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Information about Vertigo
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Information about Vertigo

I'm posting this because so many people are plagued by vertigo and dizziness.  It is a far more disabling symptom than most people realize.  I, myself, was disabled 6 years ago with a complicated form of it and understand intimately how it disrupts one's life.  By posting here and not specifically in response to someone's question I hope to give people a reference, some hope, and direction to the specific people who can most help them.  Maybe we can use this thread for a little while to discuss vertigo, dizziness and balance.

This is a long post.  I hope those of you with vertigo questions will take the time to read it and I hope it is useful.

Vertigo is true dizziness - the sensation that you are not steady or stable physically in the world.  It may be a sensation of spinning, falling, vague or persistent unsteadiness, or of poor balance. You be nauseated or actually vomit, you may fall, you may just feel like your head is "in a bubble" waving around disconnected to your body.

Vertigo is NOT fear of heights nor is it the light-headedness of feeling like you are going to faint (though many people describe that as "dizzy").

There are many causes of vertigo.  This is because there are many parts to the body that ensure that you feel steady in space.  When any system is disturbed we may feel unsteady, unbalanced or dizzy.

THE BRAIN:  The brainstem is the central controller of balance and equilibrium, so problems there may show up as poor balance, unsteadiness or dizziness.  An example is basilar migraine when the artery that supplies the brain stem is affected by the constriction of the artery.

THE INNER EAR:  The most important organ for balance and steadiness is in the inner ear.  It's called the vestibular system.  This is where all the information about "where DOWN is"  (that is sensing the direction of gravity), what kind of motion or acceleration you are doing (forward, up, down, rotational, etc) what position your head is in.   It senses all the various information and then sends it up to the brainstem.  The brainstem then coordinates the info and directs the body so that you can move appropriately, catch yourself if you stumble, and know if you are lying down or upright.

THE EYE: The eyes place a role also.  By knowing where the horizon is (seeing horizontal lines) and by seeing vertical things the eyes confirm what the body, inner ear, brain are sensing.  If you are stumbling along the eyes will confirm that the pathway is uneven and help the brain modify how you place your feet so you don't fall. It's a secondary role, but helpful.  If you can't see anything at all you must rely on the other systems to stay upright and move around.  If you have ever had double vision, you quickly learned how much you use your eyes to stay steady.

THE REST OF THE BODY:  The body - especially in the joints - has position sensors that send constant information to the brain about what position the limb or joint is in.  If your nervous system is working right you can tell - without looking - whether your elbow is bent or straight.  This is another secondary system for being steady and confident in space.  The other peripheral senses that help include the pressure sensors so you can tell when you feelt are on the floor.

There are many kinds of vertigo and causes.  The important thing that I want to explain here is that, in my personal/professional experience most doctors, including ENT and general Neurologists, do not know very much about vertigo.  They don't know how to properly test for it, how to distinguish the various causes, how to take a good history for it and, especially how to treat it.  Mostly they just give out Antivert or an antihistamine.  Unless you are having the mild dizziness associated with congestion from allergies, an antihistamine isn't going to help much.

WHO DO YOU SEE TO EVALUATE REALLY BAD OR PERSISTENT VERTIGO?

There is a subspecialty of neurology and ENT called "Neuro-otology."  This isn't a huge field, but the doc in it really know a complicated set of things.  There is also an organization in the US called "The Vestibular Disorders Association" VEDA.  Their website has a wonderfully readable explanation of vertigo and the various problems which cause it.  You will learn a ton of stuff if you read their webpages.

VEDA also publishes a list by state of the clinics, practitioners and physicians who state that they are specialists in vestibular disorders.  You can also contact major medical centers to see if they have a "Vestibular" Clinic or service.

WHY IT IS SO IMPORTANT TO HAVE VERTIGO EVALUATED:

I can't believe how often our doctors dismiss the complaint of "dizziness"  when we list it among the other symptoms we are having like severe headaches, ear problems or hearing loss, ringing, buzzing, roaring in you ears, ear fullness or pain, severe fatigue, mental fog or cognitive problems, or memory loss.

Let me explain just one scenario - it happens to be mine.  When I started having drop attacks, severe dizziness and apparent seizures (later shown to be pseudo-seizures) I also complained fiercely about incredibly severe fatigue, headaches, difficulty thinking and calculating, difficulty with auditory processing, BRAIN FOG, loss of short term memory, AND horrible problems with word recall.

My doctors seemed only interested in proving whether or not the seizure-looking attacks were real.  I kept telling them I knew the primary problem was the vertigo, the fatigue and the brain fog.  When I described these symptoms their eyes would glass over and they would change the subject.  I knew the "she's a crock" look on their face.  I went through 3 neurologists and 2 ENT's.

I finally had to research the internet myself and find my own physician.  The man I found was the one who single-handedly revolutionized the entire field of neuro-otology whe he devised the non-invasive and very simple cure for BPPV benign positional paroxysmal vertigo.  I flew about 1000 miles to see him and found the single most compassionate physician I have ever met.  He teased out the 3 different vestibular problems I had, treated 2 of them and worked on treating the third.  I was able to return to pediatric practice for a year, before everything deteriorated from the first ear into the other side, and he determined I had autoimmune inner ear disease.

The point here is that when my inner ear stopped functioning I lost the primary organ for balance and steadiness.  Without that major organ functioning quietly and automatically in the background I had to rely on my other senses to even walk across the room in the daylight.  My eyes had to take over the burden of making sure I was upright and steady.  I stay upright only when I can see vertical and horizontal lines.  If I close my eyes I start wavering and swaying immediatly.  In the complete dark I go over and don't know I'm falling until I hit.

The problem - besides the obvious - is that when the eyes take over this function they do not do it without a COST.  It's not automatic and effortless.  Using the eyes for balance uses some amount of the conscious mind and of the attention.  It very quickly results in severe mental fatigue - yes, causing fog, memory, language, and processing problems.  A good analogy is if, in a computer, the CPU was unable to run a large program, so it was left to the RAM (memory) to do the whole load.  The program would slow, bog down and crash.

If it were simple loss of balance I could have used a walker or a cane and staggered around and been able to continue medical practice.  But after being up for a few hours my brain functions began to fail with the fatigue and I couldn't handle the cognitive demands of practicing medicine.  Every day that interval of effective mental functionaing got shorter and shorter. After a night on call, I couldn't function even in an emergency.

Vertigo is a HUGE neurological symtpom and it needs the right specialist to evaluate it.  If you have recurrent or chronic vertigo or balance problems and you also have some of these mental problems which nobody has yet linked to the vertigo you deserve the right evaluation.

START HERE:  http://www.vestibular.org

Read up on this site and you will be able to ask better questions here and be able to give your doctor much better information. Feel free to use this thread to ask question about your vertigo or to ask about anything I've mentioned.

Quix
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Quixotic1


this is a great post full of info!

THANKS!
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along w/ multiple other problems concerning vertigo my bladder stopped functioning and my sex life went with it i still have issues w/ walking and seem to hit my head on things that i wouldn,t think i would normally i have become arguementative my husband says i am not the same person thats scary cause i don,t seem to understand what i,m doing wrong
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A most excellent post, Quixotic. You really know your stuff. I have had unexplained dizziness for many years and had to study up on it too, because even the best doctors (a neuro-otologist and an otoneurologist) couldn't give me a diagnosis, although I finally did get much better.

Very sorry you had to give up your work--that must have been devastating. Most people don't realize how disabling a vestibular disorder can be. Glad Dr. Epley was able to help you. He is a pretty amazing individual.

You are so right about most doctors having a poor understanding of dizziness and especially of the cognitive component (certainly MY worst problem at the time) and the fatigue that goes along with it.

Besides neuro-otologists, you have otoneurologists (neurologists specializing in dizziness "from the brain side"). I think neuro-otologists will refer people to one of these if necessary, although there aren't very many of them. I am lucky to live in a city where we have both.

Note that not all the good specialists are on the VEDA list. Some aren't, and it's not because they aren't good. It's also important to note that the professionals on the VEDA lists aren't screened by VEDA--they only have to state they have special training in vestibular issues and pay their membership fee to get on the list. So ask questions before you go see someone, to get a sense of what training they've had and what percentage of their practice is vestibular patients (this is especially important if you're going to see a vestibular therapist--their abilities and training really vary!).

Nancy
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This is a great post which I found very helpful and interesting. I've had vertigo on and off for 10 years and I'm currently going through a bout which has lasted 8 months. I also have tinnitus in my left ear and some hearing loss. I've been investigated by an ENT for Menieres, but now he's decided to refer me to a neurologist. I feel as though I'm being passed from pillar to post. I've had lots of tests over the years and nobody has come up with anything concrete. The bottom line is that 'we just don't know!' This doesn't help when you're feeling so ill that going about your daily life is a struggle. I'm in the UK and I don't know if there are any neuro-otologists practising, but after reading this post, I'm going to look. Thank you
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I like what you wrote, it was very helpful for me to read and understand a little more what has been going on with me these last few days. I am trying to get informed so i am not misinformed.

Last week i got out of bed and walked right into the wall. My unsteadiness to me is bad. I am a healthy person, i am only 24 years old and i can handle a lot of pain i do not complain a lot about sickness or anything else. So when i could not walk straight i started to wonder what happened over night. Although i started thinking about things and i have been having discomfort on the left side of my head. Nothing to do with my ears whatsoever. So i went to the doctors that day. He said my ears look fine but he still thinks that i have an ear infection. He didnt tell me to take anything for it, but he told me to go to the Neurologist and i have an appt. to get an MRI, so this started to make me wonder what is really going on. He also looked at me like i was making it all up. So far i have missed 3 days of work, i tried to drive on friday but i started to get dizzy in the car. My unsteadiness isnt an episodic thing, it has not gone away, i am able to walk and stand but i feel sick, and like i am going to fall, being in the car when someone else is driving is nauseating. So now i have to wait until Friday Nov. 14th to get my MRI so i cant go to work or school.

Sorry this was a book. But like everyone else said here it is a big intrusive problem that messes up your life and people that do not experience it do not understand it.  
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