Benign Paroxysmal Positional Vertigo (BPPV) is a common diagnosis for those
who suffer from vertigo. Approximately one-third of all vertigo cases are
diagnosed as BPPV. Symptoms of BPPV include dizziness, lightheadedness,
imbalance and nausea.
BPPV is not the result of a serious pathological condition. Rather, it is caused when crystals of
calcium carbonate known as otoconia (ear rocks) migrate from their normal
position into the semicircular canals of the inner ear . Normally, fluid moves
in the canals when the head is turned. An ear rock immersed in the fluid of the
canal can disrupt normal balance receptors when the head turns, rotates or bends.
This causes information from one side of the head to be different from the
other. The result is BPPV.
A thorough examination is needed to rule out pathological causes of
dizziness, such as stroke, severe hypertension, diabetes, tumors and viral
infections.
The primary test used to diagnose BPPV is the Dix-Hallpike manuver. In this
test, a person lays down with their head turned 45 degrees to one side and
extended about 20 degrees backward. A positive Dix-Hallpike test is noted
when a burst of nystagmus occurs: The eyes jump upward and twist so that the
top part of the eye jumps toward the down side.
There is a good chance of full recovery from BPPV. We use an ear rock
repositioning techniqe called Epleys Maneuver, which will be the subject of
another post.
Showing posts with label vertigo. Show all posts
Showing posts with label vertigo. Show all posts
Vertigo: Diagnosing an Autoimmune Disorder
Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which allows an immune response against its own cells and tissues.
Most patients who come to me suffering from vertigo, dizziness or balance disorders have been told that their conventional, allopathic medical doctor can’t help them anymore. They’ve had a number of tests to rule out tumors, strokes, hypertension, inner ear problems, virus and a host of other maladies that can cause vertigo. One area that may be overlooked is abnormalities within the immune system.
Although it isn’t a common diagnosis by conventional practitioners, vertigo can sometimes result from an autoimmune reaction against an area of the brain called the cerebellum. In other words, autoimmunity can cause some cases of vertigo. It should be considered when conventional testing and treatment fails to yield results.
Although autoimmunity is on the rise, conventional testing for many autoimmune conditions is, sadly, deficient. Antibody tests exist for conditions such as Rheumatoid arthritis, lupus erythematosus and Hashimoto's Thyroid. There are no equivalent tests, however, that are specific to the cerebellum, or even the brain as a whole.
In the absence of targeted tests of an autoimmune response against the brain, some doctors perform other autoimmune tests to try to ascertain whether a patient has an abnormal attack against any part of their body. The problem with this approach is that it’s “hit or miss”, not very specific and not dependable yielding many false negatives. (A false negative means that the patient has an autoimmune response against their brain but the testing suggests otherwise.)
Thanks to fairly new and ongoing research into the immune system it may be possible in the near future to test for antibodies (autoimmune disease) against the cerebellum. Until then, doctors need to keep an open mind what may be causing vertigo or balance problems and run tests that are available. If autoimmunity against the cerebellum is found, there are a number of nutritional strategies which can effectively reduce vertigo and other associated symptoms.
Most patients who come to me suffering from vertigo, dizziness or balance disorders have been told that their conventional, allopathic medical doctor can’t help them anymore. They’ve had a number of tests to rule out tumors, strokes, hypertension, inner ear problems, virus and a host of other maladies that can cause vertigo. One area that may be overlooked is abnormalities within the immune system.
Although it isn’t a common diagnosis by conventional practitioners, vertigo can sometimes result from an autoimmune reaction against an area of the brain called the cerebellum. In other words, autoimmunity can cause some cases of vertigo. It should be considered when conventional testing and treatment fails to yield results.
Although autoimmunity is on the rise, conventional testing for many autoimmune conditions is, sadly, deficient. Antibody tests exist for conditions such as Rheumatoid arthritis, lupus erythematosus and Hashimoto's Thyroid. There are no equivalent tests, however, that are specific to the cerebellum, or even the brain as a whole.
In the absence of targeted tests of an autoimmune response against the brain, some doctors perform other autoimmune tests to try to ascertain whether a patient has an abnormal attack against any part of their body. The problem with this approach is that it’s “hit or miss”, not very specific and not dependable yielding many false negatives. (A false negative means that the patient has an autoimmune response against their brain but the testing suggests otherwise.)
Thanks to fairly new and ongoing research into the immune system it may be possible in the near future to test for antibodies (autoimmune disease) against the cerebellum. Until then, doctors need to keep an open mind what may be causing vertigo or balance problems and run tests that are available. If autoimmunity against the cerebellum is found, there are a number of nutritional strategies which can effectively reduce vertigo and other associated symptoms.
Vertigo & Your Blood Sugar
When I started practicing in 1986 I asked a female patient to perform Rhomberg's Test, in which a patient stands with eyes closed and arms stretched out in front of them like a sleepwalker. If the patient sways or their arms drift from midline, the test is positive—there is a problem. My female patient fell over.
She was later diagnosed with diabetes. To date, this was the most dramatic relationship between balance and blood sugar that I’ve ever witnessed.
Sugar is the brain’s sole source of energy. If blood sugar is too low (hypoglycemia) or high (hyperglycemia) the brain may not be able to function normally. Abnormal blood sugar levels can cause vertigo, dizziness and balance problems. The problem is that hypoglycemia isn't easily diagnosed because:
1. To determine whether or not you have a healthy glucose level, you must fast for 10 to 12 hours before the blood test is performed. Many of my vertigo patients have had their blood tested in a non-fasting state, which often does not accurately reveal abnormal glucose levels.
2. To interpret blood test results, you need to consider the “functional range” for glucose in the body. There is a difference between a functional range and a lab range, the range typically used to interpret blood tests of glucose level. Lab ranges are determined by a statistical analysis of all the blood that goes to a lab. Your glucose level is compared to the glucose levels of all other lab samples. If your glucose level is worse than 95% of the populace, then your test will be flagged as abnormal. Lab ranges for fasting glucose levels are often 60 to 99.
In contrast, functional ranges are based upon what the American Institute Of Chemists determines is a normal range. A functional range is not based on a sick population but rather normal physiology. Functional ranges for fasting glucose levels are 85 to 99.
Remember, in the medical model once pathology is ruled out for a vertigo patient, often a diagnosis of Benign Paroxysmal Positional Vertigo (BPPV)—or “inner ear problems” is given. Many patients don't respond to the medication or vestibular rehabilitation for this diagnosis. It's important to consider other factors that can cause or play a role in vertigo—and blood sugar is one of them.
Here are some of the symptoms of abnormal blood sugar levels:
- Craving sweets but eating sweets does not satisfy craving
- Irritability if meals are missed or delayed
- Dependence upon caffeine (coffee/tea) to keep yourself going
- Getting lightheaded if meals are missed
- Eating relieves fatigue
- Fatigue after meals
- Feeling shaky, jittery, tremors
- Feeling agitated, easily upset, nervous, anxious
- Poor memory, forgetful, confusion upon wakening
- Blurred vision
- Bad temper, mood swings
- Waist girth is larger than hip girth
If you are experiencing any of these symptoms along with vertigo, blood sugar abnormalities may be to blame. Talk with a functional medicine practitioner to get the treatment you need.
She was later diagnosed with diabetes. To date, this was the most dramatic relationship between balance and blood sugar that I’ve ever witnessed.
Sugar is the brain’s sole source of energy. If blood sugar is too low (hypoglycemia) or high (hyperglycemia) the brain may not be able to function normally. Abnormal blood sugar levels can cause vertigo, dizziness and balance problems. The problem is that hypoglycemia isn't easily diagnosed because:
1. To determine whether or not you have a healthy glucose level, you must fast for 10 to 12 hours before the blood test is performed. Many of my vertigo patients have had their blood tested in a non-fasting state, which often does not accurately reveal abnormal glucose levels.
2. To interpret blood test results, you need to consider the “functional range” for glucose in the body. There is a difference between a functional range and a lab range, the range typically used to interpret blood tests of glucose level. Lab ranges are determined by a statistical analysis of all the blood that goes to a lab. Your glucose level is compared to the glucose levels of all other lab samples. If your glucose level is worse than 95% of the populace, then your test will be flagged as abnormal. Lab ranges for fasting glucose levels are often 60 to 99.
In contrast, functional ranges are based upon what the American Institute Of Chemists determines is a normal range. A functional range is not based on a sick population but rather normal physiology. Functional ranges for fasting glucose levels are 85 to 99.
Remember, in the medical model once pathology is ruled out for a vertigo patient, often a diagnosis of Benign Paroxysmal Positional Vertigo (BPPV)—or “inner ear problems” is given. Many patients don't respond to the medication or vestibular rehabilitation for this diagnosis. It's important to consider other factors that can cause or play a role in vertigo—and blood sugar is one of them.
Here are some of the symptoms of abnormal blood sugar levels:
- Craving sweets but eating sweets does not satisfy craving
- Irritability if meals are missed or delayed
- Dependence upon caffeine (coffee/tea) to keep yourself going
- Getting lightheaded if meals are missed
- Eating relieves fatigue
- Fatigue after meals
- Feeling shaky, jittery, tremors
- Feeling agitated, easily upset, nervous, anxious
- Poor memory, forgetful, confusion upon wakening
- Blurred vision
- Bad temper, mood swings
- Waist girth is larger than hip girth
If you are experiencing any of these symptoms along with vertigo, blood sugar abnormalities may be to blame. Talk with a functional medicine practitioner to get the treatment you need.
What Your Doctor Doesn’t Know About Vertigo & Your Cerebellum
The cerebellum, or “little brain” in Latin, is the part of the brain that significantly influences posture, muscle tone and equilibrium. Conventional doctors often fail to evaluate the functional role—they may scan the brain with an MRI but poor cerebellar function cannot be visualized this way.
Chiropractic neurologists recognize that a poorly functioning cerebellum is wholly capable of causing vertigo, dizziness and balance problems. Through a Functional Neurological Evaluation of the patient, they may be better equipped to identify cerebellar problems.
Here are two common ways that cerebellar problems can cause dizziness, vertigo and balance problems:
--A disc injury or pinched nerve can affect normal nerve transmission in the cerebellum (these are typically the cause of vertigo in people under 45 years old). Normally your cerebellum receives input from your muscles, tendons, joints and head movements like tilting. The right side of the cerebellum processes information from the same side of the body and the same goes for the left side. If the information from each side doesn't match up, problems arise.
--Premature aging of the cerebellum can also cause dizziness. Each day we lose thousands of brain cells. If too many brain cells are lost the cerebellum becomes unable to properly process sensory information. In a sense, the brain is like a group of muscles: If one side of the cerebellum is more neurologically active (stronger) than the other this can cause balance problems and vertigo. Thankfully, our brains are capable of re-wiring, an attribute known as neural plasticity, and it is possible to “strengthen” the weaker part of the cerebellum. If you’re over 45, check out this “Brain Game” post.
In general, for you to be balanced, your cerebellum has to be balanced. So, the first step is to undergo an evaluation by someone trained to detect functional imbalances in the cerebellum. It has been our experience that patients who were initially told nothing could be done generally make rapid progress. When it comes to dizziness, vertigo and balance problems, you don’t “just have to live with it.”
Chiropractic neurologists recognize that a poorly functioning cerebellum is wholly capable of causing vertigo, dizziness and balance problems. Through a Functional Neurological Evaluation of the patient, they may be better equipped to identify cerebellar problems.
Here are two common ways that cerebellar problems can cause dizziness, vertigo and balance problems:
--A disc injury or pinched nerve can affect normal nerve transmission in the cerebellum (these are typically the cause of vertigo in people under 45 years old). Normally your cerebellum receives input from your muscles, tendons, joints and head movements like tilting. The right side of the cerebellum processes information from the same side of the body and the same goes for the left side. If the information from each side doesn't match up, problems arise.
--Premature aging of the cerebellum can also cause dizziness. Each day we lose thousands of brain cells. If too many brain cells are lost the cerebellum becomes unable to properly process sensory information. In a sense, the brain is like a group of muscles: If one side of the cerebellum is more neurologically active (stronger) than the other this can cause balance problems and vertigo. Thankfully, our brains are capable of re-wiring, an attribute known as neural plasticity, and it is possible to “strengthen” the weaker part of the cerebellum. If you’re over 45, check out this “Brain Game” post.
In general, for you to be balanced, your cerebellum has to be balanced. So, the first step is to undergo an evaluation by someone trained to detect functional imbalances in the cerebellum. It has been our experience that patients who were initially told nothing could be done generally make rapid progress. When it comes to dizziness, vertigo and balance problems, you don’t “just have to live with it.”
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