Witchdoctoring: ups and downs of vertigo

Empty Spinning Merry-go-roundThere is nothing like bouncing along, Bluetooth in your ear, imagining a cool soundtrack setting the backdrop to this scene in your life, a cool swagger in your step, then, suddenly, BAM! Your world is a scene out of Twister with your brain in the center of the storm. You’re not sure if your body is spinning, the room is swirling, which way is up or down, or if the planet is suddenly coming to an end in an epic finale in which the Milky Way is blended by a cosmic food processor.

You have been hit with a sudden case of vertigo. Not only is balance a long-forgotten memory, but your GI track seems to think that emptying the contents of your stomach will relieve your distress. It doesn’t. Your tossed cookies only contribute to the embarrassment, as you become a scene out of Looney Tunes.

For clarity, and to preserve my sanity in explaining this, we’re talking only about vertigo, which is any abnormal sense of movement. We’re not talking about lightheadedness, passing out, or feeling woozy. Emergency physicians cringe at the complaint “weak and dizzy” because that means different symptoms to different patients, and each one can represent a blue-million diseases.

As I care for patients with vertigo in the emergency department, I try to do two things. One, figure out if what my patient has is something really bad, like dangerous or life-threatening, or, two, try to provide some symptom relief for this poor soul. Even to the seasoned physician, sometimes neither of these tasks is very easy. First, we try to establish if this is peripheral (not brain = less bad) or central (brain = bad).

Peripheral vertigo, which is the less severe and more common, originates from a problem in the inner ear. Each inner ear has three fluid-containing “tubes,” called semicircular canals that send signals to the brain to tell it how our heads are positioned in space, relative to gravity. For the math nerds out there, these canals are in the x, y, and z plane. That’s not so important to the story. Little hairs along the canal interpret that movement for the brain. To understand vertigo, just realize that as the head rotates or moves, the fluid in these semicircular canals moves.

When peripheral vertigo occurs, it is because little calcium deposits, called otoliths, have gotten into that fluid where they shouldn’t be. That means the fluid doesn’t move freely, which means that it moves abnormally. The brain gets really jacked up signals from those little hair cells and thinks that the head isn’t moving causally, but that you’re suddenly a stunt pilot doing barrel rolls over the countryside.

There are some drugs, like meclizine and Valium, that can help settle the symptoms. Also, there is a series of movements, called the Epley maneuver, that can reposition those otoliths so that they aren’t impeding the movement of the fluid in the inner ear. I once did this for a patient, and it was so effective she told me I was like a witchdoctor. I took that as a complement. I’ve been called worse.

There are multiple causes of peripheral vertigo not covered here. But, the other major category of vertigo is central. That means that the dizziness is coming from something bad going on in the brain. It’s weird, but usually the central causes of vertigo have symptoms that come on gradually. The peripheral (inner ear) causes usually hit lightning fast as described above. That said, if the balance areas of your brain suffer a stroke, that causes pretty abrupt symptoms.

Central causes of vertigo are worrisome processes like tumors, strokes, and hemorrhages. There are other causes of dizziness, including blood chemistries that are out of whack, medication side effects, and trauma, such as concussions.

So, if you find your brain suddenly transported to some phantom carnie-operated gyroscope, without the benefit of elephant ears and caramel apples, try to find this blog, attempt to click the link to the Epley maneuver (puke away from your laptop), and see if you can settle your symptoms via a little witchdoctory magic. If it helps, call your doctor and arrange follow-up. If not, ask Siri to hail you an ambulance. Please don’t try to drive. Especially in my city.

What vertigo experiences have you had that you lived, or didn’t, to tell about.