Not All Spinning Motions Cause Dizziness

In one of the stranger research projects I've encountered in awhile, French scientists reported on why in the sport of discus throwing, athletes tend to feel more dizzy than those who hammer throw.

Whether discus or hammer throwing, both require spinning on part of the athlete before letting the discus/hammer go for long distances.

59% report dizziness with discus throwing, but none with hammer throwing. Why?

This occurred even among athletes who did both sports eliminating individual susceptibilities to dizziness.

Based on slow-motion video analysis, it was conjectured that visual bearings can be used more easily with hammer throwing than during discus throwing. Moreover, less foot contact with the ground for ground-body tactile feedback and generation of head movements liable to induce motion sickness from acceleration were felt to be contributing factors.

How do these findings translate to patients who are dizzy?

1) Visual bearings - Fixate on objects that you know to be still
2) Increase body-ground contact - Wear flat shoes instead of stiletto heels as well as cane/walker use
3) Minimize sudden turning head motions - Turn with the body rather than the head, or turn the head slowly

Of note, this research project won the 2011 Ig Nobel Prize for Physics.

Reference:
Dizziness in discus throwers is related to motion sickness generated while spinning. Acta Otolaryngol. 120 (3), 390-5.

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MRI Scans CAN Cause Vertigo

Researchers at Johns Hopkins published a study that reports that MRI scans CAN cause feelings of dizziness induced by magnetic fields causing motion of the electrically charged fluid of the inner ear.

In both ears, there is a "gyroscope" called the labyrinth. Whenever the head turns or a force like gravity is exerted on this system, fluid moves within which tells the brain that motion has occurred. It's much like looking into a glass of water and based on the way the water tilts in the glass, you can guess which way motion is occurring.

In any case, the study took two groups of people, one with an intact labyrinth system and another without a functioning labyrinth system. Only those individuals with an intact labyrinth system suffered vertigo while getting an MRI. Furthermore, the stronger the MRI's magnetic field, the worse the vertigo.

Beyond the "that's interesting" trivia, these results are VERY important in any type of brain activity research. Why? Well, if a person is feeling dizzy, the brain activity you may be studying using the MRI may be attributable to the dizziness itself and the patient's coping mechanisms to deal with it rather than whatever brain activity research you may be investigating.

On a more science-fiction note, based on these findings, an MRI can theoretically be used to potentially diagnose and treat dizziness due to the inner ear. After all, if it can cause dizziness, it certainly can be used to help it as well!

Reference:
MRI Magnetic Field Stimulates Rotational Sensors of the Brain. Current Biology, 22 September 2011. doi:10.1016/j.cub.2011.08.029

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Boy With Missing Cerebellum & Pons Learning to Walk!

First off... the cerebellum and pons are part of the brain that is responsible for some very important things like balance, breathing, regulating blood pressure, heartbeat, etc.

So one would think that without a cerebellum or pons, life would not be possible.

Well... it seems that may not be quite true.

You see, there's a young boy missing those parts of the brain who not only is living without mechanical assistance, but eventually managed to sit up on his own, something he shouldn't have been able to do without a cerebellum to provide balance. Next he learned to crawl, first dragging himself military-style, then pushing himself upright. Now, he's learning to walk.

A true medical mystery.

Read more here.

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How is Love Like Dizziness? Medically Speaking...

I watched this touching video of what it is like to fall in love... that very moment when you see the love of your life for the first time... and the world falls away. Time slows down. That feeling of elation, passion, love overwhelms. Time stands still. Everything else blurs out except for him/her...

Nuit Blanche from Spy Films on Vimeo.

Now from a medical perspective, how can we test this? If "love" is considered a disease, how can we positively "diagnose" this? How can a doctor touch, see, feel, measure "love" and the severity of this affliction when all the symptoms are felt on the inside?

The simple answer is you can't. Similarly, dizziness is a problem that like love, can't be seen, touched, measured by the doctor very easily. Unlike tonsillitis where all a doctor has to do is look in the mouth and "see" the infection, we can't do the same for dizziness.

The way a physician approaches a sensation that is only felt by the patient, but no other is via several steps.

A good history. That's why when a patient with dizziness comes to a doctor's office, we ask a lot of really picky questions as it helps narrow down the possibilities. This step is just like when a friend asks exactly what you felt when you first saw the love of your life.

- What does the dizziness exactly feel like? Spinning, fainting, rocking, drunk, etc???
- Exactly how long does an episode last for? Seconds, minutes, hours, days, weeks, months???
- Can it be triggered? Turning, bending, walking, etc???

Click here for a dizziness flowchart based on answers to these and other similar questions.

Based on the history, additional testing may or may not be required. If a doctor was trying to decide if a patient was afflicted with "love", a good history may be all that is required. However, if the doctor is not quite sure, he/she may want to get an EKG to measure the pulse to ensure no supraventricular tachycardia arrhythmia ("When I see John, my heart races"), MRI scan to ensure no brain tumor (causing symptom of time standing still), ophthalmology exam ("Everything else seems to blur out except for John"), etc.

Just like for "love", a similar type workup needs to be pursued for dizziness depending on how the dizziness exactly felt like and may include audiogram, EKG, bloodwork, ENG, cardiac ECHO, 24 hour holter, 30 day cardiac event monitoring, pulmonary function tests, carotid ultrasounds, MRI/CT scans, EEG, chest-x-rays, allergy testing, tilt-table test, etc. As such, one may need to have an evaluation by a neurologist, cardiologist, ENT, pulmonologist, endocrinologist, etc to uncover the cause of your specific dizziness.

Once the cause is determined, treatment is based on addressing that specific diagnosis. As one can see, the human body's sense of balance is actually extremely complex making dizziness one of the most difficult symptom to diagnose and treat.

"Love" would be similarly difficult to diagnose with absolutely certainty if it was considered a disease as well. Based on symptoms alone (without history), love could potentially be confused with fear, anger, hate, etc.

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A New Treatment for Meniere's Disease!

I read with interest an MSNBC article that describes a brand new surgical treatment for Meniere's Disease, a debilitating disorder in which a patient suffers spinning attacks that last for hours to days. The treatment is an electrical device surgically implanted into the vestibular system of the ear, much like a cochlear implant for deaf individuals.

The device, called "UW/Nucleus Vestibular Implant," is surgically installed behind the affected ear with a small wire threaded into the labyrinth system.

In a rough manner of speaking, this new device restores balance by sending electrical impulses to electrodes implanted in the bony ear, disrupting a vertigo attack when it occurs. Consider it like a defibrillator for patients prone to ventricular tachycardia.

It does NOT cure Meniere's... it just allows a vertigo attack to be quickly aborted before it gets bad.

It is currently undergoing clinical trials at the University of Washington under direction of Dr. Jay Rubinstein and Dr. James Phillips.

Read more about this innovative treatment on MSNBC here.

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Tilt-Table Test: An Under-Utilized Study To Evaluate Light-Headed Dizziness

We often see patients for dizziness. Many of these patients do not have an ear etiology for their dizziness given principal complaint of light-headedness, especially with standing/sitting up from a laying down position. In this scenario, a blood pressure issue is the more likely cause. Why? Because when you get up from a laying down position, gravity pulls the blood down and away from your head resulting in a transient lack of adequate blood-flow to the brain resulting in light-headedness... and even a fainting spell if severe enough.

Normally, the body is able to compensate for such position changes quickly, but when it doesn't, watch out... Light-headed dizziness or fainting/blacking out will occur.

The best test to evaluate this problem is a tilt-table test. Check out the video to see how this test is performed. Be aware that not all hospitals offer this type of test.

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Feeling Dizzy or Having Vertigo? There's an iPhone App for That!!!

On April 22, 2010, Clearwater Clinical Limited released an iPhone application that helps clinicians diagnose and perform the Epley maneuver in patients with BPPV (Benign Paroxysmal Positional Vertigo).

The way it works is by placing the iPhone over the patient's forehead and than following the instructions as shown on the iPhone through each of the Epley steps.

When I tried it out, it does seem to correctly take the patient thru the appropriate steps... however, I would add one more step. Place a tissue between the iPhone and patient's forehead before use (for sanitary reasons).

Click here to download the (FREE) app from iTunes!

Click here to read more about dizziness in general.

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Rare Disorder Causing Dizziness Called "Mal de Debarquement"

The Washington Post on March 16, 2010 published a story entitled "Rare disorder makes people feel off balance for weeks or months" describing a rare condition called mal de debarquement which causes dizziness.

Two signs that a patient has mal de debarquement are if they feel a rocking sensation for weeks or months starting after a cruise and if they're fine when driving but not when standing, walking or sitting.

Read the story here.

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New Webpage Has Been Created to Assist Patients Diagnose Their Dizziness!

A new webpage has been created in flowchart format to help patients diagnose what may be causing their symptoms of dizziness. The questions asked guide patients to a possible diagnosis that MIGHT be causing their dizziness as well as to get an idea of what kind of studies may be obtained when they see a doctor. Keep in mind that these questions are geared towards an ENT workup... ie, focus is on determing whether the ears may be playing a role or not.

Click here to check it out!

Of course, any information provided on the website should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment.

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