All About Multiple Sclerosis

More MS news articles for July 2003

True vertigo is rare, but there are treatments

July 2, 2003
By Marci Laehr
The Journal Times

At the age of 25, Mollie Rosen got an inner ear infection. While that may not sound like such a big deal, it led to one of the most frightening experiences of her life.

The infection caused Rosen to experience vertigo, a loss of balance that can be extremely debilitating.

For about a week, Rosen said she would get a "funny sensation" when she turned her head a certain way. The feeling would last about 30 seconds and then go away.

Then one morning, she sat up in bed, stood up and fell back down because of an overwhelming feeling of dizziness and loss of balance.
"Every movement made my head spin," she said. "It was terrible."

Rosen's boyfriend took her to the emergency room that morning, where she was treated. "It took a long time for it to stop," she said. "I just wanted to die. It was that terrible. You can't walk. You have no balance."

Rosen was also very nauseated.

The vertigo finally subsided late that afternoon.

That was three years ago, and Rosen said the vertigo hasn't come back since, fortunately. However, it was such an awful experience, that she is always cautious. "I used to enjoy roller coasters," she said. "Now I don't dare."

Dr. Frederick S. Lorenz, an ear, nose and throat specialist for Aurora Healthcare's Burlington clinic said true vertigo is uncommon. It's not just a lightheadedness or dizziness, but a true loss of balance.

The three most common causes of vertigo are benign paroxysmal positional vertigo (BPPV), acute labyrinthitis and Meniere's disease.

Lorenz said BPPV is probably the most common.

"It affects patients of all ages," he said. "Usually not little kids, but certainly teenagers up to the elderly."

BPPV is caused by free-floating calcium carbonate crystals in the area of the inner ear called the posterior semicircular canal. The canal is part of the vestibular system which controls the body's sense of equilibrium.

Dr. Jim Mataczynski, a family medicine physician for All Saints Healthcare said the canals in the inner ear are a person's first point of balance. Those canals are filled with liquid and as the liquid sloshes around when a person moves, it sends signals to the brain. With BPPV, the calcium deposits cause a false signal to the brain which makes a person lose their sense of balance.

People with BPPV feel lightheaded, and often suffer from nausea, vomiting and sweating. It usually comes and goes away in about 30 seconds. BPPV can be brought on by a sudden change in body position, such as turning over in bed or getting in and out of bed.

The most reliable treatment for BPPV is a fairly simple, non-surgical procedure called canalith repositioning, according to an article written by Dr. Huai Cheng of the Division of Geriatric Medicine at St. Louis University which is posted on the Web site: This is done by changing the patient's head and body position in a series of steps that are thought to dislodge the calcium crystals that caused the problem.

The procedure is usually done under expert supervision, but it is easy enough that doctors often teach it to BPPV sufferers and their families.

Lorenz explained that with BPPV there is always a slight delayed onset of vertigo after a person changes position. Each time a person moves into that position, the delayed onset increases. "If you put yourself in the position, it triggers the response," he said. "The delayed onset increases, until it stops. Usually (BPPV) will disappear on its own. Those little (calcium) pebbles will settle themselves down, or move to a different chamber."

Many people have only a single passing bout of BPPV, but for some, BPPV returns unexpectedly.

Acute labyrinthitis, is also a pretty common cause of vertigo, according to Mataczynski. Like BPPV it is caused by a problem in the inner ear canal, but instead of calcium deposits sending false signals to the brain, it is a swelling of the hairs in the canal that cause the false signals.

Lorenz said labyrinthitis is viral in nature and usually follows some type of viral illness. With labyrinthitis, the vertigo does not stop and start, but is constant.

"It is usually very severe, as in `When is the world going to stop spinning?' kind of a thing," Lorenz said. "If you move your head you get sick again."

Acute labyrinthitis can take up to a couple weeks to pass, but is usually does not reoccur.

Meniere's disease can also be a cause of vertigo. Unlike BPPV and labyrinthitis, its cause is not known.

People with the disease usually get a feeling when an attack of vertigo is coming, Lorenz said. Then they might feel a pressure in the ear, followed by hearing loss and ringing, which is soon followed by severe vertigo, he said. The vertigo builds in intensity over several hours and is sometimes accompanied by nausea and vomiting.

When the episode passes, a person might feel fatigue and lethargy for up to a week afterward. Lorenz said the episodes are recurrent and progressive, meaning a person might start off having one attack a year and ten years later is suffering from an attack every month.

While the cause of Meniere's isn't known, it is thought to be connected to a fluid imbalance in the inner ear. Meniere's symptoms are often controlled by reducing salt intake and by taking diuretic drugs, which reduce the amount of fluid in the body. Severe cases can be treated with surgery.

Both Mataczynski and Lorenz said vertigo is hard to diagnose. However, the one sure way to tell the difference between lightheadedness or fatigue and true vertigo is nystagmus, or an involuntary bouncing of the eyes, Lorenz said.

"When a person has BPPV, Meniere's or labyrinthitis, you can literally see the eyes bouncing from side to side," he said. "That's the one way we can differentiate between a true vertigo from lightheadedness we label as dizziness."

BPPV, Meniere's disease and acute labyrinthitis are all causes of peripheral vertigo, Mataczynski said. There are also less common central causes. "Central vertigo is usually something going on with the brain or brain stem," he said. "That's more of a coordination problem."

Some less common causes of vertigo can include multiple sclerosis, stroke, brain infection, meningitis, tumors and rarely tumors, migraine, and seizures.

Anyone with a recurring loss of balance or vertigo should see a doctor. It is particularly urgent if the vertigo occurs with one of the following symptoms:
Severe or "different" headache

Copyright © 2003, The Journal Times