Child Neurology New York

Newspaper Article: "DIZZINESS: A Common Problem"

When is dizziness a problem?

If you whirl around and around, you'll get dizzy. That's normal. But if you get dizzy when you are getting up or lying down or sitting in a chair, that's not normal. That's when dizziness is a problem.

The symptom of dizziness is more common than you might think. It is the second most common health complaint. (The most common is lower back pain.) About 40 percent of adults seek medical help for dizziness at least once in their lives.

Dizziness feels different to different people. Some people feel lightheaded or woozy. Some feel as if they are spinning or the world is spinning around them. (This type of dizziness is called vertigo.) Others have no unusual sensation at all, but lose their balance when they stand or try to walk. Sometimes dizziness comes in spells, with little or no dizziness between spells. Sometimes it comes on abruptly and gradually gets better. Sometimes it's barely noticeable at first and just keeps getting worse. Dizziness can get so bad it makes you feel seasick, with nausea and vomiting.

What causes dizziness?

Dizziness is caused by many different health disorders. It is a common side effect of medications. It is caused by toxic chemicals and fumes and by injuries to the head or neck. Sometimes the problem is in the ear. Everyone knows that the ears sense sound, but not everyone knows that the ears also sense head movements and that ear disorders can make you dizzy. Dizziness-causing ear disorders include fluid imbalances, infections, and degenerative diseases. The most common of these has a long name - benign paroxysmal positional vertigo. It occurs when tiny crystals get lodged in the wrong part of the inner ear, and it can cause severe dizziness, especially when you lie down in bed. Sometimes the problem is in the brain. Brain disorders include tumors, migraine, multiple sclerosis, and various kinds of infections and degenerative diseases. Dizziness can be caused by partial or total blockage of the arteries that supply blood to the brain. It can also be caused by general health problems, such as thyroid deficiency, vitamin deficiency, diabetes, anemia, and immune system diseases.

Some of these disorders are serious and some are not so serious. Fortunately serious disorders are rare and not-so-serious disorders are common. Strange as it may seem, severe dizziness doesn't necessarily indicate a serious disorder. Some serious disorders cause mild dizziness and some not-so-serious disorders cause severe dizziness.

You really should see your doctor about your dizziness, even if it seems to be getting better. Your doctor can often find out what's wrong even if you're not actually dizzy at the time of your visit. If your dizziness is truly alarming, you may choose to go to the emergency room.

What happens when I see my doctor?

Your doctor will ask lots of questions. What does your dizziness feel like? When did it start? How bad does it get? Is it constant or does it come in attacks? What seems to bring it on? What makes it better? What makes it worse? What other symptoms go along with it?

If you are seeing a doctor for the first time, you will also be asked about other current or past health problems, about health problems in your immediate family, and about your lifestyle.

Some doctors prefer to ask these questions face-to-face. Others prefer to have you to fill out a questionnaire in the waiting room and then go over the answers with you. You should be aware that certain information is helpful and other information is not. Your doctor knows which information is helpful, so it's best to let him (or her) ask the questions.

You will be examined. The nurse will check your height, weight, heart rate, breathing rate, and blood pressure. The doctor will listen to your heart and lungs and examine various parts of your body - eyes, ears, nose, mouth, throat, neck, chest, abdomen, pelvis, lymph nodes, joints, bones, muscles, skin, nerves, and mental status.

What happens next?

If your doctor finds a not-so-serious cause for your dizziness or at least finds no evidence of a serious disorder, he (or she) will explain the findings and what they mean and tell you what can be done about your problem. That's usually what happens. Your doctor will begin treatment (if any is available) and send you home with instructions to return for a follow-up visit and to call in the meantime if your dizziness comes back or gets worse.

If your doctor needs more information in order to make a diagnosis, he (or she) may draw some blood and send it to the laboratory for analysis and may schedule other tests and instruct you to return for a follow-up visit after test results come back.

If your doctor finds evidence of a serious disorder, he (or she) may send you to a specialist - to an internist if it's a general medical disorder, to a cardiologist if it's a heart or circulation disorder, to a neurologist if it's a brain disorder, to an otolaryngologist if it's an ear disorder. The specialist will ask more questions, perform a more extensive physical examination, and may send you for more tests.

If your doctor finds evidence of a serious disorder that requires prompt attention, he or she may admit you to the hospital.

What can my doctor do about my dizziness?

Some disorders that cause dizziness don't require any treatment. They go away by themselves. Sad to say, some disorders won't go away by themselves and there is no effective treatment. Fortunately most disorders can be treated. If dizziness turns out to be a side effect of medication, adjusting the dosage or substituting another medication usually solves the problem. One of the most common disorders - benign paroxysmal positional vertigo - can be treated simply by turning the head a certain way so that tiny crystals in the inner ear move out of the place where they cause dizziness and back to where they belong. Many disorders can be treated with medication, surgery, diet, a change in lifestyle, or some combination of these.