| |
| |
|
Medicine Information |
|
|
|
Spin Control: What to Do When Youre Dizzy
Dizzy Dean, the great baseball pitcher of the 1930s-1940s, once quipped, "The doctors x-rayed my head and found nothing." That is as good an analogy as any in describing what often happens to patients with the symptom of dizziness. They see a doctor, get an MRI scan (the x-ray of the 21st century) and nothing is found. To extend the baseball theme, patients sometimes complete a triple-play-going from family doctor to ear specialist to neurologist. And when all is said and done, none of the doctors is willing to own the symptom. Each says it's the other doctors' problem! So where does that leave the patient? Probably out of a lot of bucks and getting more frustrated by the minute! But, upon close analysis of the symptom, a case of dizziness can give up its secrets. It turns out that the word "dizziness" gets used to describe a variety of experiences, and those different experiences can themselves result from a number of underlying causes. So the way one gets to first base is to sort through the patterns and narrow down the list of possibilities. In analyzing the symptom of dizziness, sometimes a multiple-choice approach works best. Most people can select one of the following three descriptions as most resembling their symptom: #1. A sense of motion, perhaps spinning, rotating or even just drifting in space. It doesn't matter if the person feels they are spinning or that the room around them is spinning: both mis-perceptions have the same significance. These perceptions are known as "vertigo." #2. A feeling of unsteadiness or imbalance in the body more than in the head. #3. A feeling of light-headedness, wooziness, giddiness, or even verging on losing consciousness. That the term "dizzy" can sometimes have still other connotations is illustrated by Mr. Dean's own nickname. He probably didn't get it because of attacks of imbalance. In fact, the pitcher supplied his own explanation with another of his famous quips: "The good Lord was good to me. He gave me a strong body, a good right arm, and a weak mind." Let's focus on the more usual three patterns. Distinguishing among these patterns helps separate the cases involving the head's balance (vestibular) system from those that don't. In short, pattern #1 (vertigo) is most likely to involve a disturbance in the balance system, while pattern #3 (light-headedness) is least likely. Instead, light-headedness or wooziness can be due to a momentary drop in blood pressure (for example, when standing up too quickly) or due to the same factors that produce outright fainting. Pattern #2 (bodily imbalance) is somewhere in-between-sometimes caused by a disturbed balance system and sometimes due to something else. The vestibular system consists of the left and right inner ears, certain pathways within the brainstem (junction between the upper brain and the spinal cord) and the nerves that connect the inner ears to the brainstem. A problem in any of these components can lead to the symptom of vertigo. But the kinds of problems that can disturb the brainstem-like stroke, tumor or multiple sclerosis-are quite different and usually more serious than most the conditions that disturb the inner ears or their associated nerves. So once the pattern of vertigo (mis-perception of movement) has been distinguished from the other kinds of dizziness, there is still more figuring to do-is the problem in the brain (central pattern) or in the inner ears and their connecting nerves (peripheral pattern)? Luckily, central and peripheral vertigos can usually be distinguished from each other based on the clinical history and physical exam. The key is in looking for any symptom or physical abnormality that can't be blamed on the vestibular system. How about nausea, vomiting, unsteadiness, walking into walls, blurred vision or even jumping vision? A malfunctioning vestibular system could easily account for them all. But double vision, slurred speech, weakness or numbness on one side of the body? No way. These symptoms would have to be generated outside of the balance system, and imply that other pathways in the brainstem are damaged. Where does the MRI scan fit in? The MRI is good at seeing areas of abnormal growth or damage within the brainstem, as from tumors, strokes or multiple sclerosis. It can also see tumors that arise from the nerves connecting the brainstem to the inner ears. But that's about all it can see that is at all related to the symptom of vertigo. However, there are far more cases of peripheral vestibular disease than of central (brain-based) disease causing vertigo, so that's why most MRI scans turn out negative. In short, the MRI is normal, but the patient isn't. So what can cause peripheral vestibular disease? The causes are varied, but are more usually annoying than life-threatening. The most explosive form of peripheral vestibular disease is vestibular neuronitis or "inner ear attack." The typical story for this condition is that the person awakes with violent spinning, nausea and inability to walk a straight line. This condition is at its worst on the first day, gradually improving over subsequent days and weeks. Another peripheral vestibular condition is Meniere's disease in which recurrent bouts of vertigo occur in conjunction with deafness and "roaring" tinnitus, or ringing in the ear. This is due to high fluid pressure within the inner ear which is also wired for hearing. Yet another peripheral vestibular disease involves a stone (otolith) rattling around within the canals of an inner ear. This variety can sometimes be fixed by "vestibular repositioning" in which the patient's head is put through a series of abrupt position-changes designed to make the otolith stick in one place. Medications can also be useful in diminishing the symptom of vertigo. The most widely used drug is meclizine (brand name Antivert) which is related to the antihistamines and helps simmer down an overactive inner ear. A second drug used in the same way is scopolamine, usually delivered via a patch on the skin (Transderm Scop). Finally, diazepam (Valium) can also be used a "vestibular suppressant" though is usually the last choice owing to its possibility of becoming habit-forming. And how about those other forms of dizziness that involve lightheadedness, wooziness or giddiness? As a baseball player might say, "That's a whole other ball game." (C) 2005 by Gary Cordingley Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher. For more health-related articles, see his website at: http://www.cordingleyneurology.com
MORE RESOURCES:
Medicine - Google News |
|
|
|
RELATED ARTICLES
SUPERLASIK- Enhance Your Vision; Safer Than LASIK Things are moving forward and new and advanced procedures are being developed for those who originally could not receive the standard Lasik procedure. Dr. How to Tell If Online Consultations Are Right For You As computers, Internet and technology have become increasingly more available and accepted, so have the applications for using them. Online consultations are something that is becoming more widely used by both medical professionals and those seeking medical advice. The Last Line of Defense Against Medication Errors: What You Need to Know to Keep your Family Safe This is a true story.Yesterday, I picked up a new antibiotic prescription for my daughter from my local pharmacy. Questions to Your Physician or Psychotherapist According to ongoing research about the needs of patients with emotional problems misinformation or shame to speak about the problem with the doctor or psychotherapist is a major limitation to treatment success. However, transparency, good information and participation in the course of the therapy is the most important factor for a lasting positive result. Three Antioxidants (ginko biloba, grade seed extract, and selenium) for Alzheimers Treatment Checklist of Treatments for Alzheimer's DiseasePart 3 of 83. Three Antioxidants: ginko biloba, selenium, grape seed extract. Mind Altering "It's a chemical imbalance." I've heard those words so many times in the last decade, it's becoming routine for Doctors to blame everything on it. Cholesterol Prescription Medications Can Kill You While there are numerous options for people to lower cholesterol naturally, thousands and thousands of people are taking prescription medication to lower cholesterol - risking some very dangerous side effects.These side effects can include:? An increase in cancer risk ? Elevated liver enzymes (causing liver damage) ? Yellow skin / yellow eyes ? Rhabdomyolysis (degenerative muscle tissue condition) ? Impaired kidney function ? Muscle weakness and pain ? Dizziness ? Gas ? Headache ? Heartburn or indigestion ? Nausea or vomitingCrestor, a prescription medication to lower cholesterol, has been linked to the death of a patient who developed a suspected case of severe muscle wasting. The Highway to Health - Bumped Heads I recently had a reader send me this comment:"As a full-time dad I have to deal with just about every minor illness my two children pickup, everything from a bump on the head to chicken pox. I found the Highway to Health ebook very useful and it's one of the first things I reach for when something goes wrong!"Mr John Bradbury United KingdomIt got me thinking - although the Highway to Health does cover headaches, perhaps going into a little more detail about 'bumps on the head' would be useful. Medical Tests: What Does a Normal Range Mean? We have a marvelous array of medical tests available to us. Many of them-typically blood-tests-even come with results expressed in numbers signifying the exact quantity of something that was measured. Propulsid Litigation Lawyer Says: Unnecessary Drug Killed 80 People Propulsid was a popular nighttime heartburn drug before it was pulled in the market in March of 2000. It was linked to dozens of fatal heart rhythm abnormalities. Find a Doctor How to find a doctor? There's no magical route to finding the right doctor. If you have a primary care physician just call him or her and make an appointment. Antibiotics and Bowel Flora The word Antibiotic is constructed from Greek words anti, which means "against" and bios, meaning "life", is a phrase used to describe an antibacterial substance made from micro-organisms, all though nowadays most are made synthetically. Antibiotics inhibit the growth or destroy other micro-organisms; penicillin, cephalosporin, amino-glycosides, streptomycin and tetracycline are all examples of common antibiotics. Anxiety Management With Prescription BuSpar: Don't Worry, Be Happy We've all had one of those weeks: the washing machine overflows, the dog forgets his housetraining and the toddler her toilet training, the boss is going through a divorce and making everyone miserable. And you feel like you just don't know how to handle it all. Thimerosal: Autism and Mercury Poisoning Side Effects? Thimerosal is a preservative that is added to vaccines (has been since the 1930s) that is almost half (49.6% by weight) mercury. The Truth about C Reactive Protein and Cholesterol Lowering Drugs You might disagree, but hear me out on this.. Lunesta Pregnancy And Breastfeeding Lunesta is a newly released sleeping pill. Marketed as a revolutionary sleep aid, Lunesta is the only medication approved by the FDA for long term treatment of insomnia symptoms. Rogue Online Pharmacies: The Internet War Of 2005 Online Pharmacy owners who haven't been working within moral and governmental regulations are in for the ride of their lives. In past months, many of these so called "rogue pharmacies" have either voluntarily shut down or been closed by the powers that be. Over The Counter Pain Medication: How To Choose The Right Drugs With the recent front-page news about the possible hazards of pain medications, you may be taking a look at your over-the-counter (or OTC) pain medications with a wary eye. While all drugs, including those you don't need a prescription for, can be dangerous, some basic knowledge can help you avoid the pitfalls for the pain relief you need. Lamisil Side Effects Lawyer: Lamisil Tablet While the recent Lamisil commercial featuring Digger, a disgusting cartoon fungus, is still fresh in our mind (who could forget the imagery of a toenail being pulled back and colorful germs crawling in?) it is a good time to look at the side effects of this seemingly innocuous drug. Despite the disturbing advertising campaign, who would have guessed that an antifungal tablet could have so many negative side effects?The drug comes in both cream and tablet form and is used to fight nail fungus, athlete's foot, jock itch, and ringworm. The Power of Ice Using ice to treat injuries is one of the oldest methods of pain control. Proven to be safe and effective at reducing swelling, relieving pain and decreasing muscle spasms, ice therapy is an easy self-care technique that anyone can administer.
|
| home | site map |
| © 2006 |
