Making the diagnosis: The first spell

Vertigo and dizziness come from many different causes, and it is important to figure out exactly which one is the source.  When people come to me with a dizziness problem, one of the key things to narrow down the diagnosis is to have them describe their first spell.  Here are a couple of examples:

Beth recalled having three bouts of vertigo over the last several years.  The first one was very similar to the other two.  She was in bed, and in the early morning she woke up with vertigo immediately after rolling over to her right side.  The room was spinning violently but only for about 15 seconds.  When she tried to get out of bed, it happened again.  All the spells were short.  That morning after she was up and about, she felt better, but when shampooing her hair in the shower, she had another brief bout.   She had to be careful when lying down on her right side for a couple of weeks, but it all gradually went away. 

Beth’s story is very typical of the disease BPPV: Benign paroxysmal positional vertigo.  It is characterized by repeated, similar spells that are short but violent and that are set off by movement.  This very common cause of vertigo is a mechanical problem caused by heavy crystals on the gravity sensors of the ear that accidentally fall into a spinning sensor during sleep.   The crystals keep turning on the spinning sensor when the head is tilted, setting off spells of vertigo. It’s easily fixed by the maneuver in our book, on our handouts and the video on this site. 

Contrast her story with this different one:

John enjoyed cruises.  Unlike most people, he didn’t get seasick easily.  In fact, he got his “sea legs” quickly when he got on a ship.  The problem began when he went back on shore.  Usually for a few days after the cruise ended, he’d feel a rocking feeling as if he were still on the water. This was worse at night when trying to sleep.  After a cruise a year ago, something different happened.  This time the rocking feeling did not stop;  he has continued to feel it every day since, although it was worse on some days than others.  In the last few weeks, he’s had a few days that were better, but the rocking feeling always seems to return. 

This story is very different from the description of BPPV.  Even though both are classic vestibular disorders—diseases of the balance system—they have very different symptoms and are set off by different triggers.  John’s description is typical for MdDS: Mal de debarquement syndrome, also called Disembarkation syndrome.  It is an abnormal persistence of the adaptation to the rocking movement of the ship and is treated with a different type of exercise than we use for BPPV,  and with medication that can put it into remission. 

When narrowing down the cause of dizziness, you also need to think about what it feels like. Dizziness comes in many different forms, and that will be the subject of my next post.

Published by Vertigone

I translate the medical world of dizziness for non-medical people

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