According to a survey, vertigo-unsteadiness is the third most common symptom after chest pain and generalized weakness fatigability in patients coming to the O.P.D. -
Approximately 50% of the patients in geriatric age group present with this complaint at some point of time. When a patient comes with complaint of feeling of thingsrevolving around him/her or feeling that he himself is revolving or feels imbalance, then he/she is said to have giddiness-vertigo. If the patient complains of momentary blackout or imbalance or vague generalized weakness and restlessness, it cannot be considered vertigo.
i. Giddiness on change of posture or position (benign positional vertigo)
ii. Vestibular Dysfunction (Vestibular apparatus located in the inner ear helps maintain the balance of the body).
iii. Disease of the Cerebellum
iv. Meniere’s disease
v. Decreased circulation in the brain.
vi. Fear of falling
vii. Other causes
Giddiness may start suddenly and last for few minutes, or it may be prolonged. Occasionally it comes in bouts lasting for few seconds.
Most common and important among these, is giddiness, due to vestibular dysfunction. This could be either due to vestibular neuronitis where in, the vestibular nerve is affected by virus or labyrinthitis, where in addition to giddiness the patient has deafness or tinnitus. Both these syndromes are associated with vomiting.
If giddiness is associated with vomiting, one must look for herpes, labyrinthitis, problem of cerebellar blood circulation or brain tumor. Acoustic neuroma is the common brain tumor that presents with progressive giddiness, deafness, unsteadiness, cerebellar signs in addition to headache, vomiting.
Meniere’s disease results from inflammation of the inner ear or disturbance of endolymph circulation. (Endolymph is the fluid in the semicircular canals which comprise the vestibular apparatus). This causes giddiness, deafness, tinnitus, vomiting. The symptoms may last for few minutes to days and then the patient may become completely symptom free. However, episodes may recur and then deafness and tinnitus become permanent. These patients should restrict salt in their diet and avoid coffee and chocolates.
Among the aged, benign paroxysmal positional vertigo is common. The patient has giddiness for few seconds on change of posture or position. There is no serious problem in the brain. In the geriatric age group, fall of blood pressure on getting up from supine or sitting position can also cause giddiness. This is known as orthostatic hypotensio.n.
The treatment differs according to the cause of giddiness. Commonly for symptomatic relief, antihistaminics, antianxiety, anticholinergic drugs e.gphenothiazines and even diuretics or newer drugs like Ondansteron are given. Dietary changes (viz. salt restriction) are recommended. in special cases. In some cases adaptation exercises also help.
Along with the drug therapy, small surgical procedures can also give relief. Brain tumor needs surgery in any case. If there is insufficient blood circulation, appropriate drugs should be used. Hence with adequate treatment most of the patients can get relief from this distressing symptom.