Epilepsy, maybe?

I've had some episodes in the past few years that I don't know the cause of...I didn't realize it was recurring until last week.  
I start out feeling just generally unwell for a day or so, then all of sudden I get very dizzy and nauseated, feeling like my head is spinning a hundred miles an hour and get hot and cold.
The first time I was walking when it started, and I kept running into walls until I finally laid down, and the dizziness lasted about 15 minutes.
The last time, it was much worse, couldn't get up off the floor for half an hour, and I kept vomiting because I was so dizzy. Every few minutes I would pass out briefly for about a minute or so. I was also trying to talk to a friend of mine who was trying to help, and I couldn't seem to talk.
After it's over, I feel tired but completely fine.
I'm just unsure of what this is, and now that I realize it's happened several times, I'm thinking it might be more serious.  I'm 28, pretty healthy, but my mom and brother both have epilepsy. Could these be some type of seizure?
I don't have insurance, but do you think it sounds serious enough I should save some $$ and try to get tests done, or  wait until it happens again?

[Joanna Fong, MD]

Hi indigo39,

Your episodic spells of dizziness, nausea, vertigo (spinning) can be due to several things.  I will list the most common:

1)  Yes, seizure is possible, especially if your symptoms are associated with decreased level of consciousness, jerking (clonic) or stiffening (tonic) of your limbs/body.  However, they can also occur without the typical seizure symptoms of tonic clonic movements.  They can be an aura.

For diagnosis:  
a)  Neurology visit/consultation:  history, physical examination
b)  EEG (electroencephalogram): to capture your "spells" to see if they're epileptic (seizure) or nonepileptic; to see if there's any abnormalities in between your spells.  
c)  Imaging studies: e.g. MRI brain with and without contrast - to see if there's any structural abnormalities to explain your symptoms.  

2)  Peripheral vertigo: "inner ear" problem, also known as Benign Positional Paroxysmal vertigo (BPPV).  Its onset is often sudden, positional, with severe nausea, tinnitus (ringing sound), or decreased hearing.  Symptoms are worse with bad ear facing down.  Causes of BPPV are:  headache trauma, labyrinthitis (ear infection), aging.  Probably due to dislodgement of calcium carbonate crystals (otoconia) from utricle and saccule into posterior semicircular canal (all are inner ear structures).  

For diagnosis:  
a)  Neurological examination

For treatment:
a)  Otolith repositioning maneuvers aimed at moving otoconia back into utricle (Epley maneuver); done by neurologist
b)  Labyrithine suppressants (meclizine, diazepam)
c)  Refractory cases: surgical section of posterior ampullary nerve, obliteration of posterior semicircular canal

3)  Central vertigo:  less sudden onset, less nausea, continuous symptoms independent of posture, usually no hearing loss.  Causes of central vertigo:  brainstem lesion (from stroke, demyelination, tumor, etc), cerebellar lesion (from stroke, demyelination, tumor, etc), acoustic schwannoma.  Vertebral arterial dissection is a rare cause of central vertigo; typically associated with severe headache.  

For diagnosis:
a)  Neurological examination
b)  Imaging studies:  MRI brain with arterial imaging (e.g. MRA).  CTA is a good noninvasive alternatives for arterial imaging.

Good luck.  Thanks for using MedHelp Forum.

THIS INFORMATION IS PROVIDED FOR GENERAL MEDICAL EDUCATION PURPOSE ONLY.  PLEASE CONTACT YOU PHYSICIAN FOR DIAGNOSTIC AND TREATMENT OPTIONS OF YOUR SPECIFIC MEDICAL CONDITIONS.

[nathan2321]

For God sake get a Medical Insurance. Health is more important then wealth.

I am not saying you have some sort of illness, but it will help you to pay professional consultancy charges and to get better and fast treatment.

Do it before it's too late.

[lizzie_e]

My father had that calcium deposit problem, and it's truly the most bizarre and fascinating condition. I used to go to the gym with him as a child and watch him do weights, and once he got a spell of it while I was there. He sat up and, looked at me, went cross-eyed and  immediately threw himself to his left off the chair. I would have laughed out loud if I wasn't so astonished. Shortly after that he started retching, tried to pick himself up and then proceeded to hurl himself over backwards. He was lucky not to have brained himself on the dumbell he narrowly missed on the way down. Sometimes he'd sit up out of bed and try to shoulder-barge the wall. The thing you said about "running into walls" sounds a lot like the sort of thing he used to do. He couldn't figure out which was was up or down or left or right, and he was so incredibly sick when it happened. He told me that there are tiny hairs in your inner ear that move when you move your head, to tell you where your centre of gravity is (which way is right or left etc). There were loose calcium deposits in his ears, which floated around, and occasionally brushed the hairs (making his brain think he'd just turned his head to the right or whatever) Automatically, without being able to control himself, he "corrected" his balance, so as to avoid falling over, and ended up, lo and behold, staring at the ceiling with a sizeable bump on the back of his head and a pile of puke beside him. The doctor kind of fixed it by manovering his body so the calcium deposits were wedged in a cavity where they couldn't flutter around and brush the hair follicles and screw up his balance. I'm not saying you've got this but if you do, don't worry, you'll be fine: my dad is. Also, though it sounds funny, it's not funny to watch at all: it's quite scary, so don't worry about people laughing at you! Hope my wee story made you feel better.
Oh and the other person's right: get insurance! :-)

-Lizzie

[jenoz]

You might want to look into migraine related vertigo of the silent type,
called atypical migriane, silent migraine, or bickerstaff syndrome,
I have mav caused by basilar artery migriane, it can also have the same symptoms as above.
some times causes a very spaced out feeling.
jen