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Recognizing the Meaning of Dizziness and How to Conquer It Submitted by Ramesh Singh, M.D. Neurologist, Jefferson Medical Associates
Dizziness is one of the most common complaints among patients age 50 and older who present to primary care physicians. An estimated 12.5 million Americans over the age of 65 are affected by dizziness. The prevalence of dizziness increases with age and is more common in women. Normal balance is attained through integration of inner ear, good eyesight, adequately functioning somatosensors (these are receptors present predominantly in the feet and neck, which feed information to the brain about awareness of body position in space), cerebellum (hind brain which becomes temporarily dysfunctional after alcohol intoxication) and cerebrum (the main two halves of the brain).
Dizziness is a loose term and has many forms. To grasp the gist of it, we can view dizziness as four main symptom categories – vertigo, presyncope, dysequilibrium and non-specific dizziness. Vertigo is a sensation in which patients feel that their environment is moving. Although the sensation is often rotational, patients also may feel as though they are falling. Vertigo is episodic and is commonly due to inner ear dysfunction, but can be a sign of TIA (ministroke or reversible stroke) or a completed stroke. Presyncope is usually described as a sensation of impending faint or loss of consciousness, and may begin with diminished vision or roaring in the ears. This condition may be due to adverse effects of medications, low blood pressure in the upright position or from heart problems. Dysequilibrium is a feeling that a fall is imminent and is characterized by unsteadiness or imbalance that occurs only when erect and primarily involves the lower part of the body rather than the head. In other words, the sensation disappears when sitting or lying. Common causes of dysequilibrium include inner ear dysfunction (usually both sides), stroke, peripheral neuropathy (peripheral nerve dysfunction – common cause is diabetes), arthritis of major joints in lower extremities, Parkinson’s disease, etc. Non-specific dizziness is described as a vague sensation of light-headedness, heavy-headedness, wooziness, etc. and basically includes symptoms that cannot be distinctly identified as vertigo, presyncope or dysequilibrium. It is usually due to anxiety or medication effect. There is also this entity called Presbyastasis, meaning dysequilibrium of aging, i.e., impaired physiologic function in several systems commonly affected by aging, which I jocularly tell my patients is a “Mileage Problem”!
As you can see, one could have one of the many forms of dizziness. The best place to start would be with your primary care doctor, who may then refer to the appropriate specialist as needed, or for further tests. At Jefferson Medical, we have acquired a “Balance Machine” which not only helps diagnostically, but also helps with fall prevention treatment and rehabilitation. The rehabilitation part is as simple as this: If someone wants to ride a bicycle for the first time, the brain is not ready for this balancing act. But with repeated attempts of practice, you can train the brain to achieve this balance. Similarly, with the exercises using the computer screen on the balance machine, the person can tap the inner adaptive mechanism of the brain to improve balance and prevent falls. We favor a referral from your doctor, but it is not a requirement to be evaluated on our balance machine. |
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