Thursday, July 24, 2014

VERTIGO or DIZZINESS or GIDDINESS

VERTIGO

What is vertigo?

Vertigo is a common symptom in patients presenting to neurology outpatient department. It is described as a sense of rotation (rotation of self or of the surroundings). Other terms to describe the same sensation are dizziness, giddiness, chakkar (in Hindi), tala tiragadam (in Telugu), etc.

What are the common symptoms in a patient with vertigo?

The most common feeling is a sense of rotation or imbalance. This feeling becomes more prominent while walking or moving. In some cases, even head or neck movements (such as getting up from lying down position or bending down to pick something) can aggravate the symptoms of dizziness. Other symptoms may include:

·      Nausea,
·      Vomiting,
·      Imbalance while walking,
·      Blurred vision,
·      Poor concentration.

What are the common causes of vertigo?

Vertigo can be caused by a variety of reasons. The more important of them include:

BPPV- benign paroxysmal positional vertigo

·      In this condition, there is a problem in the inner ear. Calcium crystals get deposited in one of the semicircular canals.

·      It can occur in all ages, and is common in adults and in older people. It affects 2.4% of population sometime in their lifetime.

·      It is a benign condition, which means it is not life-threatening and it does not get worse over time,

·      Symptoms are made worse with head or neck movements (positional symptoms),

·      Symptoms occur intermittently,

·      People may get better in 1-2 days, however, in some, it may last for a few months also,

·      Head injury, concussion, migraine, etc may bring on the symptoms of BPPV

·      Diagnosis is made on the basis of history and clinical examination. Hearing and vestibular tests may be helpful.

·      Treatment consists of symptomatic treatment with antihistaminic medications such as betahistine tablets.

·      Canal repositioning procedures done in office are helpful and can cure the condition, however, these procedures should be done by trained doctors,

·      Vestibular adaptation exercises help in prevention of recurrent episodes of vertigo.

·      In refractory cases, there may be a role for ear surgery. 
2
Posterior circulation stroke (Brain stroke)

·      This refers to reduction in blood supply to the back of brain, mainly cerebellum and brain stem.

·      This is more common in people with risk factors for stroke, such as high blood pressure, diabetes, high cholesterol, smoking, etc.

·      Patients often have additional symptoms such as double vision, slurred speech, difficulty in swallowing, imbalance while walking, etc. Isolated symptoms of vertigo without any additional symptoms, seldom/rarely occur due to brain stroke.

·      The diagnosis can be confirmed by doing an MRI scan of brain.

·      Treatment is done as for brain stroke (refer to my earlier blog articles on brain stroke management).

 Cervical vertigo

·      This is an uncommon cause of vertigo,

·      Occurs in the setting of severe cervical spondylosis and disc disease in the cervical (neck) region,

·      Cervical vertigo is also more common in older people.

·      Treatment is as for disc disease (refer to my earlier article on disc disease)

 Miscellaneous causes of vertigo

In addition to the above listed main causes of vertigo, we should also look for other causes. These include low blood pressure, anemia (low haemoglobin), general weakness, low blood sugars, etc. 

Who should we consult for vertigo?

Initially, a primary care physician may be consulted. If there is a doubt in exact diagnosis, the patient should be evaluated by a neurologist. 

An ENT opinion may be taken if an ear-related cause is suspected.

What is the outcome in cases of vertigo?

Most people with vertigo recover well and they do so in a few days. However, a minority of patients continue to suffer for several months. It is uncommon for the symptoms to last for more than three months.

Vertigo may be disabling in the first few days of illness, however, after that period, most people are able to normally function.




Dr Sudhir Kumar MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Jubilee Hills, Hyderabad

Email: drsudhirkumar@yahoo.com

Phone (for appointment): 0091-40-23607777, extension 6634/3011

Online consultation: http://bit.ly/Dr-Sudhir-kumar





12 comments:

Thrinath Chakravarthy Jalamadugu said...

Doctor! Really useful information.

Is there any specific age group which suffers most due to this!? And what would be the best medication?
Does it attract any specific diagnosis if this persists?

Appreciate a response. Thank you sir.

Dr. Sudhir Kumar said...

Hi Mr Trinath,

Any age group can be affected. However, it is more common in older people.

For short term relief, betahistine (vertin) tablets are the best.

BPPV and Meniere's disease are the commonest causes for long standing vertigo.

syam sundar reddy said...

Hello Doctor,

Thanks for your valuable information, One of my friend is having the symptoms which were mentioned in the above article. "Posterior circulation stroke (Brain stroke)
· This refers to reduction in blood supply to the back of brain, mainly cerebellum and brain stem.
· This is more common in people with risk factors for stroke, such as high blood pressure, diabetes, high cholesterol, smoking, etc.
· Patients often have additional symptoms such as double vision, slurred speech, difficulty in swallowing, imbalance while walking, etc. Isolated symptoms of vertigo without any additional symptoms, seldom/rarely occur due to brain stroke.
· The diagnosis can be confirmed by doing an MRI scan of brain.
· Treatment is done as for brain stroke (refer to my earlier blog articles on brain stroke management)."

Now can you please let me know that, whether it is a major health issue or minor health issue? Hope I'll get quick response from your end.

Looking forward to here from you...

Dr. Sudhir Kumar said...

Dear Syam, Please ask your friend to get clinically examined by a Neurologist to confirm the diagnosis so that appropriate treatment can be started at the earliest.

tejaswini nadendla said...

Soo helpful tqq for d info doc im suffering wth d same prblm now

Dr. Sudhir Kumar said...

Hi Tejaswini, Hope you recover fast. If needed, you can consult me.

Gorthi Ramachandra Prasad said...

Hi Doctor,

My father age 65 years. He doesn't have BP and Sugar. He fell down suddenly yesterday morning 4 am, we consulted Neurologist , after scanning to the head ,he told no clots are there. One day he is fine and today whenever he wake up and lay down he is feeling Vertigo and due to this bed rest only.Please suggest shall we meet you...

Gorthi Ramachandra Prasad said...

HI Doctor,

My Father age 65 years and does not have BP , Sugar ,no drinking & smoking. He did some excersize for back pain relief 3 days back and yesterday morning 4 am he fell down suddenly and after 15 mins he came into concious. We consulted Neurologist immediately and after scanning for head he told no clots and given medicines.Yesterday he fine he walked himself.Today from morning if he wakes up / lay down getting vertigo and complete bed rest.Please suggest what could be the reason and any further tests required.....

Looking forward for your valuable suggestion...

Dr. Sudhir Kumar said...

Dear Mr Ramachandra Prasad,

A good examination by a neurologist is needed to ascertain the cause. If in Hyderabad, I would be pleased to assist.

Best wishes,

Dr Sudhir Kumar

Dr. Sudhir Kumar said...

Mr Prasad,

Yes, you can meet me at Apollo hospital, Jubilee Hills Hyderabad (04023607777/60601066)

Anonymous said...

Sir naaku back side nerves laaguthunnai kaaranam enti sir

Dr. Sudhir Kumar said...

I need to examine you to determine the cause and decide the best treatment of back pain.