Vertigo Cures

As a rule, the main types of disturbances that we feel as humans that present to the clinician as one form of dizzy feeling or another, are vertigo: a sense of spinning; disequilibrium: a sense of imbalance; or dizziness: a feeling of being off, or disoriented. Dizziness is the vaguest of the symptoms. Let’s talk about it this week.

Dizziness is in the top three reasons why individuals present to their doctors office. It is often a confusing constellation of symptoms which patients find difficult to describe, and clinicians find difficult to diagnose.

Oftentimes, vertigo and disequilibrium will manifest such that the patient would complain to the clinician about dizziness. It is up to the clinician to ask the right questions to discern between them to correctly diagnose the patient and refer to the appropriate specialist for neurologic or vestibular rehabilitation therapy, (what I do), vs. to an ENT for a sinus infection or similar.

So what then is Presyncope? Well, syncope, means in medical terminology to pass out. So presyncope is the sensation just before passing out, without progressing into actually passing out. Most patients with presyncope will be referred to a cardiologist, assuming of course that they were even correctly diagnosed in the first place, which is not necessarily always the case. This is not a bad plan as it rules out any cardiac problems as being causative, however, the patient gets cleared from cardiology and is still symptomatic.

Well here’s the deal. Syncope/presyncope is almost always a neurologic condition. Yes, it is caused by the heart, however, the heart only does what the brain is telling it to do. To make some sense of this, imagine you are standing up. Your heart has to pump blood up to your head sort of like a small water tower. Now imagine lying down. As blood gushes into your head, baroreceptors in the carotid vessels tell your brain to tell you heart to slow down so you don’t shoot your head off. Conversely, when you arise from lying down, your carotid baroreceptors tell your brain to tell your heart it had better pick up and fast to get blood back up to your brain, (like a water tower again). When there is a problem with this regulatory system, you are going to experience presyncope. As this problem worsens, you will actually experience syncope, (actually passing out). The irony to all of this is that this is actually very easily fixed more often than not; these are the types of problems that I spend much of my day fixing for people. As syncopal problems worsen, it is not uncommon for simple head movements or turns, or visual stimulus from driving to provoke an attack. This also often precipitates into panic disorder and panic attacks, not only because of the fear and anxiety associated with the symptoms, but also because of the sympathetic nervous system and its hard wiring. (The whole “fight-fright-flight thing you learned in school).

Again, there are many causes of dizziness and presyncope is just one of them, but it is a fairly common problem and finding the right specialist early on can make a big difference in how far your symptoms will progress and whether or not they will progress into other conditions over time until properly treated.

Dr. Scopelliti is a Fellow of the American College of Functional Neurology and also a Fellow of the American Board of Vestibular Rehabilitation. Practicing at the 279 Professional Arts Bldg at Monmouth Medical Center, in Long Branch, NJ, his office focuses on the drug free management of patients with vertigo, dizziness, balance loss, presyncope, dystonia, headaches, ADD ADHD and other neurological disorders. Dr. Scopelliti has a wealth of information updated weekly on the web at http://www.dcneuro.net. Also, visit our guest book at http://www.dcneuro.net/guests.htm. Visit our Guest Book to see what real patients have had to say.

More than 300 medications that are approved for treatment of various medical conditions may cause vertigo, dizziness or both. An exacerbation in vertigo or dizziness can be another side effect of these drugs. The physician who prescribes the medication can not predict the effect on the vestibular system of his patient, if it is the first time that his patients takes this drug. Furthermore: a medication that was innocent in the past, may cause imbalance symptoms in advanced age.

When a cardiologist is injecting an IV medication as part of a life saving procedure, the possibility of vertigo as a side effect is not important. The physician must focus on the issue of saving life. The situation is different in elective treatments of which vertigo or dizziness are side effects.

Shemesh Zecharya (M.D.) from “Hadassah Ein Kerem” hospital in Jerusalem is presenting illustrative examples from the field of Cardio-vascular diseases.

What is the cause and what is the outcome of the treatment?

When the patient is experiencing a severe imbalance with vertigo or dizziness – this question may become the most important issue in the treatment. Based on the intensity it is possible to classify the diseases to two categories: Acute onset and Gradual onset. I did not use the term “Chronic onset” because the “Acute onset” may continue as “Chronic onset”.

When the patient can tolerate the process of deep investigation of the precipitating factors of his vertigo or dizziness, the physician and the patient can isolate the relevant factors and regulate the medication that could cause it. In the next line we shall try to relate to more specific examples from the spectrum of treatments for Cardio-vascular diseases.

Hyperlipidemia is a diagnosis of elevated blood fats such as Total Cholesterol, HDL cholesterol, LDL Cholesterol or Triglycerides. Analysis of the blood picture of fats by an expert can assist in recognizing an increased risk of cardio-vascular diseases or weather there is no risk.

The first step in treatment is a special diet. When there is no benefit from the dietary treatment, the physician offers a drug treatment, and the most common medications for decreasing the risk are classified as “Statins”.

This treatment can be applied slowly and gradually. In low doses of the statins, the treatment is tolerated very well. When there is need to increase the dose to high levels, some patients will suffer from side effects, Vertigo, Dizziness or Tinnitus (sensation of noise in the ears or the head) may occur.

Cardiac Arrhythmia may be accompanied by vertigo or dizziness. The Cardiologist will have to decide what is the underlying cause: the anti arrhythmic medication or the Cardiac Arrhythmia itself. When a patient is admitted to emergency room, part of the routine data exchange includes a brief convey of information using short professional terms between the medical staff, and as a result, nobody writes in the chart that there are problems of imbalance.

When there are co-dominant symptoms: vertigo and treated cardiac arrhythmia the cardiologist should differentiate between episodic abnormal cardiac activity and side effects of the anti arrhythmic medication. Drugs such as Lidocaine, Tocainide, Mexiletine, Moricizine or Dofetilide are in the list.

Another possible combination: vertigo due to side effects of medications that is limited to the episode of the cardiac arrhythmia.

A more complicated medical condition may happen when there is no vertigo, but there are attacks of nausea or vomiting. It may occur during treatment by Quinidine (nausea. May cause tinnitus), Procainamide, Propafenone, Amiodarone (nausea alone) and Ibutilide (nausea alone).

In emergency room, under conditions of stress it is possible that someone will write down in the medical chart of the patient: “vertigo, nausea and vomiting” instead of just “nausea and vomiting”.

It is obvious that in a patient with Cardiac Arrhythmia the medical staff gives the highest priority to the investigation of the cardio-vascular parameters and (temporarily) neglect all other factors. The patient that wants a relief from his/her vertigo or dizziness may remain frustrated.

In the bottom line: even if the symptoms of a cardiac event are very mild, it is important to start the medical workup from a cardiologist, and only then go to a clinic for evaluation and treatment of vertigo and dizziness.

What treatments do you give your patients?

My patients come after failure of the physiotherapy, drug treatment such as betahistine or cinnarizine, given by otolaryngologists or insufficient effect of sedative medications that were prescribed by a psychiatrist. I offer my patients metabolic intervention. In most patients it is very effective.

For further Reading about Vertigo, Dizziness & Tinnitus medical assessment and treatment.

This article can not come instead of examination and treatment by an expert.