Vertigo

Dizziness is a common complaint, especially during the summer months when people may be dehydrated with excessive sweating and inadequate fluid replenishment.

Nov. 22, 2014, 5:45 p.m. Published in Magazine Issue: Vol: 08 No. -11 November. 21- 2014 (Mansir 5, 2071)

A 48 year old man presented to the clinic with what he described as dizzinessand vertigo for a week. On further questioning this patient said that several times during the day, he sees the room spin and feels faint. These problems arise especially with certain head movements, and he says that the spinning lasts from a few seconds to several minutes. In between these spells of vertigo he says he is fine. But now he is very worried as he thinks he may soon be having a stroke or that he already has a brain tumor.

In fact he was so worked up that he had been to another medical practitioner specifically asking him to order a MRI( magnetic resonance imaging) of his head as he had read that if  this particular scan was negative, a brain tumor could be ruled out. Indeed a MRI had been performed which was normal, and he felt re assured that this was not a malignancy in the brain manifesting with these problems. But he now needed to find out what exactly was going on and seek proper treatment for this. Even if this may not be serious medical problem he said this was sure anxiety- provoking.

He had no other medical problems. He tried to exercise daily and lead a healthy lifestyle.The physical examination was normal.

Dizziness is a common complaint, especially during the summer months when people may be dehydrated with excessive sweating and inadequate fluid replenishment. Drinking enough fluids should take care of this common cause of dizziness. In the summer time people are also more prone to diarrheal diseases. Diarrhea can only compound the problem of dizziness. Feeling faint is a very common sensation in people with excessive diarrhea because of the decreased blood flow to the brain( due to fluid loss) especially when someone with severe diarrhea attempts to suddenly stand up after sitting or lying down.

So indeed, someone who has dizzy spells especially while standing up from a lying down position needs to get up gradually with support as this will allow time for the blood flow to reach the brain in adequate amount and avoid a fall. Injuries after a fall due will only compound the problem. This is especially true in elderly people who may fall down due to dizziness triggered by dehydration (especially in the summer months) and sustain a fracture.  

Dizziness which is often described as a sensation of lightheadedness has to be distinguished from vertigo. Intake of adequate fluid will take care of the problem in the patient with dizziness due to excessive sweating or diarrhea.

But vertigo is different. Vertigo as in our patient’s case is often described as a sensation that the room is spinning and fluid intake will not relieve the problem. People sometimes use these terms ( dizziness\vertigo) interchangeably and can be confusing.

What our patienthad is a very common but often alarming problem called benign positional vertigo( BPV). The name denotes that it is benign ( not serious) and should therefore help to reassure the patient. It is a positional  vertigo because turning the head to the right or left, tilting the head to look upward, lying down can often bring on the sensation of the room spinning.  The pathology lies in what is called the labyrinth (passage) inside our ears.The labyrinth of the ear is responsible for processing information with regards to position and movement. Inside the labyrinth are calcium carbonate crystals that have been displaced to cause BPV. And amazingly a certain maneuver ( called the Epley maneuver) can reposition the crystals to their normal position and help the patient.After making a proper diagnosis, health care professionals that know this technique can carry out this simpleprocedure in the examining room and provide great relief to the patient.

Buddha Basnyat.jpg

Buddha Basnyat MD

Buddha Basnyat, MD, MSc, FACP, FRCP, Director of the Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Kathmandu.

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