Friday, February 10, 2012

Presyncope As A Basis Of Dizziness by Dr. A. R. Scopelliti

As a tenet, the key form of disturbances that we feel as humans that present to the clinician as one type of dizzy feeling or another, are vertigo: a sense of rotation; disequilibrium: a sense of imbalance; or dizziness: a feeling of being off, or disoriented. Dizziness is the vaguest of the symptoms. Let’s talk about it this week.

Dizziness is in the first three reasons why individuals present to their doctors office. It is often a confusing constellation of symptoms which patients find difficult to describe, and clinicians find difficult to identify.

Oftentimes, vertigo and disequilibrium will manifest such that the individual would complain to the clinician about lightheadedness. It is up to the clinician to bringup the right questions to distinguish between them to correctly identify the patient and refer to the correct specialist for neurologic or vestibular rehabilitation therapy, (what I do), vs. to an ENT for a sinus infection or similar.

So what then is Presyncope? Well, syncope, means in medical terminology to pass out. So presyncope is the sensation just prior to passing out, without progressing into actually passing out. Most patients with presyncope will be referred to a cardiologist, assuming of course that they were even correctly diagnosed in the first place, which is not necessarily always the situation. This is not a bad plan as it rules out any cardiac problems as being causative, however, the individual gets cleared from cardiology and is still symptomatic.

Well here’s the reality. Syncope/presyncope is almost always a neurologic condition. Yes, it is caused by the heart, however, the heart only does what the brain is telling it to do. To make some sense of this, imagine you are standing up. Your heart has to pump blood up to your head sort of like a small water tower. Now imagine lying down. As blood gushes into your head, baroreceptors in the carotid vessels tell your brain to tell you heart to slow down so you don’t shoot your head off. Conversely, when you arise from lying down, your carotid baroreceptors tell your brain to tell your heart it had better pick up and fast to get blood back up to your brain, (like a water tower again). When there is a problem with this regulatory system, you are going to experience presyncope. As this disorder worsens, you will actually experience syncope, (actually passing out). The irony to all of this is that this is actually very easily fixed more often than not; these are the types of pro!

blems that I spend much of my day fixing for people. As syncopal problems worsen, it is not uncommon for simple head movements or rotations, or visual stimulus from driving to provoke an attack. This also often precipitates into panic disorder and panic attacks, not only because of the fear and anxiety associated with the symptoms, but also because of the sympathetic nervous system and its hard wiring. (The whole “fight-fright-flight thing you learned in school).

Again, there are many causes of dizziness and presyncope is just one of them, but it is a fairly common disorder and finding the right specialist early on can make a big difference in how far your disorder will advance and whether or not they will progress into other conditions over time until properly treated.