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50+: Live Better, Longer

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Dizziness Not Always Child's Play

Stop the Spinning

Type 1 -- Vertigo continued...

Dandy's syndrome usually improves over time. The bad news is that less common, deadly diseases also can cause vertigo.

"The most serious conditions are related to stroke," Samuels says. If a stroke damaged an artery that supplies blood to the brain, dizziness can result. "But generally," he says, "people with vertigo from a serious cause also have other symptoms, the most important of which are double vision and slurred speech. It would be very uncommon to have only vertigo and to have a very serious [central nervous system] disease."

Type 2 -- Lightheadedness

The technical term for type 2 dizziness is "near syncope" -- the feeling that one is about to faint.

"Like vertigo, everyone knows what this feels like because we all know what it is like to breathe deeply [enough times] to produce a sensation of lightheadedness," Samuels says. Usually, lightheadedness is caused by some surrounding circumstance impairing blood flow to the brain when a person is standing up, he says.

Blame this problem on our ancestors who learned to walk upright -- putting our brain above our heart. It's a challenge for the heart to keep the brain supplied with blood -- and it's easy for this system to break down.

When blood vessels in the brain become dilated, or expand, due to high temperature, excitement or hyperventilation, alcohol consumption, or prescription medications such as antidepressants, a person can become lightheaded. There can also be more serious causes, such as a stroke and heart disease.

Most of the time, lightheadedness is harmless, says Samuels. "We treat [patients] by getting rid of the cause, or warning them not to stand too rapidly, or to put their brain at the level of their heart if they feel lightheadedness coming on. We doctors worry if we hear of [lightheadedness] in an older person, in a person not on suspect drugs, or if it happens while exercising."

Type 3 -- Disequilibrium

"Type 3 dizziness is disequilibrium -- a problem with walking," says Samuels. "People feel unsteady on their feet, like they are going to fall."

Disorders that can disequilibrium include:

  • A kind of arthritis in the neck called cervical spondylosis, which puts pressure on the spinal cord.
  • Parkinson's disease, or related disorders that cause a person to stoop forward.
  • Disorders involving a part of the brain called the cerebellum.
  • Diseases such as diabetes that can lead to loss of sensation in the legs.

Doctors diagnose disequilibrium by conducting a simple neurological exam and watching the patient walk, says Samuels. Treatment involves determining and then treating the underlying cause which could be alcohol, or a drug such as Dilantin that affects the cerebellum, or a disease such as cancer, he says.

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