”MY HEAD IS SPINNING”

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Dizziness and vertigo rank very highly as one of the reasons patients are referred to me for consultation. The overall incidence of dizziness, vertigo, and imbalance is 5-10%, and it reaches 40% in patients older than 40 years. The estimated number of 2011 US emergency department visits for dizziness or vertigo was 3.9 million.

Dizziness is a term used to describe a range of symptoms that include feeling faint, woozy, weak or unsteady. Vertigo on the other hand refers to a sensation that one is moving and the surroundings are spinning. These are two different entities that needs a clinical to differentiate as the causes and management are different.

Dizziness and vertigo have many possible causes. Sense of balance is controlled by interplay between the eyes, sensory nerves and inner ear. When there is an inner ear disorders, your brain receives signals from the inner ear that aren’t consistent with what your eyes and sensory nerves are receiving hence causing a sensation of spinning.

Benign paroxysmal positional vertigo is a common condition that affects the inner ear that causes severe vertigo. The episodes are caused by sudden movement and changed of head position. It can be diagnosed and treated by a physician doing certain manoeuvres of the head to correct the causative problem in the inner ear. Infection of the middle ear, commonly due to viruses can also causes dizziness or vertigo.  Meniere’s disease is a  disease that  involves excessive build-up of fluid in the inner ear resulting in episodes of vertigo lasting as long as several hours. It also causes fluctuating hearing loss, ringing in the ear and the feeling of a plugged ear.

Blood circulation problems, especially low blood pressure can also be a cause of dizziness. Dizziness can also occur when one stands up too quickly or seats from a lying position, a condition known as Orthostatic Hypotension. Other conditions that we discussed previously such as heart failure, heart attack and arrhythmias can also cause poor circulation and dizziness.

Dizziness can also occur as a side effect of medication. The common implicated medications are anti-seizure drugs, antidepressants, sedatives,  tranquilizers and blood pressure medications. Blood pressure lowering medications may cause faintness if they lower your blood pressure too much. Other conditions that can cause dizziness include, but not limited to anaemia, low blood glucose, anxiety, dehydration and certain neurological conditions like migraines and Parkinson’s disease.

Even though dizziness and vertigo are quiet a common presentation, it can be difficult to determine the cause and to managed. Often a meticulous history and review of medications is done by the treating physician. Certain bedside tests need to be performed in order to establish an aetiology.

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