Friday, February 10, 2012

Dizziness and Vertigo by Dr. A. R. Scopelliti

Dizziness and vertigo are among the most common complaints causing patients to visit a physician (as common as back pain and headaches). The overall incidence of dizziness, vertigo, and imbalance-dysequilibrium} is 5-10%, and it quickly reaches 40% in patients older than 40 years of age. The incidence of falling is 25% in those older than 65 years of age. Falling can be a direct consequence of dizziness in this group, and the risk is increased considerably in those suffering with other neurologic deficits. A study reviewing presentation to US emergency room departments from 1995-2004 showed that vertigo and dizziness were quite prevalent and thus high on the list of presenting problems.

These symptoms, particularly vestibular vertigo, are associated with more frequent medical consultation, sick leave, and interruption of daily activities in general.

Research into the burden of ill health typically focuses on specific diseases rather than symptoms. This diagnosis-based approach, however, may underestimate the burden of common symptoms such as dizziness and vertigo, which appear among the most frequent problems in primary care but remain unexplained in as many as 80% of cases.

In addition, although dizziness and vertigo may be precipitated by a variety of conditions that often require a multidisciplinary approach, these symptoms rarely prompt referral to a specialist or hospital admission for investigation. In example, the most common conditions which cause such symptoms as vertigo and dizziness remain largely misdiagnosed outside of specialty clinics, (such as my own).

Data from the National Health and Nutrition Examination Survey found that those with symptomatic vestibular dysfunction have a 12-fold increase in the odds of falling.

Because of the substantial risk of injury and the resultant decline in independence and/or quality of life after falling, predicting who is at risk is most helpful. My office does just this using computerized technology, which ironically, only takes a minute to perform. Balance is not a single physiologic function. The sensory inputs for balance include vision, vestibular, and proprioceptive function. While a person is walking, the brain must instantaneously integrate this information and execute appropriate motor planning.

This function must be supported by an adequate neuromusculoskeletal system. All of these factors change with age. Further, any disease related decline in any of these systems further impairs balance. Bilateral vestibular loss is a contributor in 25% of elderly patients with imbalance. Untreated vertigo can be a risk factor for falling as well.

Our office, as a community service, does not charge for balance/risk-of-fall analysis. Call my office (below) to be evaluated.