Understanding Your Dizziness

 

The sensation of dizziness is due to a disturbance in nervous signals in either the inner ears, brain, eyes, spinal cord & leg nerves.

 

Patients have a primary cause of their dizziness and a secondary response to their dizziness.

 

The Primary Cause

The primary cause generates a sensation “dizziness” (either a spinning sensation “vertigo” or an imbalance “unsteadiness” sensation).

 

Examples of specific primary causes are as follows: –

 

Inner ear

Benign Paroxysmal Positional Vertigo (BPPV) – “Crystals in the inner ear”

Ménière’s Disease

Vestibular Paroxysmia 

Vestibular Neuritis

Superior Canal Dehiscence

Middle Ear Perilymph Fistula

Bilateral Vestibulopathy

Herpes Zoster Oticus (HZO) and Ramsey Hunt Syndrome

 

Brain

Central Positional Vertigo

Vestibular Migraine

Chiari Malformation in Adults

Motion Sickness and Persistent Dizziness

Psychological Trauma

Severe Medical Illness 

 

Eyes

Poorly fitted glasses

Binocular vision dysfunction

 

Spinal Cord and Leg nerves

Peripheral neuropathy

The primary cause once identified can be treated.

 

The Secondary Response.

The brain is not passive; it tries to handle the new troubling situation by using the frontal lobes of the brain to suppress the disturbances created by primary cause.

This secondary response initially stabilises the situation but often, paradoxically, leads to further imbalance symptoms which are typically a continuous rocking sensation and brain exhaustion. In many patients this can become the dominant problem.

This secondary response it is called Persistent Postural-Perceptual Dizziness (PPPD) and once recognised can be treated effectively.

 

The Diagnostic Challenge

The patient’s symptoms are often a mixture of the symptoms of the primary cause and the secondary response. These need to be untangled so as to get a clear understanding of the initial cause and the extent of the secondary response.

 

 

Possible Causes of Dizziness

 

Benign Paroxysmal Positional Vertigo (BPPV) – “Crystals in the inner ear”

This is a very common cause of dizziness.

The typical experience is a sudden sensation of spinning, either when turning over in bed, bending over or looking up.

 

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Ménière’s Disease

Ménière’s disease (pronounced “many-ears”) is rare problem of the inner ear.

It is a repeating problem of the inner ear in which there is a build-up of fluid in the membranes of the inner ear giving a feeling of pressure or fullness in the ears. These membranes then suddenly burst making you feel very dizzy.  

 

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What is Central Positional Vertigo and What Causes it? 

A simplistic way of thinking about this condition is to regard it as a “dangerous and abnormal benign positional paroxysmal vertigo (BPPV)” because it can be caused by disease in the brainstem or cerebellum.

 

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Persistent Postural-Perceptual Dizziness (PPPD)

This is an important common cause of “dizziness” with three key features:

i)A long-standing complaint** of non-spinning “dizziness” on most days.

ii)Associated with anxiety and low mood.

iii)Normal clinical examination.

 

 

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Vestibular Migraine

Dizziness due to migraine/ vestibular migraine is quite common. The diagnosis is based on the patient’s story as there are no clinical findings except when the patient is having an attack and there is no blood test or scan that can make the diagnosis

 

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Vestibular Paroxysmia 

VP is a rare condition in which an artery presses against a nerve of the inner ear – either on the right or left side. 

 

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Vestibular Neuritis

This is a common cause of severe prolonged dizziness due to injury of the inner ear. 

 

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Superior Canal Dehiscence

This is a rare condition and is one of a group of diseases caused by a “third mobile window”. It is due to an abnormal connection between the inner ear and the brain cavity.

 

 

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Middle Ear Perilymph Fistula

This is a rare condition in which there is a tear between the middle and inner ear. Let us explain further. 

 

 

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Advice and Medication

Advice and Medication for Acute Vertigo and Nausea for all conditions other than BPPV.

 

 

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Chiari Malformation in Adults

 

The fundamental cause of this condition is that the cerebellum is too big for the posterior fossa and is pushed down through the foramen magnum.

 

 

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Bilateral Vestibulopathy

Bilateral vestibulopathy (syn. bilateral vestibular areflexia) is a consequence of significant injury to the balance portions of both inner ears.

 

 

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Herpes Zoster Oticus (HZO) and Ramsey Hunt Syndrome

These conditions are two forms of the same disease process where Ramsey Hunt Syndrome is Herpes Zoster Oticus with a facial nerve weakness.

 

 

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Motion Sickness and Persistent Dizziness 

Motion sickness, often called sea sickness, occurs when your brain receives conflicting signals from your eyes, inner ears, skin and joints about your state of motion. 

 

 

 

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The First Attack of Vertigo – Is it a Stroke or is it Inner Ear Disease? 

If a first episode of vertigo occurs without any pre existing history of dizziness both the patient and clinician are concerned whether this represents a Transient Ischaemic Attack (TIA/ Mini Stroke) which may herald a more serious stroke with its devastating consequences. 

 

 

 

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