Published in Panorama
When Dizziness needs attention
Dizziness typically is a benign and self-limiting condition but it can be a sign of a serious underlying cardiac or neurological problem, says Dr.Rajni Ashok, Specialist, Internal Medicine, Zulekha Hospital. “It’s more of a subjective condition, which cannot be objectively checked out like fever, for example. The good news is, may be only 5% of dizziness that come to a medical OPD may be having a neurological cause.”
To approach dizziness, you have to make the patient describe the symptoms, get the history from him in his own language with a few helping words.
Typically, a patient may come in complaining, ‘I feel everything around me is rotating and I feel nausea and get vomiting’. Very often they feel they or their surrounds are spinning. This condition is termed Vertigo and may sometimes be accompanied by the person feeling a closure in his ears, a loud or buzzing sound in one ear or decreased hearing. This dizziness is more likely to be an ENT cause, due to a middle ear disease, explains Dr.Rajni.
“However,” continues Dr.Rajni, “if these symptoms are associated with loss of vision, double vision, speech disturbance, transient weakness in the extremities or loss of consciousness, the problem is obviously not in the middle ear, but in the brain. This is so because the small brain or the cerebellum also plays a vital part in our balance; it maintains our posture, stand and balance.”
“In the third instance”, continues Dr.Rajni, “a person may wobble while walking and have a drunken gait. He often feels he’s going to fall, while walking. Here we need to know whether the person really falls or has a tendency to sway. If he sways, we need to know the direction in which he sways. Is it that he is unsteady in the corners when he has to turn, when his whole body turns? This too tells us that it can still be an ear problem, or a brain problem.”
A fourth category of patients describe their dizziness by saying they feel a sense of floating, a lightheadedness. “These people,” explains Dr.Rajni, “say that though they are fully aware of everything, they are not themselves. They are not confused and do not suffer a loss of memory but they feel as if they are walking through something which appears to be preventing them from freely communicating with the surroundings. This light headedness if very often a symptom of anemia, decreased blood supply, hypo-tension or low blood pressure or a heart problem.”
Basilar Migraine often manifests with dizziness, according to Dr.Rajni. Explaining the condition, she says, “The artery which comes to the base of the brain, can close down. This basilar artery goes through the neck and it supplies the back of the brain where we have the brain stem and the cerebellum. In migraine, when this artery shuts down, you get negative symptoms which include dizziness and vertigo. This is transient because after some time, the artery opens up and the blood that was held back, gushes, producing the migraine. The time interval between this sequence of events is very short, lasting only a few seconds but then these ischemias happen. Very often these patients may be treated for vertigo because the important symptom is missed: that every time the vertigo is followed by a headache. This sequence of symptoms should clinch the diagnosis, of course, considering all other parameters as well, including the age of the patient, onset and the neurological examination.”
“Another type of dizziness is associated with cervical spondylosis,” explains Dr.Rajni. “This is a condition where the distance between the vertebrae in the spine get reduced or compressed. The blood vessels then have to come through a compromised lumen. When you have a straight neck, there is no problem, but once you move the neck, the distance is further compromised, causing a decrease in blood supply to the brain stem, and the consequent dizziness.”
“In dizziness involving the cardiac region,” says Dr.Rajni, “very often the patient will complain of a choking sensation, sweating, palpitation and just dropping out. This tells you that probably, there is some irregularity in the heart which is predisposing the patient to this condition and that the symptoms may be a warning of a heart disease. But very often, most people coming in with these sort of symptoms don’t have heart disease and what they might be having is something like a panic attack, a psychological attack,” assured the doctor.
Very often, patients with hypo-tension or low blood pressure may feel dizzy. In these cases, clarifies Dr.Rajni, “we need to know whether the person feels more dizzy while standing or sitting since this could imply that a change in posture is causing the dizzy symptom to come up – a condition known as postural hypo-tension. Very often, a person may get up in the morning to relieve himself; he feels dizzy and then collapses. This can also occur very often during fever because when there is very high fever, the blood vessels dilate in response to an increased temperature. As a result, there is a lot of pooling of blood in the periphery. So when he suddenly stands up, he feels dizzy and collapses. Without a post event confusion, if a person collapses whenever he is upright, it implies there is something which is causing a problem when he is erect. Similarly, in diabetics of long standing, the tone of the nerves and blood vessels is weak because of which, there is again a pooling of blood in the periphery. So these patients are more vulnerable to dizziness and postural hypo-tension.”
Dizziness can also occur in patient who are on hypertension medication, says Dr.Rajni. “Very often when hypertensives come to the clinic, you check the right upper extremity blood pressure and say it’s high and hence dose of medication needs to be increased. Then after two days the patient comes back saying he’s dizzy after taking the increased dosage, when he is working. The important thing to do would be to check the person’s blood pressure sitting or lying and after two minutes, while he is standing. If you find the standing pressure is significantly falling down, don’t change the dose of medication because you may be doing more harm than good!”
Eye problems, incorrect refraction after acquiring new glasses and patients who have been operated for cataract, can all have problems of dizziness, according to Dr.Rajni. Some people experience dizziness, nausea and even vomiting when traveling by plane or on water or even in amusement park rides and this is particularly more common in children, says Dr.Rajni.
“Over and above this,” opines Dr.Rajni, “psychological factors can contribute to dizzy feeling. In these cases, the patients claim to be dizzy all the time. A mentally and physically drained out person can feel dizzy and give way to a feeling of “I can’t do anything!” They very often have a fear of crowds, of moving objects, of traveling, curtains with dark stripes, of changing shades and the like.”
So under what circumstances should a person consult a physician for dizziness? Dr.Rajni enumerates the following conditions under which patients should necessarily seek the opinion of the medical personnel.
1. If the symptoms are persistent
2. If the person has any preceding or associated symptoms.
3. If the person experience loss of conscious ness.
4. If the individual feels palpitation, anxiety and these symptoms continue for a long time.