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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35753
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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In 2005 I woke up with vertigo as if the room was

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Hi--In 2005 I woke up with vertigo as if the room was tilting/spinning-- the first 24 hours can barely move and vomiting/dry heaving, then the next 2 weeks extreme off balance , motion sickness----everything fine until the above symptoms happened in 2007 this time lasting about 4 weeks, since then never felt the same, never a day without a slight nausea feeling, and hard to look up or move to fast with out the motion sickness feeling. My doctor said it is vertigo and it can last 3 days to 9 months. ( I got use to the nausea and motion sickness I let it go) May 10, 2013 the vertigo (where it feels the room is spinning happened again. I have not been able to recover from this one (its now June 26, 2013) now I am experiencing a more extreme nausea and if I move too much the room starts spinning around and I get even more nauseated. If I am lying down and turn my head to the right the room spins around and my eyes feel like they are twitching and my head instantly gets nauseated and I get a tingling sensation in my head as if your hand falls asleep, I have been to the doctor 3 times since May 10, 2013 my doctor says the same thing its vertigo give it time, I was off work for 3 weeks then tried to go back and on the 2nd day had to leave due to extreme discomfort with the above symptoms, then went back to the doctor and he said bed rest, I tried again to go back to work this week made it 2 days, and again the extreme nausea, if I move it sets in and motion sickness, it is basically a minute by movement thing. I am 46 years old, I work as a claims rep for a insurance company, I have to work, I can go on disability, but I'm hoping this will end soon, please advise, just get rest as I have been or get another doctor? Please advise--thank you

Hello Lisa,
I am Dr. Arun and will be helping you today.

What are the specialists you have consulted?
What are the investigations done?

Any significant past medical history like migraine, low thyroid?

Customer: replied 4 years ago.

Hi--only seen by my Doctor specializes in Internal Medicine. No migraines no low thyroid. No tests done of any kind, my doctor said my symptoms do not warrant any.


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%

9) Other

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;

1) audiometry,
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.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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