Dizziness for Newbies

Dizziness is something that we all experience, at least a few times in our lives. It can be the dizziness of going round and round on an amusement park ride or it could be an out of kilter feeling that makes us sit down and hold our heads. No matter what the cause, dizziness is not the easiest thing to describe.

I think it would be helpful for newbies to know what our doctors are looking for when we describe our dizziness. It is useful to categorize the forms of dizziness into four areas:

Vertigo
Imbalance
Lightheadedness
Vague

When you experience vertigo (rotational vertigo), the world literally appears to rotate about you. Sometimes it feels more like you are rotating, not the world, about an axis (like a pirouetting ice skater), but the idea is essentially the same. It is an unmistakable sensation and I doubt any body who experiences this form of dizziness will ever forget it. When it is prolonged and intense, it can evoke an emetic response (nausea, diarrhea …). Nasty stuff.

Vertigo results when there is an imbalance in the signals reaching the eye muscles due to asymmetry of neural activity between the left and right vestibular nuclei. The cause of this imbalance can be the inner ear, pressure on neural pathways, tumors, medications, etc. In short, vertigo is a symptom, not a disease. If you ever have the chance to witness a person having a vertigo attack, you may be able to notice that their eyes are moving back and forth. The person sees the world moving because their eyes are moving. It’s that simple. (Vertigo is an example of nystagmus.)

Imbalance in walking or other physical activity is another form of dizziness. Here, a person may feel like they will fall over. They may not be able to walk a straight line. Their gait can also be affected.

Lightheadedness is yet another form of dizziness. This sensation can be felt when getting up too quickly. Some forms of lightheadedness can result in fainting.

The last form, which I call vague dizziness, is the hardest to explain. Indeed, its very name suggests that this is so. It is not vertigo, it is not imbalance, and it is not lightheadedness. Rather, it is a vague feeling that a person is not feeling too well in the head. I want to emphasize this form of dizziness is real; it is not a fabrication. Sufferers genuinely feel dizzy, but in a vague sort of way. Sometimes the source of this dizziness can be traced to anxieties, phobias, medicines, etc. Many times its origin is only poorly understood.

It is perfectly possible for a person to have more than one type of dizziness. For example, I have had intermittent vertigo attacks while having serious ongoing balance problems.

Initially, when your doctor is trying to diagnosis your condition, he will be trying to decide if your dizziness is vertiginous or not. Another factor will be the length of time that your dizziness lasts. Is it for seconds? Does it last minutes, hours or days?

There is a greater chance that your doctor will be able to reach the correct diagnosis if you are accurate in describing your type(s) of dizziness. That’s the best we can do as patients.

Good luck.

Joe

 

Great post, Joe. Thanks!

I'm going to leave it here a couple of days and then suggest that Ray move it to the Database.

 

And I DO fall over, for no reason! I also feel like I am walking on a waterbed, or sofa cushions....I have no idea which way the floor is tilting, but I swear it is....

 

thanks for the information Joe i seem to have had all of them and sometimes in the same day!!!!! i am a newbie and due to see the ENT doc for the second time with this complaint so i will have my list ready. Thanks again for the info and hope you keep well

Ali

 

Thanks very much for your post Joe - great stuff.

If you don't mind, can you please attempt to categorize the type of dizziness I often experience. I have real trouble explaining it to doctors....

Usually I try to refer to it as dizziness brought on by visual disturbances but I have no idea if that is an accurate way of describing it. For instance, I'm very dizzy right now and when I turn my head my visual field is extremely choppy. It seems to take a minute for my eyes to catch up to the rest of my body. At times my visual field seems to grow small and then large very quickly, something like what our retinas do when we adjust to light. Hope that makes sense. Other times I get the sensation of suddenly dropping. It happens when I'm dizzy and I'm lying down with my eyes closed to control it. The feeling is much like flying in an airplane when it hits a low pressure pocket and suddenly drops.

Any idea how this kind of issue could be better defined? I'd sure love to have the correct words to provide to doctors during assessments - right now I don't think they really get it.

Oh yes, one more thing - since this thread is such a great source of information and obviously destined for the database, do you think someone could also add a definition of 'disequillibrium'. I've seen one person explain it in the past and it made a lot of sense. Actually it seemed to somehow fit in with what I experience (as described above).

Thank you,
Amethyst

 

Amethyst - Might you also have this:

Oscillopsia is a visual disturbance in which objects in the visual field appear to oscillate. The severity of the effect may range from a mild blurring to rapid and periodic jumping. Oscillopsia may be caused by loss of the vestibulo-ocular reflex, involuntary eye movements such as nystagmus, or impaired coordination in the visual cortex (especially due to toxins). Sufferers may experience dizziness and nausea. Oscillopsia can also be used as a quantitative test to document aminoglycoside toxicity.

 

You're right Linda. I've read that paragraph before and wondered if it applied to me. I guess it could explain the dizziness couldn't it (or at least a big portion of it)? i.e dizziness as a result of oscillopsia? Thanks for pointing it out - I'll try to get some questions in on the subject when I meet with my new ENT soon.

Amethyst

 

Joe has Oscillopsia, so he can elaborate from personal experience.

 

Sounds great.....I'd love to hear more on the subject.

 

This is cool--keeping definitions straight makes it easier to communicate. (I for instance have experienced four distinct types of vertigo and have named them all. I've noticed that the "best thing to do" to lessen nausea differs by type.)

 

Hi Amethyst,

I am very glad you asked your question because it was something that I pondered over when I was making my little list: should I include the dizziness of involuntary eye motions? I was tempted to have a broad heading called nystagmus and then include vertigo and oscillopsia as examples of nystagmus. But I was concerned that the post would end up getting too wordy. In the end, I compromised by making a parenthetical remark about vertigo being a form of nystagmus.

When I made the list, I was not trying to help anybody come to any diagnostic conclusions. That is the business of a trained physician. Rather, I was hoping to help them get an idea of the different meanings associated with dizziness, and perhaps, they would be better able to communicate their type of dizziness to their physicians.

I agree with Linda: your symptoms sound like oscillopsia (an involuntary eye movement). A different possibility is nystagmus, another type of involuntary eye movement. In nystagmus, there are two phases in the eye movement: a slow phase in which the eye wanders off centre followed by a rapid correction back to centre. In oscillopsia the frequency of the eye motion is higher than the frequency of nystagmus; however, the amplitude of the motion is smaller. Oscillopsia can cause objects to appear blurred or wavy in appearance. This can lead to feelings of dizziness and nausea.

When a person has nystagmus, another person should be able to tell by watching their eyes; oscillopsia is more difficult to discern by an outside observer. They may only notice that a person is squinting.

I’ve tested positive for oscillopsia. The test was done by having me read a Snell chart before and after having my head gently rocked back and forth. There was a very noticeable deterioration in my ability to read the chart. Nowadays, I can easily tell if my oscillopsia is active by observing objects and seeing if they wiggle around in a slight fashion. When I have had nystagmus, objects appear to move larger distances. It is more than a blurring.

In my case, my oscillopsia was referred to as a “gaze stability” problem. I do exercises to help with this condition. My doctors think it is secondary to my inner ear problem.

Your statement of “dizziness brought on by visual disturbances problems” is quite good. If you tell your doctor that, then he will be able to take it from there. You will have provided an important clue for him to follow up.

Joe

 

Thanks for that Joe, but I think my Doctors have given up!! I don't seem to fit neatly into any category. I get "rotaional Vertigo" even when I'm sitting in a chair, haven't been able to walk in a straight line for months now, am extremley lightheaded a good lot of the time and find it hard to focus on anything - Most of the time, to others, I'm sure it looks as though I'm on drugs - I really look "spaced-out" . I don't exactly get "bouts" of feeling this way, these days, it tends to be more or less constant, though some days are better than others - I'm really beginning to get too attached to my "Duvet" - it's an uphill struggle getting out of bed - and on the days I do get out of bed, I just don't seem to have the energy for anything - though "touch wood", I've felt sick a few times but have only really been physically sick once - I suppose I should be thankful for small mercies. :

 

Thanks Joe, you're the best. Your explanations are wonderfully enlightening.

I understand what you're saying about not setting out to provide diagnostic conclusions and I'm sure that's best. What you have provided me with is even better, a greater understanding of the nuances that differentiate oscillopsia and nystagmus. Until now I certainly never had any idea that oscillopsia was a form of nystagmus. That's one I never understood in the least when reading through other sites' explanations. I think I'm starting to get it now (but I'm sure I have a long way to go still).
May I pick your brain just a little more? Please feel free to turn me down, it's so rare to run across such a well educated and helpful person - sure don't seem to find anything like it in a doctor's office.

In a recent assessment performed by my neurotologist he noted that no "spontaneous or gaze nystagmus" was observed however, my fistula test was positive and he noted that I had "a mild but significant conjugate deviation of (my) eyes to the right". Any idea if this deviation would be considered a form of nystagmus? My ENT later suggested it was but offered no explanation of it.

No matter what I'll try again to cover this subject with my ENT because I've experienced a number of issues due to whatever visual disturbances I'm experiencing, driving being the worst. I too perform exercises for 'gaze stability' issues, as prescribed by my VRT therapist (it has helped a great deal). She explained that she was unable to offer any conclusions without diagnostic tests but from what she saw in me I have a number of significant issues with my vestibular occular reflex. Since my reaction to tracking exercises was so severe she was quite surprised that my balance system did not seem to be affected at all. A later ENG also came back normal so I have been grappling with all these terms, trying hard to figure out which systems are affected, and which are not. Thanks for helping me to shed more light on this subject, I really appreciate the help. And I'll definitely use the statement 'dizziness brought on by visual disturbances' when I'm speaking with my doctors. I'm happy to hear my statement actually makes some sense.

Amethyst

 

Good post! Thank you.

 

Hi Amethyst,

I do not think conjugate deviation of eyes is necessarily a form of nystagmus. Since the word conjugate means “pairing or joining together”, “conjugate deviation of your eyes to the right” means that both your eyes are simultaneously rotated slightly to the right. I think your neurotologist was telling you that your gaze deviates to the right. You can contrast this to the condition called strabismus in which a person has difficulty seeing because one eye has weakened muscle that does not allow it to follow precisely the other (conjugate) eye.

Each eye has three pairs of opposing eye muscles that allow us to control our eye motion. Since it the small fovea region of the retina which provides most of our visual clarity, it is important that our eyes remain parallel so that we get the same imagine being processed by our brains. If it should happened that we lose this ability, we can experience all sorts of secondary problems, such as vision and balance issues, mental confusion, etc.

I find it amazing that our brains can stabilize the focus of our eyes so extremely well ... even when we turn our heads. The vestibular ocular reflex is a true marvel.

Once again I thank you for your questions because it made me rethink how these conditions are related and how confusing the words can be. When I look up the word oscillopsia, I find that it is defined as “a visual sensation that stationary objects are swaying back and forth”. Using the same dictionary, I find that nystagmus is defined as “a rapid, involuntary oscillatory motion of the eyeball.” Hence, I think it is safe to say that oscillopsia is a sensation that may arise if a person experiences nystagmus. I hasten to add that not all nystagmus would give rise to oscillopsia.

Joe

 

Very enlightening Joe and Amethyst. Due to this post, I am revisiting all my symptoms and will take them to my neurologist when I next see her.

There are soo many gaps I see during my time of evaluation from both my neurotologist and neurologist. Neither one has asked about any eye movement difficulities, nor have they looked at my eyes either or performed any tests in that respect. I did stand with my eyes closed and try to seek out my nose with my fingers, but neither of them ever watched any eye movement. Wish I could get the two of them in a room together.

If a patient doesn't know to discuss these things, how will a doctor know how to diagnose ? I have been living with soo much of this my entire life. I always thought everyone else had the same things I did. This is soo frustrating and I feel soo defeated at times.

Again, thanks Joe and Amethyst Good post.

Sparrow

 

Great post, Joe.


Maggie

 

Very true. However, there's one oddity that I've noticed, at least: I can't move my eyes in a horizontal movement (e.g., look from left to right or vice versa) without skipping. That is to say I don't think humans can perform that maneuver smoothly.

Also, nystagmus sucks. Very dangerous when driving.

And now back to the regularly scheduled on topic posting.

 

Sparrow - I'm so happy to hear that this post has been helpful to you. It sure has been to me thanks to Joe. Some real food for thought.

What's quite clear to me from this thread is the fact that I need to pursue this matter further through proper diagnostic testing. Now thanks to you Joe, I have an understanding of the key terms, thereby facilitating an open dialogue with my doctors. As Sparrow said, "If a patient doesn't know to discuss these things, how will a doctor know how to diagnose ?". That's such an important point. Although I've read a number of discussions on many symptoms such as tinnitus, hyperacusis and vertigo - - nystagmus, oscillopsia and the vestibular occular reflex seem to be much less commonly addressed. Trying to research these terms online has not been an easy process in my opionion - having only found either very general, short definitions of the terms or far too complex medical documentation for my understanding. Thanks for breaking it down into words that I can understand Joe. What a wonderful teacher you are - and what a gift you share with all of us.

Amethyst

 

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