Common Conditions We Treat Causing Dizziness, Vertigo, and Balance Problems
Below you will find a list of conditions we treat. Click on them to expand the answer.
Dizziness and Balance Deficits in the Elderly
Dizziness, vertigo, and imbalance represent one of the most common complaints that elderly patients bring to their physician. Unfortunately, dizziness and balance disorders lead to disequilibrium, fear of falling, inactivity, and increased fall risk, functional disability. Such falls lead to limited mobility and reduced independence. Dizziness/Imbalance are rarely caused by a single source, many times it is a combination of deficits affecting the visual, vestibular, and somatosensory systems. Frequently there is not definitive cause of these symptoms and often they go untreated.
Benign Paroxysmal Positional Vertigo BPPV (ear rocks)
B: Benign- not life threatening
P: Paroxysmal- sudden onset
P: Positional- changes of head position
V: Vertigo- the allusion of objects moving in the environment
BPPV is a vestibular disorder that causes vertigo, dizziness, and imbalance because of the displacement ofotoconia (ear rocks/crystals) into a semi-circular canal in your inner ear. With changes of head and body position (looking or reaching up/down, lying supine, sitting up from a supine position, or rolling onto one side in bed), otoconia are displaced, sending false signals to the brain causing vertigo. Did you know, 20% of elderly suffer from undiagnosed BPPV?
Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in an area of the brain called the substantia nigra (motor control). Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally. Common symptoms of PD include: tremors (in your hands, arms and legs), bradykinesia (slowness of movement), rigidity of extremities and trunk, postural instability, decreased balance and coordination, and dizziness.
Multiple Sclerosis (MS)
Multiple sclerosis (MS) is an immune system disease that affects the central nervous system (the balance system). In MS, inflammation damages myelin (the protective covering around nerves) causing lesions (scar tissue) to form. The resulting lesions interfere with nerve signals (information) from the brain going to different body parts. I other words; not being able to communicate desired task. Dizziness, vertigo, and balance deficits are often early symptoms in patients with MS. Other common symptoms include weakness, numbness, gait difficulties, pain, emotional changes, and depression.
Concussion/Traumatic Brain Injury (TBI)
You do not have to strike your head to suffer from a concussion or TBI, the damage is done by movement of your brain against your skull. The immediate treatment protocol for post TBI/Concussion patients is rest and observation until cleared by medical professionals. Yet, after being cleared to return to general ADL’s, many patients complain of dizziness, vertigo, imbalance, and a general decrease in quality of life. If not addressed, these symptoms will continue to aggravate recovery. Patients, young and older, complaining of dizziness, vertigo, and balance related issues after a period of rest, should have a formal dizziness and balance assessment performed.
A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Long term stroke side effects include dizziness, vertigo, balance deficits, general weakness, postural instability. These side effects can lead to a decreased activities of daily living and an increase in fall risk.
Cancer treatment side effects on the central nervous system are common and can linger long after treatment has stopped. Multiple treatment approaches (chemo, radiation), as well as, the cancer itself, cause side effects that prevent simple activities of daily living. These side effects include dizziness, vertigo, balance problems, peripheral neuropathy (numbness in the extremities), poor coordination, postural instability, inability to hold objects, general weakness and fatigue, changes in taste and smell, and nauseousness.
Cervicogenic dizziness and balance problems are brought on because of neck pain, stiffness, and a lack of head range of motion. Patients complain of dizziness, vertigo, balance problems, and difficulty walking with head movements during activities of daily living. Patients often complain of dizziness and balance deficits with head movements and varying head positioning. Since your neck muscles are also involved in telling your brain where your head is moving through space, like your vestibular system/inner ear, cervicogenic dizziness is often mistaken for a vestibular problem; patients continue to complain of dizziness and balance deficits with traditional vestibular rehabilitation. Neck pain and stiffness need to be treated for resolution of cervicogenic dizziness and balance deficits. The key is to know what to look for when evaluating patients for cervicogenic dizziness.
Labyrinthitis and Vestibular Neuritis
Dizziness and balance symptoms often are a result from a virus or infection that inflames the inner ear or the vestibular (balance) nerve, which connects the inner ear to the brain. Patients complain of vertigo, dizziness, difficulty with balance, and hearing loss may occur. These infections of the inner ear are mostly viral and do not cause pain as with middle ear infections (around the ear drum). Inflammation of the inner may be the result of a systemic viral illness (one affecting the rest of the body, such as ( chicken pox/shingles, infectious mononucleosis or measles) or the infection may be confined to the vestibular system. Symptoms of neuritis and labyrinthitis can range from subtle dizziness to a violent spinning sensation. Patients also complain of nausea, vomiting, unsteadiness and imbalance, difficulty with vision, and difficulty concentrating.
Meniere’s disease is a vestibular (inner ear) disorder that produces a recurring set of symptoms. Meniere’s disease is characterized by fluctuating vertigo, hearing loss, ear fullness, tinnitus, (ringing in the ear), fatigue, dizziness, imbalance, difficulty ambulating. Meniere’s disease results from an abnormally large amount of a fluid called endolymph collecting in the inner ear. Some things that may set off an attack include stress, overwork, fatigue, emotional distress, additional illnesses, pressure changes, certain foods, and too much salt in the diet.
Mal de Debarquement syndrome
Mal de Debarquement syndrome is the feeling of imbalance or dizziness after traveling by car, ship/boat, train, or airplane. Experiencing movements not being exposed to in everyday activities triggers Mal De Debarquement syndrome. Taking a cruise or boating is the most common causes. For some, the illusion of movement seems to last for long periods of time; weeks, months, even years after the beginning of the symptoms. One explanation for the syndrome may be that the problem is not in the inner ear and most likely occurs someplace in the balance areas of the brain. The brain adapts to the motion of the ship or other vehicle; but once the movement stops, the brain is unable to re-adapt. The term often used to describe this is, “sea legs.” Symptoms include the sensations of bobbing, rocking, swaying, swinging, floating or tumbling. These may be accompanied by unsteadiness, disequilibrium, anxiety, difficulty concentrating.
Vestibular Migraine is a disorder usually associated with headaches, and can cause several vestibular syndromes. Vestibular migraines are very common, yet underdiagnosed. Several vestibular syndromes are caused by migraine. Benign recurrent vertigo consisting of spells of vertigo, occasionally with tinnitus but without hearing loss. In addition to the syndromes caused by migraine, several vestibular disorders have been linked to migraine. Studies indicate that people with migraines are much more likely than other people to experience severe motion sickness and may be more likely to suffer from Meniere’s disease or BPPV. Stress, anxiety, hypoglycemia, fluctuating estrogen, certain foods, smoking, and other factors can trigger migraine.
Acoustic neuroma is a nonmalignant slow-growing tumor on the sheath of inner ear’s vestibulo-cochlear nerve (balance and hearing nerves), which relays balance and sound information to brain. Patients often complain of feeling dizzy, being off balance, hearing loss (on one side), and in advanced stages, can cause facial numbness and decreased facial muscle function. Dr. Shumrick is the rehab medical advisor for The Acoustic Neuroma Association of America.
Pump Head/Cardiac Post Perfusion Syndrome
Pump head is a term used for neurocognitive symptoms following bypass heart surgery. Symptoms of post perfusion syndrome include dizziness, balance deficits, defects associated with attention, concentration, short term memory, fine motor function, and speed of mental and motor response times. “Pumphead,” refers to the state in which patients seem to linger after being hooked up to a heart-lung machine for open-heart or valve surgery.