Vertigo is a sensation of feeling off-balance. Vertigo can make you feel like you are spinning or that the world around you is spinning. It can create a sensation of falling, tilting, swaying back and forth, being pulled in one or several directions, or being generally unstable.
Dizziness is a sensation of light-headedness. It can make people feel like they are about to faint and lose consciousness.
Vertigo and dizziness often involve some level of nausea. More severe cases may involve headache, sweating, heart palpitations, ringing in your ears, inability to hold your eyes still, vomiting, and a feeling of being unable to sit up or stand without passing out. Vertigo can range from a mild annoyance to a severely debilitating problem. Many vertigo sufferers are bedridden. Vertigo can make it impossible for you to interact with the world.
Vertigo is often caused by a problem with the vestibular system. This includes the inner ear and the vestibular nerves. The problem can also involve any of the brainstem, cerebellar, and brain regions that receive inner ear input. When the input from the vestibular system does not match the input from the eyes or the muscles, this sensory mismatch creates the inappropriate perception of motion.
One of the most common causes of vertigo is known as Benign Paroxysmal positional Vertigo, or BPPV. The inner ear has two systems of receptors, known as the otoliths and the vestibular canals. The otoliths sense the head’s tilt in relation to gravity and movement in translational planes, such as up, down, and side-to-side. They require tiny crystals called otoconia in order to function. The vestibular canals are receptors that sense head movement in rotational planes. BPPV occurs when these crystals are dislodged and floats into one of the canals. The canal provides the wrong input to the brainstem, and creates a vertigo-producing sensory mismatch.
BPPV is usually easy to fix with repositioning maneuvers, wherein the head is placed in a sequence of positions that allow the crystal to float back where it belongs or recalibrate by means of central brainstem mechanisms. More complicated cases of BPPV involve more than one canal. We successfully resolve complicated BPPV on a regular basis.
Meniere’s disease is a condition involving fluid buildup within the inner ear. It can cause episodic vertigo, ringing of the ears, and a sensation of ear pressure or aural fullness. This can progress to create hearing loss. There are several important factors that need to be addressed in Meniere’s disease beyond the sensory mismatch that it creates, including diet, salt intake, and inflammation. Management of these factors can often halt the progression of the condition, while appropriate neurological rehabilitation can resolve the vertigo sensation and balance difficulties.
Vestibular neuritis or labyrinthitis usually results from a viral infection. This creates inflammation in the inner ear that damages the vestibular receptors or vestibular nerves. Therapies to deal with the viral infection can be necessary, as is again appropriate neurological rehabilitation to improve the function of the damaged tissue.
Mal De Debarquement Syndrome
Mal De Debarquement Syndrome is a type of vertigo that creates a rocking sensation, as if the individual is constantly on a boat. This is the result of a mismatch between the two types of vestibular receptors, the Otoliths and the Vestibular Canals, along with dysfunction in the brain and brainstem systems that make these receptors work together.
Orthostatic hypotension is a form of dizziness that develops when people shift their position towards being more vertical. People often feel like they are about to pass out during sit-to-stand transitions. This involves poor coordination between the vestibular system and the brainstem mechanisms that regulate blood flow to the brain.
Postural Orthostatic Tachycardia Syndrome (POTS) is a more severe orthostatic issue, wherein people lose the ability to properly regulate heart rate as well. This is a common consequence of traumatic brain injuries, but can also be the result of viral infections, mold exposure, chemical sensitivities, and other types of autoimmune conditions.
POTS comes from a disruption of the cardiovascular system, specifically when the patient changes position from lying down to standing up. The brain and body have a highly regulated system that controls blood pressure and heart rate to keep blood flowing to the brain regardless of position. With POTS, this system is not functioning properly. POTS patients often feel symptoms of a racing heart, headache/migraine, chest pain, lightheadedness, fainting, and brain fog.
POTS is a form of Dysautonomia, which means that there is dysregulation of the autonomic nervous system, which controls the automatic processes of the body including blood pressure, heart rate, and breathing. POTS is most common in women from ages 13-50 and is commonly caused by head trauma, infection, and chronic illness, especially when the patient is immobilized for an extended time.
Traumatic Brain Injury (TBI)
TBI frequently result in vertigo and dizziness. Vertigo is one of the most common symptoms of an injured brain. Vertigo can also be the result of neck injuries. The forces that create TBI also commonly damage the vestibular system and the neck muscles and joints. This can create severe sensory mismatches. We frequently see patients that have suffered injuries to all of these systems simultaneously.
Vertigo can also be the result of migraine headaches, or more insidious brain problems such as tumor or stroke. And in far too many cases, dizziness and vertigo can be a consequence of prescription medications and their interactions, or even from certain dietary supplements.
Our treatment for different types of vertigo varies depending on the cause. In most cases, our goal is to rehabilitate the brain and receptor mechanisms that are creating the mismatch, and make them integrate properly with your other systems. This is usually a very successful approach, and for the vast majority of our vertigo patients this approach yields our best results. In other cases, our goal is to teach the brain to adapt to the impaired reflexes, and teach it to rely on other mechanisms to maintain balance and decrease the vertigo sensations.
In all cases, our treatment starts with a comprehensive neurological examination, followed by cutting-edge neurodiagnostic testing. We use several advanced technologies to map and graph the function of every system involved in your vertigo, including important visual reflexes, vestibular function, and the feedback from your muscles and joints. We assess how these systems integrate in several different balance conditions. This allows us to precisely identify and quantify which systems are creating the mismatch, how they integrate, and the exact circumstances under which their integration fails.
We then create a neurorehabilitation program that is unique to your brain only, and specific to your individual pattern of dysfunction and fatigability. This enables us to get our best results in the shortest time possible. More importantly, it allows you to move beyond your condition and begin to engage in the world normally again.
No matter how long you have suffered from your vertigo or dizziness, it is never too late to start getting better.