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Vail Doc: When your world is spinning

Dr. Drew Werner
Vail, CO Colorado

Dear Doc,

I woke up this morning feeling fine, but as soon as I turned over in bed the whole room started spinning and I thought I was going to throw up. My doctor said I had a virus in my vestibular system. How serious is that, and when will I get better?

–Spinning in circles in Vail

Dear Spinning,

Your symptoms sound classic for a common and very bothersome although not serious condition known as Benign Paroxysmal Positional Vertigo (BPPV) or more simply Benign Positional vertigo (BPV). The complicated name says it all. Benign means harmless or not life threatening. Paroxysmal means sudden, intermittent and uncontrollable. Positional refers to the symptoms occurring with a change in or movement to a certain position. Finally vertigo refers to a spinning type of sensation as if the world is revolving too fast around you.

Rather than referring to a specific disease or illness, BPPV is a descriptive term which has a number of possible causes. Opening our memory vault and searching under balance you might recall high school biology and the semi circular canals. These three fluid containing tubes make up our vestibular system. Each canal is positioned in one of three directions, horizontal, vertical or diagonal. The hollow tubes are interconnected and lined with tiny cilia or sensory hair cells. As the fluid in the canals flows with gravity, different clia are activated giving us our position in the world – with our eyes closed. Our sense of touch, influenced by gravity and our vision make up the rest of our clues to our orientation in the world. Working together, we are remarkably in balance. When these systems disagree however, vertigo results with minor to severe consequences. From a mild dizziness to uncontrollable nausea and vomiting, BPPV can be debilitating.

A casual late night observer outside a college pub or other drinking establishment gives us our first clue to one cause for vertigo; drug toxicity. Alcohol and other drugs impair our vestibular system, which sends strong messages to the brain about our body’s position. The eyes and feet disagree and a drunken swagger is the result as the body tries to cope with mixed messages. Fortunately, alcohol’s effects are temporary. Rarely, however, other drugs may cause permanent damage to our vestibular system. Amusement park rides, rocking boats and spinning in circles are familiar causes of vertigo. In these cases, our vestibular systems are over activated and we recover usually quickly once we can rest. True BPPV, however, comes on suddenly and often without warning. A sudden turn of the head, or change in position can bring on an unexpected sense of spinning accompanied by nausea and sometimes vomiting.

The sudden onset can be alarming and even frightening. A visit to your doctor will typically reveal nothing wrong other than nystagmus with the Dix-Hallpike maneuver. By positioning your head in certain ways, your doctor can elicit the uncomfortable dizziness and observe an unusual phenomenon with your eyes. As the dizziness subsides the affected person’s eyes will flutter back and forth as they gaze in a particular direction. The same thing can be easily observed in dizzy children who tolerate the sensation usually much better than adults do. Although this falls in the “don’t try this at home on an unwilling subject” category, should you know someone who likes getting dizzy watch their eyes after they have gotten “I’m about to fall over” dizzy. Once they are sufficiently dizzy have them stand as still as they can and look directly at your outstretched finger. It helps if your finger is not directly in front of them, but off slightly to one side. Ask them to stare directly at your finger and you will notice their eyes making fine left-right movements as their brain tries to cope with the messages from their over activated vestibular system and your steady finger in their visual field.

The most common cause of BPPV is a virus infecting the inner ear where the vestibular system is located. It may occur after other viral symptoms, but often comes on with no other symptoms whatsoever. The infection causes what your doctor may refer to as a labrynthitis or vestibular neuronitis, which is the underlying cause of your BPPV. Treatment may consist of an over-the-counter medication called meclizine, or a referral to specially trained physical therapists. In most cases, BPPV resolves in a few days to a few weeks. Rarely, it can last longer, or be a sign of another condition. So, contact your doctor if the vertigo is severe, persistant or associated with any other symptoms such as double vision, numbness, weakness or headaches.

Dr. Drew Werner is the vice chief of staff at Valley View Hospital in Glenwood Springs and the Eagle County Health Officer. He lives in Eagle with his family. E-mail comments about this column to cschnell@vaildaily.com.


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