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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35801
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I asked you a question on the 22 of last month and would

This answer was rated:

Hello again, I asked you a question on the 22 of last month and would like to follow up. I'm Stephen and I asked about a mystery dizziness problem my sister was having. If you don't have a copy of the conversation we had I can send it to you in full.
She has now seen the ENT specialist and had balance tests, a head rotation test and physical examination of her ears done. All of these went well. What do you think we should do next and do you have any intuition of what might be going on?
Thank you
Hello and welcome, Stephan.

Here is the link of our previous interaction;

Other causes than ear should be thought off.

The causes of 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%

9) Other

So BPPV would be the most likely explanation in her case. An MRI with the gadolinium contrast should be done to rule out a condition called as acoustic neuroma. MRI with gadolinium enhancement is 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 her doctor. Chronic dizziness 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 she is 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.

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. 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. In individuals who have migraine, dizziness and vertigo can occur as part of the aura or separately. Spells usually last approximately an hour but can last several hours or days in patients who have severe symptoms. Most patients who have migraines have a long history of recurring symptoms. So that too should be assessed as a cause if she a history of migraine.

It is privilege assisting you.

Dr. Arun

Customer: replied 4 years ago.
Do you think the head rotation test makes vestibular problems unlikely or should we go ahead with further vestibular tests?
Also, the dizziness is present regardless of her head position or exercise level (its there even when she wakes up in the morning), but head movement makes it worse.
Thanks, Stephen.
You are very welcome, Stephan.

Ideally first, an MRI with gadolinium contrast should be done to rule out any brain issue. If that is normal than the further vestibular tests would be recommended to completely rule out internal ear / vestibular problem.

Best regards,

Dr. Arun
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