Dizziness might be a sign of vertigo

Dear Dr Donya, I would like to get your opinion regarding a problem my wife is suffering from. She is 31-years old and we have 2 daughters, the youngest is 2-years old. Since the second pregnancy she has suffered from periodic dizzy spells every couple of months, lasting two to five days, which leave her very weak.

The symptoms are worst when lying down/sleeping, and particularly when moving positions from on her back to her side, or from her side to a standing position.

Sometimes she really feels like she is going to faint, and this makes her sleep poorly or not at all. Sleeping on her back doesn't bring the same feeling. The symptoms started when she was seven months pregnant with our second child.

The gynecologist prescribed stugeron but my wife didn't take it due to her pregnancy. She has been tested for anemia but the results were negative. At that time the doctor did say her blood pressure was a bit low however. She has diabetes in her family but she herself has tested negative. She exercises regularly and isn't overweight. We would be very grateful for any guidance you could give of possible causes or treatment as we haven't been able to identify the problem despite a number of tests.

-- Alex

Dear Alex,

From your information I think your wife has vertigo which has a wide variety of symptoms such as dizziness. Dizziness is one of the most common complaints. Our balance is maintained by information received from peripheral parts such as vestibular (ear), visual (eye) and somatosensory receptors; each receptor type transduces a specific form of information and sends it to the brainstem (part of the brain).

Information received by all receptors is processed mainly in the brainstem vestibular nuclei and the cerebellum. Interaction between these centers will set the appropriate response, which will ensure balance. The problem of imbalance happens either when there is a peripheral disease or central nervous system disease (brain).

The symptoms of vertigo patients can vary;

* Vertigo is illusion of movement relative to one's surrounding, usually rotatory but may be linear.

* Dysequilibrium or imbalance which patients usually complain of unsteadiness related to ambulation.

* Presyncope which is feeling of faintness or impending loss of consciousness and usually related to cardiovascular disorders.

* Lightheadedness: non specific sensation of unsteadiness or floating.

The causes can be:

* Peripheral vertigo: acute labyrinthitis, benign paroxysmal positional vertigo, Meniere's disease, perilymp fistula, vestibular neuritis, head injury such as fracture, metabolic derangement, hyperlipidemia, hypothyroid.

* Central vertigo: multiple sclerosis, migraine headache, vascular insufficiency, temporal lobe seizure.

For your wife; Vestibular neuritis could be the one as her spells last for two to five days, which is quite long.

The associated symptoms will help doctors evaluate its cause, such as hearing loss, ear fullness, tennitus or ear discharge might indicate peripheral vestibular pathology. While CNS (central nervous system) symptoms such as blurred vision, diplopia, dysarthria, incontinence, motor or sensory deficit indicate central pathology. The symptoms can happen suddenly or intermittent symptoms usually indicate a peripheral cause while more constant or progressively worsening symptoms indicate a central cause.

Looking for exacerbating factors; such as symptoms that worsen with head movement indicate a peripheral and more benign etiology, symptoms that worsen with closing the eyes indicate a peripheral vestibular cause and symptoms worsened by loud noise suggest perilymphatic fistula.

But Alex what I can give you will not be enough to diagnose your wife without examining her, and I should not guess what she has by reading your email. You should take her to see ear specialists or neurologists to find out what the problem is.

-- Dr. Donya