Dizziness or Giddiness or Vertigo

Prof JC Sanasam *

People commonly call it dizziness or giddiness when they feel some disorder of the head and or body, maybe in terms of imbalance or a sensation of heaviness or floating of the head, or a bodily sensation of swaying or plunging down or being pushed in one direction, or a sensation of whirling or spinning or rotation of the head and or body.

Clinicians did not take the term dizziness or giddiness seriously because, common colloquial terms they are, such symptoms do occur in individuals who had not slept well, or had taken too many a drink, or has had chewed betel nuts vigorously, or had smoked too much, or has had read a book or watched TV or worked on the laptop or PC for too long, or had a slap from somebody, or has had therapy of antihistaminics or other depressant and narcotic drugs, or has had some fever with involvement of nose and sinus or refractory problems of the eyes, kind of things like that.

They took it more seriously only when the patient said he or she had a reeling or whirling or spinning or rotatory sensation of the head; this they used to call vertigo. Even about vertigo, they were kind of skeptical classifying it into false vertigo (or subjective vertigo) and true vertigo (or objective vertigo).

When the spinning sensation is such that the patient feels he himself or his own body reels or rotates but the surrounding objects remain as usual, clinicians call it a false or subjective vertigo; and if the patient feels the surrounding objects, like walls, ceiling, chairs, table, trees, houses rotate in front of him then it is known as true or objective vertigo.

The true vertigo is more or less exactly like the spinning sensation we used to feel during our childhood games when we used to reel and reel our body and opened our eyes and saw the surrounding objects all rotating in front of our eyes, difficult to tolerate for some time but coming back to normal sensation when the physiological system restored itself (physiologic vertigo).

True vertigo is often associated with nausea (sensation of tendency to vomit) and even vomiting itself as is seen among those who suffer from motion sickness during a vehicle-ride in the hills or during a flight in the aircraft. Now clinicians have realised that any symptom, maybe kind of dizziness or giddiness in the language of the patient, should be thoroughly investigated to rule out serious disorders like hypertension (high blood pressure), pre-heart-stroke or brain-stroke syndrome, severe anaemia (lack of cells and oxygen in the blood like in leukemia), Alzheimer’s disease, Acoustic Neuroma and other Cerebello-pontine tumors (brain tumors), so on and so forth.

Dizziness and vertigo are common medical issues, affecting approximately 20-30% of the general population. Vertigo may be present in patients of all ages. The prevalence of vertigo rises with age and is about two to three times higher in women than in men. It accounts for about 2-3% of emergency department visits.

Vertigo is a very uncomfortable and frightening symptom, many a time mimicking as if the earth or the world around is spinning or upside down. More common causes are of ENT origin like
Benign Paroxysmal Positional Vertigo (BPPV – a non-dangerous vertigo due to certain deficit of the inner ear physiology and system, triggered by certain positions of the head and or body),
Méniere’s disease or Endolymphatic Hydrops (due to improper circulation of fluid in the inner ear and stagnation of the fluid in a certain niche in the inner ear structure),
Vestibular Neuronitis (a viral infection and inflammation at the centre-nerve cells or neurons responsible for maintenance of the equilibrium or balance sensation of the head and or body),
labyrinthitis (infection or inflammation of the inner ear structure for example with pus collection in the ear niches or structures),
vestibular migraine (migraine, a vascular headache disorder but which somehow or other has affected the vestibular or equilibrium physiology),
vestibulo-basilar insufficiency (VBI - lack of blood supply to the area of the brain where there is the vestibular or equilibrium centre;
for example, due to disorder of the neck spine-bones which compress or distorts the arteries or blood vessels in the neck and eventually insufficient for the blood to reach the brain) etc.

Most cases of ENT origin are very often associated with impairment of hearing to total deafness. Head injury of all types, starting from concussion to fracture of skull and brain edema (swelling of brain tissue due to collection of fluids or clots) involving especially the area responsible for maintenance of balance or equilibrium) are also fairly common causes of vertigo.

Other disorders which can manifest with atypical vertigo, dizziness or giddiness or shaming symptoms has been mentioned above. Of all these labyrinthitis of ENT origin, and most of the other systemic or central disorders to do with the brain all are life-threatening.

Discussion on the differential diagnosis will be a lengthy, tiresome reading with technical nomenclature and parlance, difficult for common readers to understand. If such vertigo or such kind of disorders develop it is best to go to a relevant clinician and entrust him or her to find out the cause and manage accordingly.