Spin Control: What to Do When Youre Dizzy
Dizzy Dean, the great baseball pitcher of the 1930s-1940s, once quipped, "The doctors x-rayed my head and found nothing."
That is as good an analogy as any in describing what often happens to patients with the symptom of dizziness. They see a doctor, get an MRI scan (the x-ray of the 21st century) and nothing is found.
To extend the baseball theme, patients sometimes complete a triple-play-going from family doctor to ear specialist to neurologist. And when all is said and done, none of the doctors is willing to own the symptom. Each says it's the other doctors' problem!
So where does that leave the patient? Probably out of a lot of bucks and getting more frustrated by the minute!
But, upon close analysis of the symptom, a case of dizziness can give up its secrets. It turns out that the word "dizziness" gets used to describe a variety of experiences, and those different experiences can themselves result from a number of underlying causes.
So the way one gets to first base is to sort through the patterns and narrow down the list of possibilities. In analyzing the symptom of dizziness, sometimes a multiple-choice approach works best. Most people can select one of the following three descriptions as most resembling their symptom:
#1. A sense of motion, perhaps spinning, rotating or even just drifting in space. It doesn't matter if the person feels they are spinning or that the room around them is spinning: both mis-perceptions have the same significance. These perceptions are known as "vertigo."
#2. A feeling of unsteadiness or imbalance in the body more than in the head.
#3. A feeling of light-headedness, wooziness, giddiness, or even verging on losing consciousness.
That the term "dizzy" can sometimes have still other connotations is illustrated by Mr. Dean's own nickname. He probably didn't get it because of attacks of imbalance. In fact, the pitcher supplied his own explanation with another of his famous quips: "The good Lord was good to me. He gave me a strong body, a good right arm, and a weak mind."
Let's focus on the more usual three patterns.
Distinguishing among these patterns helps separate the cases involving the head's balance (vestibular) system from those that don't. In short, pattern #1 (vertigo) is most likely to involve a disturbance in the balance system, while pattern #3 (light-headedness) is least likely. Instead, light-headedness or wooziness can be due to a momentary drop in blood pressure (for example, when standing up too quickly) or due to the same factors that produce outright fainting. Pattern #2 (bodily imbalance) is somewhere in-between-sometimes caused by a disturbed balance system and sometimes due to something else.
The vestibular system consists of the left and right inner ears, certain pathways within the brainstem (junction between the upper brain and the spinal cord) and the nerves that connect the inner ears to the brainstem. A problem in any of these components can lead to the symptom of vertigo. But the kinds of problems that can disturb the brainstem-like stroke, tumor or multiple sclerosis-are quite different and usually more serious than most the conditions that disturb the inner ears or their associated nerves.
So once the pattern of vertigo (mis-perception of movement) has been distinguished from the other kinds of dizziness, there is still more figuring to do-is the problem in the brain (central pattern) or in the inner ears and their connecting nerves (peripheral pattern)?
Luckily, central and peripheral vertigos can usually be distinguished from each other based on the clinical history and physical exam. The key is in looking for any symptom or physical abnormality that can't be blamed on the vestibular system.
How about nausea, vomiting, unsteadiness, walking into walls, blurred vision or even jumping vision? A malfunctioning vestibular system could easily account for them all. But double vision, slurred speech, weakness or numbness on one side of the body? No way. These symptoms would have to be generated outside of the balance system, and imply that other pathways in the brainstem are damaged.
Where does the MRI scan fit in? The MRI is good at seeing areas of abnormal growth or damage within the brainstem, as from tumors, strokes or multiple sclerosis. It can also see tumors that arise from the nerves connecting the brainstem to the inner ears. But that's about all it can see that is at all related to the symptom of vertigo.
However, there are far more cases of peripheral vestibular disease than of central (brain-based) disease causing vertigo, so that's why most MRI scans turn out negative. In short, the MRI is normal, but the patient isn't.
So what can cause peripheral vestibular disease? The causes are varied, but are more usually annoying than life-threatening. The most explosive form of peripheral vestibular disease is vestibular neuronitis or "inner ear attack." The typical story for this condition is that the person awakes with violent spinning, nausea and inability to walk a straight line. This condition is at its worst on the first day, gradually improving over subsequent days and weeks.
Another peripheral vestibular condition is Meniere's disease in which recurrent bouts of vertigo occur in conjunction with deafness and "roaring" tinnitus, or ringing in the ear. This is due to high fluid pressure within the inner ear which is also wired for hearing.
Yet another peripheral vestibular disease involves a stone (otolith) rattling around within the canals of an inner ear. This variety can sometimes be fixed by "vestibular repositioning" in which the patient's head is put through a series of abrupt position-changes designed to make the otolith stick in one place.
Medications can also be useful in diminishing the symptom of vertigo. The most widely used drug is meclizine (brand name Antivert) which is related to the antihistamines and helps simmer down an overactive inner ear. A second drug used in the same way is scopolamine, usually delivered via a patch on the skin (Transderm Scop). Finally, diazepam (Valium) can also be used a "vestibular suppressant" though is usually the last choice owing to its possibility of becoming habit-forming.
And how about those other forms of dizziness that involve lightheadedness, wooziness or giddiness? As a baseball player might say, "That's a whole other ball game."
(C) 2005 by Gary Cordingley
Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher. For more health-related articles, see his website at: http://www.cordingleyneurology.com
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Buy with confidence at Online Mexican Pharmacy
The foremost benefit of buying prescription medicines and other medical supplies from a Mexican pharmacy is the secure buying procedure and easy on the pocket rates. The health and medical care laws in Mexico are not that strict infact completely different and relaxed as compared to the US laws.
Watch Out for Misleading Pharmaceutical Advertising
In 1997, the Food and Drug Administration relaxed the rules for drug advertising on television and radio. Since that time, the airwaves have been flooded with commercials for all sorts of drugs.
Stopping Hospital Infections
Each year hospitals end up killing twice as many people than automobiles, some 90,000 deaths in the United States. It is not from malpractice, it is due to infections.
Facial Pain: When a Nerve Is a Live Wire
Of all the places in the body that can hurt, the face might seem the strangest. But for some people, that's exactly where the agony occurs, and the cause is a nerve gone haywire.
Medical Billing PDA: 21st Century Convenience for Medical Practices
Medical Billing PDAOne of the first things I notice about a medical office, whether it be with my dentist, my family doctor, or my optometrist, is the walls full of color-coded files containing medical histories, billing information, and tracking information for prescriptions check ups and various other things. As a patient, it is fun to trace the colored tags across the files and wonder what they mean.
Phentermine Price Watch: Comparison Shop To Buy Phentermine At The Best Values Online
When compared with the other prescription diet pills, Phentermine is the best buy if you're looking for a way to just finally get a handle on your weight loss without embarassing gas problems or dangerous blood pressure levels. When you begin taking Phentermine, you'll enjoy another huge benefit: Unlike other diet pills that block fat, Phentermine stops your cravings so you can focus on eating healthy foods in healthy portions.
Melatonin, Sleep Enhancement, and ADHD
Overview Melatonin is a natural hormone, which is produced and secreted by the pineal gland. Melatonin plays an important role in the regulation of many hormones in the body.
Ingrown Toe Nails Medical Treatment
Medical Care:Treatment options depend on the stage of ingrown toenails, medically known as onychocryptosis.Stage 1 can be managed by recommending shoes with a comfortable wide toe box or open-toed shoes.
Onychomycosis - One Of The Many Nail Fungus Out There
Many natural changes in fingers and toenails come with age. Fine ridges, for example, may start developing from the cuticle of the nail tip.
Bextra and Vioxx Withdrawal Spawn Advertising Pause from Bristol Myers
Pharmaceutical giant Bristol Myers Squibb has announced that they will suspend direct-to-consumer advertising for their prescription drug products for a year. This comes in the wake of the well-publicized withdrawals of Merck's Vioxx and Pfizer's Bextra, two non-steroidal anti-inflammatory drugs (NSAIDs) that were voluntarily withdrawn from the market recently.
Lunesta is a newly released sleeping pill. Marketed as a revolutionary sleep aid, Lunesta is the only medication approved by the FDA for long term treatment of insomnia symptoms.
Curing Lou Gehrigs Disease
ALS is the disease that took the life of the famed baseball player. The disease benched Lou Gehrig from the game that he loved and later took his life.
Lipitor Lawyer: Statin Drugs Cause Muscle Damage in 98%
Doctors have been encouraged to prescribe the cholesterol-lowering drugs called statins quite liberally. Patients who suffer heart attacks often have elevated levels of cholesterol, so statins like Lipitor are prescribed to lower the cholesterol.
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