Dr Pawan Ojha gives the lowdown on the disease of the vestibular system.
Do you often get a spinning feeling while lying down on your bed or when you are still? Often do you experience dizziness that disrupts your balance? This could be a sign of vertigo. Dizziness might imply vertigo, fainting, poor body balance, or even fits. Vertigo is a type of dizziness where you feel like spinning. These feelings may last from a few seconds to days and often worsen with movement.
WHAT CAUSES DIZZINESS? Vertigo is commonly caused by disease of the vestibular system. The vestibular system inside the inner ear helps in sensing our head position in space relative to the body, and works in an integrated manner with the brain to maintain body position. Vertigo can also result from diseases of the vestibular nerve or parts of the brain that deal with body balance.
IS VERTIGO A BIG PROBLEM? The diseases related to the inner ear and its nerve supply are generally considered less worrisome. ‘Benign Positional Vertigo’ often causes the most severe vertigo but can be treated easily by experts. It occurs when the calcium deposits of Otolith organs of the inner ear fall in the inner ear canals to cause short episodes of severe vertigo upon head movement, such as while lying down or getting up from the bed. Another important cause of vertigo is ‘Vestibular Neuritis’ which occurs due to viral infection or autoimmune disease of vestibular nerve, where vertigo, nausea, or vomiting can last up to several days. Meniere’s Disease is caused by a build-up of fluid in the inner ear tubes, causing episodic vertigo with ringing in the ears and hearing loss. The exact cause is unclear, a viral infection, an autoimmune reaction or a genetic component coule be the trigger. Many people who have migraine often complain of vertigo with or without headache, that is called ‘Vestibular Migraine.’ A neurologist can often easily identify and treat the underlying migraine to relieve vertigo.
WHAT’S THE MOST WORRISOME KIND OF VERTIGO? Vertigo that is caused by brain disease should be considered worrisome and treated on an urgent basis. Stroke is an important and serious condition causing dizziness. In a population-based study of more than 1,600 patients, 3.2% of those presenting to an emergency department with dizziness were diagnosed with a Stroke. Apart form this, brain infection, Multiple Sclerosis, hypothyroidism and other biochemical disturbances can cause vertigo even in the absence of fever.
So, one should not delay consulting a doctor as soon as one feels sudden dizziness. Warning signs for a serious cause of vertigo include severe headache, persistent vomiting and imbalance, double vision, vision problems, sudden hearing loss, or early signs of brain stroke (weakness or numbness in arm or leg , face drooping to one side, trouble while speaking or swallowing). People who are older than 60 years, with diabetes, hypertension, smoking and history of heart disease or brain stroke, should be extra careful. Doctors might require an urgent MRI of the brain to diagnose the brain problem and treat it in time.
TREATMENTS ARE AVAILABLE: Medications prescribed to relieve Vertigo include betahistine, antihistamines and anti-emetics. Benign Paroxysmal Positional Vertigo (BPPV) can be treated by physical repositioning procedures performed by expert doctors. Video-Nystagmography equipment might need to be used for complex cases. Special precautions in vertigo are limiting sodium intake, avoiding caffeine, chocolate, alcohol, and tobacco. If diagnosed in time, brain stroke can be effeciently treated with clot busters and/or interventional treatment. If vertigo is caused other serious problem, such as brain tumor or injury to the brain or neck, surgical treatment might be necessary to rectify those problems. Vestibular rehabilitation in the hands of expert physiotherapists forms an essential part of vertigo treatment. With correct diagnosis and treatment, most patients can be relieved of their vertigo effectively.
(Dr Pawan Ojha is Senior Neurologist-Hiranandani Hospital, Vashi-A Fortis network Hospital)
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