Distinguishing between vertigo and dizziness

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Vertigo: Who's at risk?

Drs. Samadi and Siegel weigh in

Vertigo and dizziness are among the most common symptoms prompting patients to visit a physician. In the emergency department, these symptoms account for up to 10 percent of all adult visits, translating into over 10 million visits a year. Furthermore, this represents only a small proportion of afflicted individuals, as nearly 80 percent of patients seek care directly from their primary care physician.

Due to the vague nature of these symptoms, the possible causes are endless – ranging from benign to more serious conditions; however, making the distinction between true vertigo and other forms of dizziness or light headedness is critical. Vertigo describes the illusion of motion or a spinning sensation and typically points to a problem with your inner ear, especially if the sensation is triggered by sudden movement.

The sensation of vertigo is caused by a disruption in the signals between your brain and your body’s position and balance systems. Your inner ear contains specialized cells that help detect motion and changes in positions. Typically this information reinforces visual cues regarding your body’s position and movements. When there is injury or disease to the inner ear, it can send false signals that conflict with visual and positional information. As your brain tries to process these confusing signals, vertigo can occur.

Sudden attacks of vertigo are more commonly due to benign disorders of the inner ear, and while bothersome, they can be less worrisome.  Viral infections of the inner ear can interfere with normal signaling, causing a sudden attack of vertigo that can last for over 24 hours. Usually, patients will have a history of recent runny nose, cough or fever. On the other hand, short episodic attacks associated with changes in head position are suggestive of a condition called benign paroxysmal positional vertigo. While symptoms can be debilitating, the condition can be easily treated by a physician through series of specific physical maneuvers to reposition the components of the inner ear.

Dizziness or lightheadedness, on the other hand, could be indicative of a heart or vascular problem. While stroke is a rare cause of dizziness, over 50 percent of patients diagnosed with stroke report dizziness.  Early diagnosis of stroke is vital in order to administer key medications that can prevent permanent damage.  In order to maximize the effectiveness of the medication, it should be administered within 90 minutes of symptom onset.  Additional stroke red flags include:

- Trouble with speaking or understanding

- Numbness or weakness on one side of your body or face

- Blurred or double vision

Furthermore, if a stroke occurs in the balance center of your brain, sudden vertigo can also occur.

This time of year, as the temperature begins to climb, dehydration and heat stroke are two other important causes of dizziness to remain aware of. In the United Sates, heat waves claim more lives – approximately 334 deaths per year – than hurricanes, floods, tornadoes and earthquakes combined. Heat stroke occurs when the body’s temperature regulation fails or becomes overwhelmed, and patients can rapidly deteriorate.

The key is prevention. If possible, intense physical actively should be avoided during excessively hot or humid times of day. However, if it is unavoidable, it is best to slowly acclimate to the environment and drink plenty of fluids. The elderly are at higher risk for heat exhaustion due to underlying medical conditions and increased dependence on others. When temperatures are very high, spending time in an air conditioned environment can be very beneficial in preventing negative effects of heat. In fact, during heat waves, large cities will often open cooling centers to help reduce the risk of heat-related illnesses.

Overall, while dizziness is often transient and related to benign conditions, it is an important symptom to discuss with your physician. When associated with chest pains, breathing difficulty, changes in vision or speech and/or muscle weakness, dizziness could signal a more threatening condition and one should call 911 or visit an emergency room immediately.

Dr. David B. Samadi is the Vice Chairman of the Department of Urology and Chief of Robotics and Minimally Invasive Surgery at the Mount Sinai School of Medicine in New York City. He is a board-certified urologist, specializing in the diagnosis and treatment of urological disease, with a focus on robotic prostate cancer treatments. To learn more please visit his websites RoboticOncology.com and SMART-surgery.com. Find Dr. Samadi on Facebook.