What are Dizziness and Vertigo?

Jul 27

Dizziness is a sensation of light-headedness. It can make people feel like they are about to faint and lose consciousness.

Vertigo is a sensation of feeling off-balance. Vertigo can make you feel like you are spinning, or that the world is spinning around you. It can create a sensation of falling, tilting, swaying back and forth, being pulled in one or several directions, or being generally unstable.

Dizziness and vertigo often involve some level of nausea. More severe cases may involve headache, sweating, heart palpitations, ringing in your ears, inability to hold your eyes still, vomiting, and a feeling of being unable to sit up or stand without passing out.

Vertigo can range from a mild annoyance to a severely debilitating problem. Many vertigo sufferers are bedridden. Vertigo can make it impossible for you to interact with the world (15).

What causes Dizziness and Vertigo?

Dizziness and vertigo are often caused by a problem with the vestibular system. This includes the inner ear, the vestibular nerves, and central brainstem and brain regions that process this input.

Vertigo and dizziness can also involve any of the brainstem, cerebellar, and brain regions that receive vestibular input. When the input from the vestibular system does not match the input from the eyes or the muscles, this sensory mismatch creates the inappropriate perception of motion (16).

What are Different Types of Dizziness and Vertigo?

One of the most common causes of vertigo is known as Benign Paroxysmal Positional Vertigo, or BPPV (1). The inner ear has two systems of receptors, known as the otoliths and the vestibular canals. The otoliths sense the head’s tilt in relation to gravity and movement in translational planes, such as up, down, and side-to-side. They require tiny crystals called otoconia in order to function. The vestibular canals are receptors that sense head movement in rotational planes.

BPPV occurs when these crystals are dislodged and float into one of the canals. This makes the canals respond to gravity, which can create an inappropriate sensation of head movement. The canals are tubes filled with thick fluid, and tiny hair cells live on the bottom of the canals. When the head moves, it takes a second for the fluid to catch up. This bends the hair cells, which fire the vestibular nerve, and this input tells the brain that the head is moving in that direction. In BPPV, when the involved canal is placed in a vertical plane, the crystals float down the side of the tube until they bang into and bend the hair cells. This makes the brain believe that the head is turning in the direction of the canal when the head is still. The canal provides the wrong input to the brainstem, and this creates a vertigo-producing sensory mismatch.

BPPV is usually easy to fix with Epley Maneuvers, also known as Canalith Repositioning Maneuvers, wherein the head is placed in a sequence of positions that allow the crystals to float back where they belong. More complicated cases of BPPV involve more than one canal. We successfully resolve complicated BPPV on a regular basis.

Meniere’s disease is a condition involving fluid buildup within the inner ear (2). It can cause episodic vertigo, ringing of the ears, and a sensation of ear pressure or aural fullness. This can progress to create hearing loss.

There are several important factors that need to be addressed in Meniere’s disease beyond the sensory mismatch that it creates, including diet, salt intake, and inflammation. Management of these factors can often halt the progression of the condition, while appropriate neurological rehabilitation can resolve the vertigo sensation and balance difficulties.

Vestibular neuritis and labyrinthitis usually result from a viral infection (3). This creates inflammation in the inner ear that damages the vestibular receptors or vestibular nerves.

Symptoms of vestibular neuritis or labyrinthitis can often be severe, with an acute phase of debilitating spinning sensations, nausea, vomiting, impaired balance and gait, and unstable vision. This will usually stabilize over a few days, and over the next 1-2 months people gradually regain function. However, there is usually a substantial residual deficit where people feel unsteady on their feet, feel dizzy with head movements in a particular direction, and have ongoing nausea and visual difficulties.

Therapies to deal with the viral infection can be necessary, as is again appropriate neurological rehabilitation to improve the function of the damaged tissue. We have successfully treated many patients with these disorders through our NeuroRescue program.

Mal De Debarquement Syndrome is a type of vertigo that creates a rocking sensation, as if the individual is constantly on a boat (4). This is the result of a mismatch between the two types of vestibular receptors, the otoliths and the semicircular canals, along with dysfunction in the brain and brainstem systems that make these receptors work together. By properly quantifying the function of all of these systems, then designing a precise NeuroRescue program based on this data, we can usually get MdDS symptoms under control, and in many cases, fully resolve the sensation of motion.

Vestibular migraine is considered the most common cause of recurrent spontaneous vertigo attacks. It requires a current or past history of migraine attacks, with vestibular symptoms of moderate to severe intensity. Migraines involve impaired blood flow to neurological systems, and when this affects the brainstem and cerebellum, dizziness and vertigo often accompany a migraine headache (17).

Central vestibular disorders involve mismatches between the visual, vestibular, and proprioceptive systems (5). Dizziness and vertigo can be the result of lesions in the peripheral vestibular receptors of the inner ear, or they can involve problems in the central cerebellar, brainstem, and brain systems that process vestibular input. These systems combine input from the inner ear with feedback from the visual system and from muscles and joints to create a coherent picture of where the body is in space and how it is moving. There are a number of diagnostic findings that help reveal the presence of central vestibular disorders, such as changing patterns of a type of reflexive eye movement called nystagmus, problems with the ability to visually follow moving targets, and so on. While central disorders are generally considered harder to treat than peripheral vestibular issues, we have some of our best successes resolving central vestibular issues.

Traumatic brain injuries frequently result in vertigo and dizziness. Vertigo is one of the most common symptoms of an injured brain. Vertigo can also be the result of neck injuries, creating cervicogenic dizziness (6). The forces that create a concussion or traumatic brain injury also commonly damage the vestibular system and the neck muscles and joints. This can produce severe sensory mismatches. We frequently see patients that have suffered injuries to all of these systems simultaneously. Proper treatment of such cases requires the ability to precisely quantify the function of all of these systems, which is one of the first steps in our NeuroRescue Program.

How are Dizziness and Vertigo Usually Treated?

In most cases, the primary type of treatment offered to dizziness and vertigo patients are medications. These can be vestibular suppressants, anti-nausea agents, or medications that suppress anxiety. In many cases, patients are prescribed anti-depressants as well. While these may provide some benefit in reducing the symptoms, they usually do little to address the actual cause of the problem (18).

People may be referred to physical therapists that perform various types of vestibular therapy. This can be helpful in some situations, however still in most cases therapy programs are designed more towards reducing symptoms through habituation therapy. This helps the brain build compensations for underlying problems, but again in most cases does not directly address the impaired reflexes that are creating the problem at a fundamental level (19).

How is the NeuroRescue Program Different?

Our treatment for different types of dizziness and vertigo varies depending on the cause. In most cases, our goal is to rehabilitate the brain and receptor mechanisms that are creating the mismatch and make them integrate properly with your other systems.

This is usually a very successful approach, and for the vast majority of our patients, this yields our best results. In other cases, our goal is to teach the brain to adapt to the impaired reflexes and teach it to rely on other mechanisms to maintain balance and decrease the vertigo sensations.

In all cases, our treatment starts with a comprehensive neurological examination, followed by cutting-edge neurodiagnostic testing. We use several advanced technologies to quantify the function of every system involved in your vertigo, including important visual reflexes, vestibular function, and the feedback from your muscles and joints.

We assess not only how these systems work, but also how well they integrate into several different balance conditions. This allows us to precisely identify and quantify which systems are creating the mismatch, how well they integrate, and the exact circumstances under which their integration fails.

We then create a NeuroRescue program that is unique to your brain only, and specific to your individual pattern of dysfunction and fatigability. This enables us to get our best results in the shortest time possible. More importantly, it allows you to move beyond your condition and begin to engage in the world normally again.

We use a wide variety of therapies for treating dizziness and vertigo. These may involve various types of canalith repositioning maneuvers for BPPV (7), or specific exercises to retrain the integration of your eyes and inner ear during head movement (8). It may involve specific forms of eye exercises to enhance your stability (9), or transcutaneous electrical stimulation to stimulate your vestibular system (10). It may involve specific types of visual stimulation exercises (11), or visual stimulation coupled with specific head movements (12). It may involve the use of transcranial magnetic stimulation to decrease your dizziness (13), or even the use of exercises performed in a virtual reality environment (14).

No two presentations of dizziness and vertigo are alike, and the same holds true for the NeuroRescue program. A cookie-cutter approach will be doomed to fail in conditions as complicated as dizziness and vertigo. All of our therapy protocols are tailored to the unique needs of the individual.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that are involved in your dizziness and vertigo. We begin by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your brain are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your brain. It works to improve energy, endurance, and functional capacity within your involved fragile systems.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to return you to living a healthy, vibrant, and fulfilling life.