  Have you ever heard of vision being diminished with neck movement?  I have had several episodes in the past where I turned my neck to the right, or looked upward, and my vision went out of focus for a few minutes.  I have had a normal brain MRI, normal MRA of brain, and I am currently scheduled for a MRA of the neck.  It feels as if blood flow is being reduced with certain neck movements.  Can a chiropractor help this?  Do I need to see a neurologist?  Also, have been having numbness down both arms and into my feet, I am hoping the chiropractic treatment can help this.  I also have bilateral carpal tunnel syndrome.   Any advice?  Any additional testing that you would recommend?

ANSWER: Dear Christine,

Yes, in fact you can also have a Cranial Nerve-4 palsy (go ahead and google this one) that will affect your vision, and it is also possible to have cervical spine structures affect your visual fields.  There was a paper (maybe two) published on this topic of alterations in visual field following neck joint manipulation.  Also, it well known that cervical spine irritation to nerve ganglia can provoke dizziness.   This is commonly seen with neck injuries and it is called "cervicogenic vertigo."   This must be differentiated from benign paroxysmal positional vertigo (BPPV) with a cervicogenic vertigo test, where you sit on a stool, stare at an object while the doctor holds your head very still, and you twist your body left and right.  Your head remains still, but your body and your neck twists.  If this causes dizziness, it's your neck and not your head.  I'll bet your MRA is negative...   Your chiropractor must be diligent in doing a focal neurologic and vascular examination, or he/she must refer you to the neurologist (or both).   Cervical cord compression can cause all the symptoms you describe.  Depending on how much compression, the DC must be extremely careful in doing any neck joint manipulation!!   If there is any real concern about your carotid arteries, then wait until the MRA rules out any problems.   Did the chiropractor listen to the arteries with a stethescope?   If you have significant cord compression with positive neurologic signs (loss or alteration of reflexes, weakness), you may have to consult a spine or neuro' surgeon.    If your MRA is positive for such items as aneurysms or arterial wall dissection defects, they you are ASAP to the vascular surgeon.   

'Hope this helps.

Dr. G

---------- FOLLOW-UP ----------

QUESTION: Thank you Dr. Gillman, you made me feel like I was not crazy.  The problem is trying to get any of the doctoros that I am seeing to tell me this, or recommend me for the right type of tests.  My neurosurgeon says he does not believe in cervicogenic dizziness, and says that no doctor will give me the therapy that they do for this because of my disc herniations.  I am at a loss.  What type of doctor should I be seeing for this, are there any listings of doctors who treat this in my area (New Jersey).

Answer
Hi Christine,

'Sorry you're having such difficulties with your doctors.   I would recommend you email me off-list on finding a DC in Jersey (Hey! I'm from 'Jersey!).   I know of a few, but you have to let me know what region of Jersey you're from.  Contact me at [email protected] and put some identifying info in the title-box so your mail doesn't get spammed...  

'Best,

Dr. G'