Dizziness & Vertigo
When experiencing dizziness or vertigo, patients often describe a wide variety of symptoms, including light-headedness, feeling of movement, feeling like they’re on a boat, feeling like they or the world is spinning, seeing black spots, passing out or feeling like they’re going to pass out, blurred or double vision, problems focusing and just feeling off balance. As functional neurologists, we are extensively trained to recognize and differentiate these conditions in order to treat the root cause or your symptoms.
Getting to the Root Cause is Key
Dizziness and vertigo can occur for various reasons that range from mild to severe. Getting to the root cause is essential for a full and speedy recovery. At Carolina Functional Neurology Center we often see patients with dizziness or vertigo that fall under the following categories: peripheral vestibular disorders, central vestibular disorders, autonomic dysfunction, metabolic conditions and higher vestibular disorders.
Peripheral Vestibular Disorders
The most common cause of vertigo is known as benign paroxysmal positional vertigo (BPPV). This causes sudden vertigo when moving the head in specific positions, often seen when lying back in bed or tipping the head back in the shower. Patients may experience nausea and vomiting due to the perceived increase in motion. Other types of peripheral vestibular disorders include: vestibular neuritis, Meniere’s disease, and acoustic neuroma.
Central Vestibular Disorders
Central Vestibular disorders are often seen after a traumatic brain injury (TBI), concussion (mTBI), chronic/unresolved peripheral vertigo, and with other central nervous system disorders (ie. multiple sclerosis, cerebellar atrophy). Central vestibular disorders can present similarly to peripheral vestibular disorders or can look very different. Patients may complain of lightheadedness, feeling like they are on a boat or swinging on a bridge, feeling off balance, uncoordinated, bobbing up and down, nausea, vomiting, car sickness, slurred speech, headaches and more. Central vestibular disorders usually present with dysfunction in the brainstem or cerebellum.
Autonomic Dysfunction
The autonomic nervous system (ANS) plays a vital role for the proper function of every aspect of the brain and body. The ANS controls all of the “autonomic” things our brain does for us everyday; such as heart rate, blood pressure, sleep/wake cycle, digestion, breathing, proper blood flow, and reproductive health. Patients with dysfunctions in this system can experience feelings of dizziness, lightheadedness, and vertigo. This is why it is an important area to examine when a patient presents with these symptoms.
Metabolic Conditions
Dizziness and vertigo can be symptoms of other underlying chronic conditions. We have seen patients experience feelings of dizziness and vertigo associated with anemias, dysglycemia (poor blood sugar regulation), thyroid disorders, celiacs disease, gluten sensitivities, medication induced and more.
Higher Vestibular Disorders
The vestibular system is a complex and intricate system that has integration all the way up into higher cognitive aspects of the human brain. What this means is the vestibular system plays a role in the interpretation of where we are in space and where space is in relation to us. It helps to create a sense of “self” and align us properly with the world around us. Patients suffering from vestibular dysfunction may experience dizziness and vertigo but they can also present with anxiety, depression, loss of sense of self, memory loss, difficulty finding words, visual disturbances (changes in visual field), and sensory disturbances (numbness/tingling).
Dizziness & Vertigo Diagnostics
Proper diagnosis is crucial in uncovering where within the vestibular system the dysfunction is located. As seen above, the vestibular system is very complex and patients can present in varying ways. A comprehensive examination of all possible areas is key for proper diagnosis.
At CFNC, we use a multitude of diagnostic and examination tools to peer into the functionality of the peripheral, central, autonomic, metabolic, and higher cognitive components of the vestibular system. When we can pinpoint the areas of dysfunction for an individual patient we can then begin formulating a customized treatment plan that suits each individual patient’s needs.
Diagnostic Testing for Dizziness & Vertigo
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Neurological Examination
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Vestibular Examination
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Computerized Dynamic Posturography
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Videonystagmography
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Video-oculography
Dizziness & Vertigo Treatment
Dizziness or vertigo treatment is not about the specific therapy that treats the specific condition, it is about exercises and regulating the areas of the brain that need to be improved upon. Therapy may include neurological rehab such as eye movement therapies, somatosensory exercises, light/sound therapy, peripheral nerve stimulation, tilt table therapy, limbic retraining exercises, memory tasks, higher cognitive tasks, and hyperbaric oxygen therapy. It may also include functional medicine treatment in the form of supplementation, dietary, and lifestyle changes.
Common Treatment Methods for Dizziness & Vertigo
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Eye Movement Therapy
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Repositioning Maneuvers
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Balance exercises
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Somatosensory Exercises
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Mild Hyperbaric Oxygen Therapy
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Memory and Cognitive Tasks
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Individualized Supplementation
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Dietary and Lifestyle Changes
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Light and Sound Therapy
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Peripheral Nerve Stimulation
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Tilt Table Therapy
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Limbic Retraining
