Your primary care physician should refer your to a neurologist, cardiologist and ENT specialist for evaluation as the causes can be divided on the system, which is involved;
1) Inner ear or internal ear disease
2) Central nervous system
3) Cardiovascular, or
4) Systemic diseases
The causes of vertigo and dizziness according to the decreasing incidence are;
1) Benign paroxysmal positional vertigo (BPPV) 20%
2) Vestibular 15%
3) Migraine and motion sensitivity 15%
4) Anxiety and depression 10%
5) Meniere's disease 7%
6) Cerebellar disease 6%
7) Transient ischemic attacks 5%
8) Orthostatic hypotension 4%
Internal ear disease vertigo is termed true vertigo in which one feels rotational movement of self or the surroundings. The false vertigo or nonvertigo has feeling of light-headedness, unsteadiness, motion intolerance, imbalance, etc. You need to consult first an ENT specialist to exclude the diseases of internal ear. They will perform some clinical tests (vestibular diagnostic tests) to establish the cause. Often, dizziness can be a multisensory disorder due to any combination of peripheral neuropathy, visual impairment, and musculoskeletal disease. Many patients who have thyroid dysfunction can present with dizziness as an initial complaint.
Following are the investigations which will clinch the diagnosis;
2) vestibular tests.
The most commonly performed vestibular tests are as follows:
Electronystagmography (ENG)The rotating-chair test, also referred to as sinusoidal harmonic acceleration (SHA), Computerized dynamic posturography (CDP).
3) blood tests for autoimmune disorders,
4) computed tomography (CT), and magnetic resonance imaging (MRI).
5) The saccadic test
6) The gaze test
7) Pursuit eye movements test
8) Optokinetic Nystagmus test
9) Head shake nystagmus test.
10) Positional nystagmus testing
11) Bithermal calorie test.
12) Rotating chair test.
13) An alternative to the rotating-chair test is the active head-rotation test,
14) Computerized dynamic posturography
An ENT specialist and a neurologist with a Rehab specialist in tandem are involved in the investigative work up and care.
MRI with gadolinium enhancement is also particularly useful in detecting smaller intracanalicular tumors such as acoustic neuromas. It is also recommended for identifying sclerotic and demyelinating white matter lesions characteristic of multiple sclerosis. So that can be another investigation considered by your doctor. Chronic dizziness / vertigo associated with the floating, rocking and light headedness and is induced by eye movements (head being still) should be also investigated or correlated to anxiety and depression, if all the medical imaging, blood work and examination is negative. If you are on any medications, their side effects also should be ruled out for lightheadedness, as drugs are quite a common cause for this symptom. Dizziness may be provoked by only certain movements, such as standing up after lying down for at least 10 minutes in orthostatic hypotension, or may occur after vertical or oblique head movements, such as lying down, turning over in bed, or sitting up in benign paroxysmal positional vertigo (BPPV). Simply moving the eyes with the head stationary causes dizziness and there is no eye movement disorder (ocular misalignment or an internuclear ophthalmoparesis), then dizziness is likely to be the result of anxiety. When dizziness occurs without provocation (spontaneous) and is vestibular (ear disorder) in origin, it frequently is exacerbated by head movements.
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