RSD Puzzle #024

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

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INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

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RSD PUZZLE #24
Visual And Hearing Problems

RSD patients frequently develop blurring of vision, reading difficulty, problem with focusing, dizziness in the form of vertiginous attacks (either the body or the objects moving around). As well as hearing problems such as buzzing in the ear (tinnitus).

It is immaterial which part of the body has had the damage causing RSD. As the enclosed figure shows, the sympathetic nervous system is intermingled and connected through sympathetic ganglia which are on each side of the vertebrae from lower cervical spine region all the way down to the tail bone. This chain of sympathetic connections causes the spread of RSD to symptoms and signs both across the midline to the opposite side (from hand to hand or from foot to foot) and vertically up and down the spine. As a result, the patient may have RSD due to a knee injury or injury to the foot or hand and yet may develop stimulation and abnormal function of the sympathetic system causing constriction of the blood vessels to the brain. When the blood vessels are constricted in the distribution of vertebral arteries in the cervical spine and in the distribution of the blood vessels providing circulation for the hearing center and brainstem, the patient develops attacks of dizziness, trouble with focusing with the eyes (due to brainstem dysfunction which has the responsibility of coordinating the eye movements), and buzzing in the ears (tinnitus).

Treatment with alpha blockers (such as Clonodine, Hytrin, etc.), as well as newer antidepressants such as Trazodone or Zoloft, provide excellent relief for the above symptoms (figure enclosed) and Muscle relaxants such as Baclofen and Trizanidine.

At times the original injury that has caused RSD may cause retinal detachment (damage to the retina of the eye) or bleeding of the eye. For this reason, the patient should have careful eye examination by an ophthalmologist as well.

H. Hooshmand, M.D.

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