Wednesday, March 31, 2004

Dizzy spells have wide range of causes

By Allen Douma, M.D.
Tribune Media Services

Q. I’m a 70-year-old male who has had some bad dizzy spells over the last three years. They are becoming more frequent, occurring almost every day. I was seen in the emergency room, but they didn’t know what was causing the dizziness. I take atenolol for my blood pressure and Zantac for heartburn. My neck has ached for the last six months and I’ve thought that maybe the neck pain is related to the dizziness. I also had a melanoma removed many years ago. Please tell me what to do. — J.Z., St. Cloud, Minn.

A. Dizzy spells have a number of possible meanings, so the first thing you need to do is to define your symptoms more exactly. Although there doesn’t seem to be much of a difference between dizziness and lightheadedness, the difference is important, especially in determining cause and recommending treatment.

One type of dizziness is call vertigo. This involves the sensation of motion when there is none (e.g., the room seems to be spinning around), or a sense of exaggerated motion in response to little movement. It can be accompanied by nausea and vomiting, hearing loss or ringing in the ears.

Vertigo is usually caused by abnormalities of the inner ear, which is our organ of balance. It can also be caused by abnormalities of the nerves connecting the inner ear to the brain, or changes in the brain itself. These nerves do not go through the neck, so it’s unlikely that your neck pain is related.

Abnormalities may be due to infections, tumors, head trauma, pressure on or inflammation of nerves, as well as problems with the blood vessels supplying these tissues. Melanomas do metastasize to the brain, but if yours was removed many years ago, it’s unlikely to be the cause dizziness now.

Vertigo can also be a feature or symptom of a number of systemic (whole body) diseases. It can also occur as a side effect of some anticonvulsant, antibiotic, hypnotic, analgesic and tranquilizing drugs, and from alcohol.

It has been reported that both atenolol and ranitidine (Zantac) cause dizziness in a small percentage of people. Did you give the health-care professionals who examined you in the emergency room all your medical history, including the medications you’re taking?

The symptoms of vertigo should be distinguished from feelings of imbalance, light-headedness or fainting spells. Syncope (the “e” is pronounced) is the medical term for passing out or fainting.

In contrast with vertigo, lightheadedness and syncope are caused by too little oxygen reaching the brain. When this happens as you suddenly sit or stand it’s called postural hypotension. A person often notices this condition when he gets up rapidly from bed, especially if he has been lying down for while.

Hypotension can be caused by many other conditions, including excessive stress, high fever, anemia, and some medications for high blood pressure, such as atenolol. Were your dizzy spells related to any of these things?

Dizziness can also be the result of TIAs (transient ischemic attacks) caused by small blood clots in the arteries of the brain, or by strokes. However, the dizziness associated with strokes usually lasts for a longer time and may not ever go away.

Another common cause of dizzy spells is abnormal heart rhythms, during which time the heart doesn’t pump enough blood to the brain. The so-called arrhythmias can come and go, so you have occasional “spells.”

As you can see, there are many possible explanations for dizzy spells. The key to treatment is determining the cause. As with every medical problem, this requires that you carefully record your exact symptoms and what you are doing when they start and stop. Determine if there is anything you do that makes the symptoms stronger or weaker or happen more or less frequently.