Recently a client of mine told me about a coworker who went to the hospital for a sudden attack of dizziness, nausea, vomiting, vertigo (earth moving, room spinning), altered vision. An immediate reaction for most people would be to suspect a stroke. However, those who are in a health profession that treats vestibular disorders may recognize that dizziness and vertigo are mostly associated with the vestibular system (located in the inner ear).
Rarely are strokes a cause of dizziness. One study shows that a stroke was present in only 3.2% of dizziness presentations (including other signs) in the emergency department, and in only 0.7% of patients presenting with “isolated dizziness”. The reason is due to blood supply to the brain. There are 2 major pathways that feed blood to the brain. One pathway is the carotid arteries which supplies the anterior portions of the brain. The other pathway is the vertebral arteries which enter the brain posteriorly and supplies the vestibular system. The majority of strokes occur due to problems with blood flow along an arterial branch supplied by the carotid arteries. This blood flow does not supply the vestibular system. Strokes involving blood flow from the vertebral arteries are rare; therefore dizziness, vertigo, and jumpy eyes/vision (nystagmus) are unlikely symptoms due to stroke.
The diagnosis of my client’s coworker turned out to be an inner ear infection causing Vestibular Neuritis. This is the second most common cause of vertigo (specific type of dizziness where there is the illusion of movement occurring in the environment). It is thought to be mainly the result of a viral infection of the vestibular portion of the vestibulocochlear nerve (8th cranial nerve). If the cochlear portion of the nerve was affected there would also be ringing in the ears or hearing loss. Onset is often preceded by a feeling of being unwell and an infection of the upper respiratory or gastrointestinal tracts. The main symptom is sudden onset of severe prolonged vertigo that is made worse by movement of the head. Other symptoms include nausea, random jumpy eyes (nystagmus), and disequilibrium or imbalance.
Within a few days these symptoms begin to resolve but the patient can be left with persistent dizziness and imbalance, and episodic vertigo. These long term symptoms may arise because input from the vestibular system on the affected side gets knocked out or diminished. Thus you get input telling your brain that you are moving to one side, whereas your other systems involved in movement and position sense are telling your brain that you are not moving. This creates conflicting information to your central nervous system and it gets overwhelmed, creating symptoms as mentioned previously. If correctly diagnosed immediately, a dose of corticosteroids can dramatically improve symptoms and recovery time.
Even though this condition can have long term effects, there is good news. With vestibular neuritis, many cases caused by viral infections leave no permanent symptoms. Almost half recover completely, and most of the rest improve substantially. For those who do get persistent symptoms due to the vestibular deficit, the central nervous system can adapt and be trained to adjust with vestibular exercises. You do not have to live with these symptoms; they can be resolved or minimized by seeing someone who does vestibular rehab. Rate of recovery is improved the sooner you receive treatment to the occurrence of symptoms.
There are many conditions other than vestibular neuritis which cause dizziness, imbalance, and vertigo. As mentioned earlier, it can be treatable with relatively simple solutions. If you have these kinds of symptoms then see someone who has training in vestibular assessment and treatment. This is a fast growing branch of physiotherapy, and many people as well as other health professionals may not know that vestibular physiotherapy can help. So be your own health advocate and find a physiotherapist with vestibular training if vestibular rehab is not offered as a suggestion to you. It can make a significant impact on your quality of life. There are physiotherapists here at One to One Wellness Centre that have vestibular training and can help you.
Dizziness and vertigo symptoms are surprisingly common, therefore more information is to come in future blogs regarding vestibular conditions and treatment. Stay tuned.