Why Am I Dizzy?

Why Am I Dizzy? – As vertigo and symptoms of dizziness are one of the top 5 reasons individuals seek medical attention, I feel it is necessary to understand both the symptoms themselves and what is likely causing them. These frightening and often debilitating symptoms have many potential causes, and proper assessment and diagnosis are essential to treating them effectively.

First, we must understand the symptoms. Vertigo is derived from the Latin “vertere”, meaning to turn. Vertigo is always associated with a sensation of turning or spinning, whether it is the individual spinning, or the environment spinning around the individual. Most cases involve the environment spinning around the individual, which is most often a less complicated presentation.

Dizziness is often describing as “lightheadedness” or feeling as if one is going to faint. Spinning is typically not associating with dizziness.

Disequilibrium is a loss or alteration in our sense of balance, often associated with feelings of being on a boat or the effects of alcohol on the way we walk (i.e. “drunken gait”).

Why Am I Dizzy? –  Nausea and/or vomiting often accompany vertigo and may, although less often, be associating with dizziness and disequilibrium. Dizziness and disequilibrium typically do not lead to vertigo, but untreated vertigo will often lead to these symptoms due to compensatory changes within the brain.

There are many possible causes of vertigo; by far the leading cause is related to debris (otoconia) made up of calcium carbonate crystals that dislodge from their proper place within the inner ear canal system. This condition, called Benign Paroxysmal Positional Vertigo (BPPV), is due to the disruption of signals transmitted to the brain regarding angular acceleration of the head from this debris in the affected ear canal. Fortunately, this condition is treating with great success via head positioning maneuvers designed to relocate the debris to its proper location, followed by rehabilitation for the inner ear vestibular (balance) organs. Aging and head trauma are the two main predisposing factors for BPPV. The one major drawback is that this condition is often not assessing appropriately, therefore leading to incorrect or non-treatment.

Other causes of vertigo include:

1. Vestibular neuritis or neuronitis, which, as its name implies, involves inflammation of the inner ear. Although treated with anti-inflammatory agents, symptoms often persist and require rehabilitation of inner ear balance organs.
2. Meniere’s disease, which consists of a triad of symptoms including vertigo, tinnitus (ringing in the ears), and progressive hearing loss, is causing by an increase in a certain type of fluid within the inner ear causing pressure on balance and hearing centers. A more ominous and poorly understood condition, certain types of therapeutic interventions can be effective. Especially with regard to the vertigo component.
3. Perilymph fistula is a defect in the membrane or window. Between the middle and inner ear causing pressure changes affecting the inner ear.
4. A certain class of antibiotic medications, aminoglycosides. Can cause damage to the eighth cranial nerve leading to vertigo and hearing loss.

There are many causes of dizziness, a list too exhaustive to explore here, but many are related to:

1. Medication side effects (it is one of the most common side effects across all classes of medications).
2. Changes in heart rate and blood pressure (postural hypotension and vasovagal syncope).
3. Anxiety disorders and panic attacks may lead to dizziness as well.

Why Am I Dizzy? – Disequilibrium is often related to an alteration in brain feedback from any of the major systems. Related to balance including visual, muscle and joints, and inner ear systems. The number of metabolic, physical, and functional conditions that may affect these systems is quite lengthy as you could imagine!  Alcohol, recreational and therapeutic drugs, environmental exposures, and head injuries. Among many other triggering agents, can play a large role in the disruption of equilibrium. As noted, untreated vertigo will also lead to symptoms of both dizziness and disequilibrium.

Treatment for all of these disorders is wide-ranging and the effectiveness of any given treatment is dependent upon the accurate diagnosis of the condition creating the symptoms. All conditions affecting balance will benefit from active rehabilitation of the involved systems once the causative factor has been established. Although to the individual experiencing these symptoms, it appears that the prognosis is hopeless, long-term outcomes are favorable for the vast majority of conditions outlined! Diagnostic and treatment interventions will be discussing in greater detail in future articles – Why Am I Dizzy?