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Dr Susanna Kent - Dizziness - 19 Jun


Dr Susanna Kent - Dizziness

"I feel dizzy doc"
Dizziness can mean different things to different people. When someone complains of feeling dizzy, they may be describing several things (as long as your name is not Paris Hilton).

1.  Presyncope

This is the feeling that you get of being about to faint or nearly blacking out. The symptoms are the result of poor blood pressure to the brain.
Causes include getting up too quickly (postural hypotension) so it takes awhile for your BP to increase, heart arrhythmias, anaemia and fainting  (which happens because a nerve is activated which slows the heart and drops the blood pressure)

2.  Anxiety

Often people with anxiety or depression report feeling light headed or spacey and this can often be secondary to hyperventilation such as what happens in panic attacks.

3.  Disequilibrium

This mainly happens in the older person.  It is a sensation of being afraid of falling and can happen when people have problems with vision or coordinating or strength.  They do not talk about spinning relative to the environment.  They may have suffered a stroke or be on medication that affects the cerebellum (a part of the brain essential for balance and coordination)

4.  Vertigo

This is common.  It is a feeling of moving relative to the environment or the other way round.  It is common and a common reason for going to the doctor.

Causes:  

1.  About 10% are due to something going wrong in the brain. This can include multiple sclerosis, stroke, brain tumours.  Usually there are other symptoms as well as the vertigo.

2.  90% are due to problems in the inner ear.
The inner ear consists of 3 semicircular canals and a collection point called the utricle.  It is responsible for letting you know where you are in space.

1. Benign paroxysmal positional vertigo

This is common.  For some reason small crystals have broken free from the utricle and gone into the semicircular canals.  This then affects the person's sensation of where they are in space.
Symptoms that occur included sudden onset of vertigo with specific head movements eg rolling over in bed or bending over.

Symptoms gradually disappear over several months and there are exercises that you can do which helps put the crystals back into the utricle.  You can ask your doctor for these exercises.

2. Vestibular Neuronitis

This is thought to be caused by a virus.  These symptoms tend to last for only days rather than weeks as in BPPV.  Symptoms can be there even when the person is not moving their head.  Symptoms can improve with medications such as buccastem or stelazine which stop the nausea and vertigo.  They don't tend to improve with exercises.

3. Meniere's disease

This is a problem due to increased pressure in the inner ear.  The person gets repeated attacks of vertigo often also associated with tinnitus and decreased hearing.  There are repeated attacks over a period of years often with hearing loss and worsening tinnitus.  Often there is not a lot that can be done.


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