It all started with a trip to the bathroom in the middle of the night. When James stepped down from the bed, half asleep, he suddenly felt as if he were being flung from a moving vehicle. His back banged hard against the window sill as he landed on the floor. Then he realized he was very dizzy.
For anyone, and particularly for a 72-year-old man, that kind of incident is almost certain to prompt a visit to a doctor. As he sat in the waiting room, his mind went back to the bold lettering on the side of his blood pressure medication: “May cause dizziness.”
The doctor agreed. The dizziness might well have been caused by his medication. But there were many other possible causes as well–some serious and some not so serious.
BENIGN PAROXYSMAL POSITIONAL VETIGO (BPPV): James’s dizziness occurred when he was rising from bed or changing head position, even looking up at the sky. It was quickly found to be positional vertigo, the most common cause of dizziness and an easy one to treat.
The doctor asked him to lie back on the examining table with his head in a series of different positions. In several of these positions, James felt the same powerful sense of dizziness, and he clung tightly to the examining table, fearing he might otherwise be thrown against the wall.
The doctor was performing what is known as the Epley Maneuver, and it’s a good way of diagnosing as well as treating positional vertigo.
Instructions for performing it can be found online, for example at (http://www.dizziness-and-balance.com/disorders/bppv/epley/fifth.html).
As the doctor explained, the dizziness might recur. Symptoms vary in nature and intensity but are typically brief and involve some change in head position.
The condition occurs when small calcium crystals become dislodged from their normal fixed location and flow into the semicircular canals of the inner ear where they can move with a change of head position, affecting balance.
Many other causes of vertigo or dizziness originate in the inner ear.
INFLAMMATION IN THE INNER EAR can cause nausea and vomiting as well as intense, constant vertigo–sometimes severe enough to force bed rest.
MENIERE’S DISEASE causes sudden episodes of vertigo, sometimes lasting several hours, as well as hearing loss, ringing and a feeling of fullness in the affected ear. The cause is an excessive buildup of fluid in the inner ear.
MIGRAINE can cause episodes of vertigo that can last several hours or several days, with or without headache and sensitivity to noise and light.
ACOUSTIC NEUROMA is a non-cancerous growth on the nerve that connects the inner ear to the brain. Symptoms may include ringing and hearing loss in one ear plus dizziness or lack of balance.
All of the above benefit from medical attention. Rarely, dizziness is associated with a severe or life threatening problem such as a stroke, brain hemorrhage or multiple sclerosis. In such cases, the dizziness is usually accompanied by other symptoms such as double vision, slurred speech, weakness, numbness, poor coordination or severe balance problems.
ORTHOSTATIC HYPOTENSION: It’s important to distinguish between dizziness and light headedness. Dizziness is the feeling that the world is spinning–the disorientation you deliberately produced in yourself for fun when you were a kid but is not so welcome when you’re age 60. Lightheadedness is the feeling that you’re about to faint. And, sometimes, you do faint and fall to the ground.
Orthostatic hypotension is low blood pressure associated with standing up or sitting up too quickly. Start to walk too quickly, and you’re likely to find yourself on the floor. In most cases, the fainting episode ends quickly once you hit the turf.
The solution is simple: take it easy and stand for a minute or two while your blood pressure adjusts and starts pumping blood to your brain.
DEHYDRATION: Another major reason for lightheadedness is loss of blood volume caused by dehydration.
Endurance athletes know the importance of replacing fluids that are lost through sweating. Seniors who take diuretics or other medications to treat hypertension are also vulnerable to dehydration or an electrolyte imbalance that causes the same symptoms.
Ironically, persons being treated for high blood pressure can let their blood pressure drop too low as a result of failure to drink enough water, particularly during warm weather.
ATRIAL FIBRILLATION is an irregular heart rhythm that can result in poor output of blood from the pumping action of the heart. When the brain doesn’t get enough blood flowing to it, even for a brief period, the result is lightheadedness.
Most of the above causes of lightheadedness are fairly easily controlled. There are rare causes of lightheadedness that are severe and sometimes life threatening. These include cardiomyopathy, a weakness of the heart muscle, or internal bleeding.
LOSS OF BALANCE, WEAKNESS, UNSTEADINESS: Sometimes the person merely feels unsteady or lacks balance while walking or standing. This feeling can occur with positional vertigo or with other abnormalities of the inner ear.
In maintaining balance, we depend on our eyes as well as the balance mechanisms in the inner ear. As a result, failing vision or dim lighting can contribute to a feeling of disequilibrium. Sensory nerves, particularly those in the legs, affect balance, and these, in turn, can be affected by arthritis or muscle weakness. In some cases, unsteadiness is an early sign of a neurological disorder such as Parkinson’s disease.
Any severe or persistent dizziness that can’t be explained is reason for a doctor’s visit.
Call 911 if the dizziness is associated with:
• a bad head injury;
• a very stiff neck;
• a severe headache of a kind you have never had before;
• blurred vision;
• sudden hearing loss;
• trouble speaking;
• leg or arm weakness;
• loss of consciousness;
• difficulty walking;
• chest pain or a noticeable change in your heart rate.
Dizziness and lightheadedness can occur at any age, but they are more common, and usually more frightening, after age 65. A child may seek dizziness from games or carnival rides; an older adult, worried about the possibility of a fall, is not having much fun when the world goes spinning around and around.
REFERENCES:
“Benign paroxysmal positional vertigo,” Johns Hopkins Medicine.
“Dizziness: lightheadedness and vertigo–topic overview,” WebMD Medical Reference from Healthwise, last updated January 2, 2013.
“Dizziness,” emedicinehealth, medically reviewed by a doctor on February 13, 2014.
Mayo Clinic Staff, “Dizziness,” MayoClinic.com, September 6, 2012.
Mayo Clinic Staff, “Benign paroxysmal positional vertigo (BPPV),” MayoCllinic.com., July 10, 2012.
V. Nadarajan, et al, “Transient ischaemic attacks: mimics and chameleons,” Practical Neurology, 2014;14(1):23-31.
“The ten-minute examination of the dizzy patient,” Seminars in Neurology, 201;21(4).
“What causes dizziness?” Healthline, medically reviewed by George Krucik, M.D., M.B.A.
John C. Wolf, D.O., “Even short ‘dizzy spells’ can signal serious disease,” Family Medicine column
12/19/2014
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