Rocks in Your Head
Rocks in Your Head - by Michael Nelson MD house call neurologist and CEO Memento Care Homes
Dizziness is a challenging symptom for patients and physicians. I always have to ask the patient to describe their sensations in detail rather than accepting that they have used the right word. In school, we learned to write stories that included the how, what, when, where, and why. I need to get those story details out of the patient. Vertigo is a rotational sensation that is frequently strong enough to be incapacitating. The Alfred Hitchcock movie, Vertigo, unfortunately adds to the confusion because the main character has a fear of heights, not vertigo. There is also light-headedness, which is the feeling like you are going to pass out, like after you stood up too quickly. There is also imbalance, which is a feeling like you are riding in a large boat or walking on a dock.
Benign paroxysmal positional vertigo (BPPV) is a condition in which the patient will experience a strong rotational sensation for a few seconds, typically with head movements. It used to be just benign positional vertigo (BPV), but someone decided that was too easy and had to add paroxysmal. I most often hear that the symptoms occur after rolling over in bed. If you read a textbook about BPPV, it will describe an endolith becoming lodged into the semicircular canals. I usually describe to patients that a small calcium deposit (or rock) floats into circular tubes in the inner ear and tells the brain the head is moving when it is not. This kind of vertigo does not last more than a few seconds, but you may have it with even slight head movement.
How does that calcium deposit get to the wrong place? Frequently, there is a very mild head trauma, such as hitting your head on the car door or kitchen cabinet. I find it rare though that a patient will remember any event though. There are more significant injuries such as a car accident, especially if the airbag went off. We’ve all hit our heads and did not develop vertigo, so you have to add a dose of bad luck in there too.
The treatment of this kind of vertigo does not involve a fancy scan, expensive pill, or other modern miracle. After picking the correct ear through the Hallpike-Dix maneuver, the Epley maneuver can put the calcium deposit back into place. It is named after John Epley who described it in 1980. It involves putting the patient through a series of head movements that basically lets that rock move through the tube (semicircular canal) back where it belongs. While it is not guaranteed to work 100% of the time, I love having a patient come in with BPPV and cure them by simply doing an Epley maneuver in the office.
Unfortunately, there are concerning causes of vertigo such as stroke and tumor so proper diagnosis should be made by a physician. Neurologists and otolaryngologists are specialists who diagnosis and treat vertigo. As always, the information contained in this article is for educational purposes only and does not replace proper medical care.
Michael Nelson MD is a board certified adult neurologist who performs house calls in the San Francisco Bay Area and also is the co-founder and CEO of Memento Care Home Network.