D

izziness and balance problems A guide for patients and carers

A Brain and Spine Disorders Booklet

Brain & Spine Foundation

Dizziness and balance problems
A guide for patients and carers Published by the Brain and Spine Foundation ©British Brain and Spine Foundation 1998 Reprinted (3) 2002 ISBN 1 901893 022 British Library of Cataloguing in Publication Data A catalogue record for this book is available from the British Library Editor, Brain and Spine Booklet Series: M Alexander CBiol MIBiol Medical illustrations: Philip Wilson FMAA RMIP Cover design: Image International Print: Clifford Martin Press

Brain and Spine Foundation
The Brain and Spine Foundation aims to improve the quality of life for people with neurological disorders and to reduce neurological disability by providing a national focus for research, education and information. Brain and Spine Foundation 7 Winchester House Kennington Park Cranmer Road, London SW9 6EJ Tel: 020 7793 5900 Fax: 020 7793 5939

Email: info@brainandspine.org.uk Website: www.brainandspine.org.uk Registered charity no.1010067

Contents
Acknowledgements

Page

2

Introduction

2

What is dizziness?

3

How does the balance system work?

3

What other symptoms could I have?

6

What tests might I have?

7

What diseases can cause dizziness?

8

What treatments are available?

14

Some do’s and don’ts

18

Conclusion

19

Glossary

20

Other organisations that may be able to help

23

1

PhD. Brain and Spine Foundation. It has been written to answer some of the questions often asked by people who are experiencing these problems. who has written this booklet. National Hospital for Neurology and Neurosurgery. Hon. since they are in a position to offer advice and information to meet your own specific needs. However. 2 . 2002 Introduction This booklet is intended to provide some general information on dizziness and balance problems. MRC Human Movement and Balance Unit. Consultant Neurologist. Words that are printed in bold are explained in the glossary. as well as their families and carers. and Dr Rosalyn Davies. National Hospital for Neurology and Neurosurgery. London for her invaluable assistance with this project. The medical information in this booklet is evidence-based and draws on current best practice guidelines. Consultant in Audiological Medicine. it is important that you speak to your own GP or to the doctor or physiotherapist who is looking after you. London and Consultant Clinical Scientist.Acknowledgements The British Brain and Spine Foundation would like to thank Adolfo M Bronstein MD. because dizziness affects each person differently and because it can have so many different causes.

It is important to realise that dizziness and vertigo are not diseases as such. They are symptoms . If you have this problem your doctor may find it helpful if you try to describe your dizziness by comparing what you feel with something that everyone may have had direct experience of. For example.that is. or outer ear. The ear has three main components: the external.What is dizziness? “Dizziness” is a broad term used to explain how we feel when our sense of balance is not quite right. or as if they were drunk. How does the balance system work? It is often said that the sense of balance comes from the balance organs located in the inner ear. whose main function is to transmit the sound from the outer to the inner ear. some people who complain of feeling dizzy. which is the only part that can be seen from the outside. Most people who experience dizziness actually find it quite difficult to explain exactly how it makes them feel. The labyrinth is 3 . the middle ear. To understand why you feel dizzy you need to know a bit about how the balance system works. Or they may feel “wobbly”. This is largely true and indeed most cases of dizziness and vertigo are due to problems in these balance organs.like a cough. sensations which indicate that something is wrong . which as we know can have a number of different causes. Just like a cough. or as if they were on a merry-go-round or a boat. and by the time we are old most of us will have experienced it. Fortunately it is very rarely the symptom of a serious or life-threatening illness. Dizziness is a common symptom. and the labyrinth. giddy or offbalance say they feel as if everything is spinning around. or as if they are spinning around. it can be caused by lots of different things. Doctors use the term vertigo to describe this condition. Others feel as though they were walking on cotton wool or on a mattress. or inner ear.

which is responsible for hearing. and the vestibular organ. Outer ear Pinna Outer ear canal Middle ear Eardrum Ossicle bones Eustacian tube Inner ear Cochlea Labyrinth Semi-circular canals Bone Auditory nerve Outer ear canal Cochlea Eardrum Ossicle bones Eustacian tube The structure of the ear Figure 1: Diagram showing the structure of the ear 4 . This close link between the hearing and balance organs in the ear is the reason why your doctor will ask you what your hearing is like. which is responsible for balance. It is divided into the cochlear organ.located deep inside some of the hardest bones in our skull.

our brain will use more information from our lower limbs and our inner ear. legs and hips. on the other hand. the information coming from our legs and feet will be less reliable and we will tend to use our vision and vestibular organs more. This also explains why many forms of dizziness are either triggered or increased by movements of the head. it is important to bear in mind that the maintenance of balance is a complex function and that while the ear is a very important component of the system. which inform the brain when the head is moving in a straight line and indicate the position of the head with respect to the pull of gravity. we are walking on a sandy beach during the day.The vestibular. The brain has to know how the feet and legs are positioned with respect to the ground and how the head is positioned with respect to our chest and shoulders. because of the complementary support 5 . So while dizziness and imbalance usually arise from disorders of the inner ear. ankles. when the information conveyed by our eyes is reduced or unreliable. If. There are three sets of tubes or semi-circular canals in each vestibular organ. particularly in the neck. For instance. We almost never have to rely solely on the information provided by the balance organs of the ear. it is not the only one. This information is conveyed to the brain by detectors of position and movement located in our muscles. because this makes your brain think that your head is moving or turning when it is not. or balance. However. tendons and joints. There are also two structures called the “otoliths”. in the dark. Dizziness or vertigo occurs when the right and left balance organs do not work together (in symmetry). and these detect when you move your head around. In order to have a good sense of balance we need to be able to see where we are and be aware of the position of certain key parts of our body in relation to the other parts and to the world around us. A crucial aspect of the efficiency of the balance system is that our brain can control balance by using the information that is best suited at any particular point in time. and that is why even people who have lost the function of both inner ears do not entirely lose their sense of balance. organs inform the brain about the movements and position of your head.

whether it starts spontaneously. the closeness of the hearing and balance organs explains why you may experience hearing disorders in the course of your dizziness. clumsiness or weakness in your legs. If you do. 6 . Accurate answers to these sorts of questions are very useful for your doctor. As mentioned above. Problems with the nerves carrying the impulses from the balance organs to the brain or problems in the balance centres of the brain can also cause dizziness. you are likely to have either tinnitus . the dizziness you experience could indicate that the balance organs in the ear are being affected by a previous or current infection. to establish if other nerves in your face or head are involved. What other symptoms could I have? Even when your dizziness is caused by inner ear problems you may not suffer from any hearing problems. If you have had repetitive ear infections with ear discharge. but these are less common.provided by the eyes and the detectors of movement located in our joints and muscles. and they will spend some time enquiring about the circumstances in which your dizziness occurs .or various degrees of hearing loss. whether it first started after you had the ’flu. which may contribute to your unsteadiness. numbness in your face or trouble with your speech. or whether it appears to be related to the movements or position of your head. Your doctor may also wish to know whether you have experienced any numbness.a ringing or buzzing noise in one or both ears . most people usually regain a good sense of balance. or completely out of the blue. They may also ask you whether you have or have had double vision.

What tests might I have? GPs refer patients who complain of dizziness to a number of different hospital consultants. During this test you will have some cool or warm water run into your ears so that the temperature of the balance organs in the inner ear can be modified. nose and throat specialist (an ENT surgeon). or they may be referred to an otologist .a doctor who specialises in disorders of the brain and nerves. The latter may be either an audiological physician or an ear. This test is performed because the balance organs of the ear control the movement of the eyes very precisely and a problem with the ear or brain centres controlling balance can cause abnormalities in eye movement. Another balance test called the caloric test is very informative. They may be referred to see a neurologist . You may have a head or brain scan (e. you may see more than one of these specialists. The tests that you have may vary slightly according to the type of specialist you see.a doctor who specialises in problems of the ear. In some specialised departments or “dizzy patient” units. CT or MRI scan). The most common of these records your eye movements with wires attached to the skin surrounding your eyes. You should bear in mind that all these tests and scans will not be necessary for everyone. This test creates a minor and temporary difference between the balance organs on the left and right sides of your head and makes you feel dizzy for a couple of minutes. Some people may not need any tests at all. which are basically carried out to rule out any cysts. Your doctor may request a number of hearing tests. You may also have to undergo special balance tests. growths. 7 . This is called ENG (electronystagmography). inflammation or blood supply disorders of the brain.g. During some of these you have to say if you can hear certain tones and in others the hearing system itself is assessed directly using wires that are temporarily glued to your scalp.

but if you have been referred to a neurologist or otologist such general conditions will usually have been excluded in advance. that almost everyone complaining of dizziness or vertigo will be asked to undergo. Certain forms of dizziness will be brought on by this procedure.There is one test. Dizziness as a 8 . as being dizzy can also make you feel anxious or depressed. however. and then he or she will ask you to lie down rapidly with your head turned to one side and then to the other. blood disorders such as anaemia or certain heart conditions. In this section we will describe some of the specific conditions that can lead to dizziness. and this is called the positional test.g.that is one that will be carried out by the doctor during the examination. but this dizziness will always be short-lived. and the procedure will not make your dizziness worse. can only be diagnosed by performing this manoeuvre and effective treatment can only be prescribed if the diagnosis is made correctly. lasting no more than a minute. such as benign paroxysmal positional vertigo (or BPPV). This is a clinical test . e. Your doctor will ask you to sit on the couch. The treatments given for any of the specific diseases that cause dizziness will also be described. This test or manoeuvre will establish if the dizziness is triggered or made worse by movements of the head. What diseases can cause dizziness? Many diseases can give rise to dizziness or off-balance sensations. Being tense or irritable can also provoke dizziness or a sense of imbalance. It is therefore of utmost importance that you keep your eyes open while your doctor performs this test. and this can be a vicious circle. Your doctor will know by the presence of any eye movements during and immediately after the test what form of dizziness you have. You should also be aware that a number of medications can cause dizziness as an unwanted side effect. Certain conditions.

7. accompanied by nausea or sickness and unsteadiness. 4. 6. These symptoms frequently develop a few days or weeks after a bad cold or ’flu. People with this condition often prefer to stay in bed because any movement makes the vertigo worse. Viral labyrinthitis As the name indicates.symptom . but we will deal with that later. in the section What treatments are available? Most cases of dizziness. 3. Other names frequently used for this condition are “vestibular neuronitis” (as some doctors think that the problem lies in the nerve cells or neurons connected to the inner ear) or “epidemic vertigo”. because small epidemics of this condition can sometimes occur. Viral labyrinthitis Benign paroxysmal positional vertigo Ménière’s disease Vertigo of vascular origin Post-traumatic vertigo Peripheral vestibular disorder “Central” or neurological causes. 2. The minority of people who 9 . but the initial dizziness is intense and distressing. vertigo or other off-balance sensations are due to one of the seven following conditions: 1. troublesome dizziness or will suffer recurrences of the condition either spontaneously or associated with later bouts of the common cold or ’flu.independently of what has caused it . which may just last for a few days or may persist for two or three weeks. With this condition there is rather sudden onset of a spinning vertigo. this is a viral infection of the labyrinth. 5. Only a minority of patients with viral labyrinthitis will experience persistent. or inner ear.can also be treated. but most make a full recovery. Some people remain a little unsteady afterwards. Viral labyrinthitis does not cause any hearing problems.

Treatment in the initial stages of viral labyrinthitis includes anti-vertiginous drugs. but they are nevertheless a nuisance and limit them in their everyday working or social lives. which are medicines that are identical or similar to those used for car or sea sickness. Examples are the movements associated with turning over in bed or looking up to hang clothes on the washing line. the more commonly used of which are the Epley manoeuvre and the Semont manoeuvre. and is typically brought on by certain head movements. These can be performed in the doctor’s or physiotherapist’s room and consist of a series of movements of the head guided by the doctor or physiotherapist. the posterior semi-circular canal. BPPV often causes a highly specific nystagmus (jerky movements of the eyes) which is unique to the condition. Most people with this form of vertigo know exactly what type of movements can induce the symptoms and so learn to avoid them.experience prolonged or recurrent problems do not suffer from intense symptoms. Due to the intricate connections between the balance organs of the ears and the eye muscles. It is. however very short-lived. lasting a minute or less. Benign Paroxysmal Positional Vertigo (BPPV) The dizziness experienced in this condition is intense and also has a rotational or spinning character. and not all doctors are yet familiar with them. Recent developments have allowed new treatments to be devised to clear out the particles trapped in the semi-circular canal. 10 . without the need for any specialised instruments. The diagnosis can only be established by the positional test described earlier on. These procedures offer a non-invasive and effective form of treatment but are fairly new. It is now pretty well established that the cause of this vertigo is the accumulation of certain particles or crystals within one of the “tubes” of the balance organs. These include the so-called particle repositioning procedures.

but will not necessarily slow down the progression of the deafness. 11 .“water tablets”.a phenomenon called endolymphatic hydrops. spinning vertigo. including both tinnitus and a loss of hearing. This is largely because patients are worried that people might think they are drunk because they are “all over the place and sick”. That is why one of the main treatments for this condition is a strict low-salt diet and a diuretic . Each attack typically lasts for two. In between attacks the person may have fairly good balance and experience no dizziness. fluid and pressure in the ear is reduced.Ménière’s disease People with Ménière’s disease suffer from repetitive attacks of intense. making them useless. People usually experience noticeable changes in their hearing either before or during the vertigo attacks. There is usually a tenderness or pressure in one of the ears either before or during these attacks of vertigo. Approximately one third of people with Ménière’s disease have symptoms in both ears. In this way the risk of a build-up of salt. Usually there is no warning that one of these vertigo attacks is going to occur. it improves after attacks but there is a tendency for it to get worse over time and become permanent. but they may be brought up when they are sick. Some anti-vertiginous drugs come as suppositories and they can reduce the intensity of the vertigo attacks. up to 24 hours and affected people are frequently sick.which help get rid of excess salt and fluid in the body. This form of treatment can be of benefit in reducing the frequency and intensity of each vertigo attack. but each episode or attack is due to a build-up of pressure in the inner ear . This hearing loss is initially fluctuating . Antivertiginous drugs can help some people if taken as soon as the first symptoms develop. The actual cause of Ménière’s disease is not known.that is. but they will experience various degrees of hearing loss. and this leads to anxiety that they may happen in public places.

Patients may have additional symptoms. Post-traumatic vertigo Dizziness commonly occurs after moderate to serious head injuries and frequently occurs after only minor head injuries. limb fractures or worries related to the head injury and the treatment will have to take all of these issues into consideration. and strokes). These people may benefit from anti-migraine treatment. There are essentially two types of vascular dizziness. blurred vision and numbness in the face or limbs. smoking. In older people. high levels of blood cholesterol. and therefore vascular dizziness can come from a combination of “peripheral” (inner ear) and “central” (brain) dysfunction. The blood vessels that supply both the labyrinth and the balance organs of the brain are shared. slurred speech. The symptoms can include double vision. the dizziness and accompanying symptoms are likely to come and go. The actual mechanism that makes people feel dizzy can again be a combination of peripheral (inner ear) and central (brain) disorders. Unless the deficit in blood supply has caused a stroke. With the first type. generally in younger people (less than 50 years of age). the symptoms are usually an indication of general vascular disease and relate to the so-called vascular risk factors such as high blood pressure.Vertigo of vascular origin The term vascular is given to describe conditions that are caused by a reduced supply of blood reaching a particular organ. In the case of dizziness. the organs in question are the labyrinth and the lowermost part of the brain which contains the balance centres. 12 . obesity or a family history of vascular disease (high blood pressure. the symptoms appear during certain types of migraine. Treatment here is aimed at reducing the vascular risks. and most doctors will also prescribe a small aspirin a day to thin the blood as long as there are no reasons why aspirin should be avoided (such as stomach ulcers). heart attacks.

There may be relatively minor permanent symptoms (but disabling nevertheless) or recurrent episodes of vertigo. The part of the brain that organises balance is the lowermost part of the brain and includes what is called the brain stem and the cerebellum.Peripheral vestibular disorder In many cases doctors are only able to diagnose that the cause of the dizziness is a peripheral vestibular disorder . the majority of people in this group improve with time. not the brain . In some cases.without being able to establish the exact underlying disease. Strokes or demyelination (for instance. which can therefore also be affected. stress. BPPV and Ménière’s disease are all peripheral vestibular disorders. tiredness. such as head movements. Central or neurological causes of dizziness A minority of people complaining of dizziness have a neurological disease. This part of the brain also deals with the organisation of movement.that is. Any of these problems can be picked up in the neurological examination carried out by the doctor and from brain scans. viral labyrinthitis. the problem is in the ear. posture and speech. but in others even these tests will be normal. menstrual periods or viral infections. which may or may not be triggered by certain factors. Recovery can be helped by rehabilitation procedures (see What treatments are available?). Don’t worry if your doctor cannot be 100 per cent sure of the cause of your balance disorder because it has been shown that in the long term. but we reserve the term here for conditions that cannot be properly classified into any of the well-defined groups. inflammation or tumours in this area and bony deformities of the back of the head and the upper spine can all cause dizziness and balance disorders. Strictly speaking. multiple sclerosis). abnormalities may show up in the specialised balance tests. 13 .

the trunk and finally the whole body under different visual conditions (e. while looking at steady objects or at a moving ball). tend to recover on their own. which tend to correct this imbalance are known as “vestibular compensation”. A point that cannot be stressed too much is that in order for the brain to put into place the mechanisms of vestibular compensation. The mainstay of treatment.What treatments are available? Although many causes of dizziness. the tendency to fall or veer to one side. In essence. if you have been referred to a hospital consultant it is quite possible that the dizziness has not cleared up of its own accord in your case. This compensation can be achieved even when the damage to the inner ear is permanent. is vestibular rehabilitation. post-traumatic and non-specific peripheral vestibular disorders. the head. it has 14 . As a result. common to almost all the conditions mentioned above. Vestibular rehabilitation It has been shown that if the vestibular system is damaged. ankles. These exercises involve movements of the eyes. vestibular compensation relies on your brain learning to cope with the disorientating signals coming from the inner ears and learning to use alternative signals from your eyes. BPPV. If this is the case then do not despair! You are also likely to do well in the long term. with the eyes open and then closed. such as viral labyrinthitis.g. One way of helping the development of vestibular compensation is by doing so-called vestibular exercises. the jerky eye movements (nystagmus) and the dizziness gradually disappear. most symptoms of dizziness and vertigo appear as a result of an imbalance between the functioning of the right and left vestibular organs in the inner ear. legs and neck to keep you balanced. The processes. a number of mechanisms operate in the brain which tend to improve the functioning of the balance system. As explained earlier.

these repositioning procedures can bring about a rapid recovery in one or two sessions. For example. Although most cases of BPPV will sort themselves out within a few weeks to a few months. this is now the treatment of choice for this condition. You should not go to the extreme of trying to induce dizziness by moving or exercising to such an extent that you are sick or become exhausted. some of the organisations listed at the end of this booklet might be able to help. People who have recurrences of BPPV can either have the repositioning procedure repeated or they can be shown exercises (e. If the brain does not sense any dizziness or imbalance it will not realise that something is wrong. If the surgery you attend is not familiar with vestibular exercises (sometimes called Cawthorne Cooksey or balance exercises).quite the contrary. As you progress to the more difficult exercises of the rehabilitation programme you may experience dizziness. and the exercises you are doing will help your brain to detect this imbalance and then gradually put it right.to sense that imbalance or dizziness are present. Brandt-Daroff exercises) which they can do at home. if you are taking regular anti-vertiginous drugs or are lying absolutely still in bed.g. you reduce and eventually stop your anti-vertiginous medication. For this reason. the physiotherapist or other professional in charge of your rehabilitation may ask you that. 15 . This should not be interpreted as a “red flag” to stop the exercises . if your doctor is not entirely familiar with these procedures you can find out about them from some of the organisations listed at the end of this booklet or from regional physiotherapy or audiology centres. Particle repositioning procedures As mentioned above under BPPV (Benign Paroxysmal Positional Vertigo). Again. you do not experience any dizziness. What this means is that an imbalance between your left and right vestibular systems still exists. in agreement with your doctor.

Maintain this and every subsequent position for about 30 seconds. should only be reserved for the first few days of an attack of dizziness because. These tablets.Figure 2: Self guided positional exercises One session should include six repetitions to either side. The same applies to tranquillizers. Counselling. Eyes may be closed to reduce vertigo 1. Sit up again and repeat on the other side. Anti-vertiginous drugs A variety of drugs are available that can make you feel better during the initial or severe phases of many vestibular disorders. Continue five more on each side. relaxation therapy. not tablets. Sit on a bed with head turned 45˚ to one side 2. however. and at least three sessions should be completed daily. or that. as the risks of addiction and their interference with the development of vestibular compensation usually outweigh their possible benefits in reducing anxiety. breathing exercises If you have suffered from dizziness for a long period of time you may be concerned that it will never go away. Quickly lie down to opposite side with head still turned so that the area behind the ear touches the bed. as mentioned above. long-term improvement depends on vestibular compensation. in spite of what 16 BMJ Publishing Group .

In some cases. or you may be worried about going to work or attending social events for fear of embarrassment.also report symptoms of dizziness and unsteadiness. 17 . For instance. This occurs because their moving surroundings confuse their balance centres. The type of operation they will undergo will vary according to the individual preferences of the ear surgeon. Surgery is a more likely option for people whose dizziness is associated with ear discharge.but who have an intact balance system . some people who have a fear of public places or who experience panic attacks . counselling. In some cases what was initially thought to be a vestibular disorder may have actually been brought on by stress. Sometimes this is the result of excessive breathing. relaxation or breathing exercises help people to feel more in control of the situation and can also cut down the episodes of dizziness which are brought on by tension or hyperventilation. long-standing middle ear infections or ear drum perforations. there may be something seriously wrong with you. People with vestibular problems will usually benefit from being reassured about the non-sinister nature of the disorder. and this together with spontaneous or rehabilitation-induced vestibular compensation will gradually reduce their feelings of anxiety. However. fear or tension. The distinction is not always easy. some people with balance disorders suffer increased bouts of dizziness in crowds and shopping centres. You may be worried that you are not able to look after your children properly. Surgery will only be considered if long term use of drugs and rehabilitation treatments have failed to bring about a noticeable improvement. or whilst driving or looking at moving images on TV or at the cinema. or hyperventilation. Surgery Only a very small minority of people with dizziness have to undergo surgery to see any improvement in their symptoms.doctors tell you.

There is a well-known vicious circle.. Initially. anxiety.. walks may be enough. Don’t suffer in silence. Cycling and swimming are probably less effective in helping the process of vestibular compensation. It starts with you avoiding moving around so that you don’t feel dizzy. try to avoid keeping everything to yourself. 18 . inactivity . This may extend to avoiding pleasant social activities. but are worth trying if they are your preferred form of exercise. This inactivity prevents the process of vestibular compensation. as the brain is not exposed to the abnormal signals coming from the balance organs. Ball games that use eye-head-body coordination are ideal. leading to depression.Some do’s and don’ts It is important to avoid becoming inactive in order to avoid episodes of dizziness. As far as possible. and more dizziness. which can set in and is to be avoided at all costs. Once you talk to people about your symptoms you will realise how common dizziness is and you will also realise that most stories people tell you about themselves or friends who have experienced dizziness have a positive conclusion. and this lack of vestibular compensation means the dizziness won’t go away. It is a good idea to do your exercises regularly and take part in physical activities and sports. try to participate actively and with faith in the process of recovery. Finally.

Conclusion Although dizziness can be a symptom of a number of diseases. Whether you are referred to an ear or a brain specialist. since this helps the process of vestibular compensation. head scans) that you undergo will usually rule out any serious underlying disorder. the investigations they carry out and the specialised procedures (e. This compensation process can be further assisted by specialised programmes of rehabilitation that are now available in many neurology. These procedures are fairly simple head movements guided by the doctor or the therapist that are aimed at clearing the posterior semi-circular canals of the inner ear of particles trapped within them. Doctors recognise that even if the underlying disease is not life-threatening. In addition. It has now been shown that all people with dizziness can make a substantial and sustained recovery as long as they make an effort to gradually get back to being physically active. anti-motion sickness tablets. ENT. the resulting dizziness is a nuisance to the affected person and can lead to problems in their social and working lives.g. acute phases of dizziness. 19 . which are the cause of BPPV. Ten or 20 years ago there was not much that doctors could do to help a person with dizziness apart from prescribing anti-vertiginous. when the person is usually almost unable to leave bed. in practice most cases of dizziness are due to relatively mild disorders of the balance organs of the inner ear (the labyrinth or vestibular organs). It is now realised that these tablets are only useful for the initial. audiology and physiotherapy departments. the treatment of a common condition called benign paroxysmal positional vertigo or BPPV has been revolutionised by the development of particle repositioning procedures.

This is achieved by irrigating the ear with cool and then warm water. Demyelination Loss of the protective “insulating” myelin sheath that covers nerve fibres. Long-term treatments are usually not effective. Stugeron (Cinnarizine).Glossary Anti-vertiginous drugs Medicines that can reduce dizziness. Some examples are Stemetil (Prochlorperazine). inside of the skull and the ear. Tablets that are sometimes used in Ménière’s disease to get rid of excess salt and water in the body. CT scan A computer-aided x-ray used to provide a clear picture of a part of the body. vertigo or car/sea sickness. the vertigo. Serc (Betahistine). Endolymphatic hydrops The build-up of pressure in the inner ear that causes the vertigo attacks in Ménière’s disease. This is generally much less common than dizziness caused by peripheral vestibular disorders that is. Benign Paroxysmal Positional Vertigo (BPPV) A balance disorder caused by particles trapped in the semicircular canals which form part of the balance organs. and may have been present for many years. Diuretic Caloric test A balance test that relies on cooling down or warming up the balance organs. for example the brain. multiple sclerosis. comes on suddenly following certain movements of the head and comes and goes as clusters of attacks. 20 . brain tumours or cysts and deformities of the upper spine or the back of the head are possible causes. These particles are usually crystals that have become detached from other parts of the inner ear. due to inner ear problems. rather than the ear. “Central” or neurological causes of vertigo Dizziness that results from problems in the balance centres of the brain. Strokes. As the name indicates. which can be intense.

The more commonly used are the Epley manoeuvre and the Semont manoeuvre. Ménière’s disease A condition in which repetitive attacks of vertigo are accompanied by pressure in the ears. jerky movements of the eyes. Nystagmus Abnormal.ENG An electro-nystagmogram is a recording of the eye movements during visual and rotating chair tests and is used to assess a person’s balance systems.the organs of balance. MRI scan Magnetic Resonance Imaging is a technique that gives very clear pictures of an area of the body (e. BPPV (Benign Paroxysmal Positional Vertigo) and some vascular problems. These movements clear out the particles trapped in the semicircular canals. The hearing is usually not affected. The term is more commonly used.g. The balance organs control the movement of the eyes and when the balance organs or centres are damaged there can be nystagmus an abnormal jerkiness of the eyes. Particle repositioning procedures Treatments used for some specific types of positional vertigo. when a doctor knows that the problem is in the inner ear but is unable to be more specific. The pictures obtained are of very high quality and use magnetism rather than x-rays. the ear) in any plane. and can be noisy.and the vestibular organs . Labyrinthitis An inflammation.the hearing organ . 21 . The scan process is painless but somewhat claustrophobic. Ménière’s disease. however. which contains the cochlea . They include labyrinthitis. Positional test An examination conducted by your doctor to see if certain movements or positions of the head bring on or make worse your dizziness or nystagmus (see above). of the labyrinth. which consist of doctor-guided head movements. tinnitus and deafness. Peripheral vestibular disorders Strictly speaking all causes of dizziness due to inner ear problems. This is the only way that conditions grouped as positional vertigo can be diagnosed. Labyrinth The inner ear. usually caused by viruses.

These involve exercises for the eyes. This can occur with dizziness or be a symptom on its own. Dizziness is a symptom. Symptoms The sensations or feelings reported by patients which tell them that something is wrong .e. trunk and the whole body in different visual conditions (looking at objects far away or close up. There are three canals on each side so that rotations in all planes can be sensed. Frequently. Vascular vertigo Dizziness caused by problems with the blood supply to the labyrinth or the balance centres of the brain.Post-traumatic vertigo Dizziness resulting from a head injury. Viral labyrinthitis A viral inflammation of the labyrinth. usually following a cold or ’flu. people who are overweight. neck. It is based on reducing this imbalance and making up for the problems in this area by educating the brain to rely more on visual and joint/muscular impulses. It causes dizziness/vertigo lasting days or weeks. vertigo is used to mean spinning or rotational dizziness. smokers. people with high blood pressure and people who don’t take enough exercise. 22 . Semi-circular canals The ‘tubes’ of the labyrinth that detect rotations of the head. or having the eyes closed). Vestibular rehabilitation (Sometimes called CawthorneCooksey exercises) Physiotherapy programmes which re-educate the balance system. Tinnitus Buzzing or ringing in the ears.as opposed to signs. It is sometimes called vestibular neuronitis. Vestibular compensation The process that allows the brain to regain balance control when there is an imbalance between the right and left vestibular systems. Vertigo The term used by doctors to describe a form of dizziness with a strong sensation of movement of the patient or their surroundings. It can occur in people who suffer from migraine or in those with “vascular risk factors” i. which are things the doctor observes.

org (Research. awareness/training services) Tel: 0808 808 1000 www.migraine. advice.migrainetrust.org.org. training. support campaigns.uk (Information and support on neurological disorders for patients. information and self-help groups) Migraine Action Association Unit 6 Oakley Hall Lodge Business Park Great Folds Road Great Oakley Northamptonshire NN18 9AS Depression Alliance 35 Westminster Bridge Road London SE1 7JB Tel: 020 7633 0101 www.Other organisations that may be able to help Brain and Spine Helpline Brain and Spine Foundation 7 Winchester House Kennington Park Cranmer Road London SW9 6EJ Hearing Concern 7-11 Armstrong Road London W3 7JL Tel: 0845 0744 600 (voice) 020 8742 9151 (textphone) www.hearingconcern.uk (Advice.org.depressionalliance.uk (Information.org.brainandspine.uk (Information and support) Migraine Trust 45 Great Ormond Street London EC1N 3HZ Tel: 020 7831 4818 www. information and support) 23 . carers and health professionals) Ménière’s Society 98 Maybury Road Woking Surrey GU21 5HX British Tinnitus Association 4th Floor The White Building Fitzalen Square Sheffield S1 2AZ Tel: 01483 740597 (voice) 01483 771207 (textphone) (Information. support and self-help groups) Tel: 01536 461333 www.tinnitus.com (Information. advice and support on Ménière’s disease) Tel: 0800 018 0527 www.

communication support services.uk (Information/advice on tinnitus and dizziness) Tel: 0808 808 0123 www.rnid.nhsdirect.nhs.NHS Direct Tel: 0845 4647 www.uk (Medical advice and information on NHS services) RNID Tinnitus Helpline Castle Cavendish Works Norton Street Radford Nottingham NG7 5PN RNID (Royal National Institute for Deaf People) 19-23 Featherstone Street London EC1Y 8SL Tel: 0808 808 6666 www.org. advice.uk (Information. training and research) 24 .tinnitushelpline@rnid.org.

Kennington Park. Please sign and date this form in the box below as confirmation. London SW9 6EJ Telephone: 020 7793 5900 Fax: 020 7793 5939 Helpline: 0808 808 1000 Email: info@brainandspine.org. Postcode Email or you may donate by Visa/Mastercard/CAF card by filling in the details below or calling our donation line on 020 7793 5900 Card Number Expiry Date Signature I am also interested in: I Making a Bequest to the Foundation in my will I Setting up a standing order I Organising a fundraising event I Current Research and Education projects I Volunteering Brain and Spine Foundation.org. YES! I would like to help.uk Website: www.Supporting the Brain and Spine Foundation In order for the Brain and Spine Foundation to continue to fund its vital research and education work in brain and spine disorders. 7 Winchester House. Cranmer Road.1010067 25 .brainandspine. we need your help. Please find enclosed a gift of £10 £15 £25 £ other Please accept this as a Gift Aid donation Yes Signature Name Mr/Mrs/Ms Address No Note: All donations now qualify for Gift Aid if you are a tax payer.uk Registered charity no.

1010067 26 .uk Registered Charity No. Please make your cheque payable to the Brain and Spine Foundation.org. (Price includes £1. London SW9 6BR. FREEPOST. if you are able to pay for them. and post your order to us at: Brain and Spine Foundation. 7 Winchester House. However. Name (Mr/Mrs/Miss/Ms) Address Postcode Please tick as appropriate: Aids and the brain Angiogram (leaflet) Back & neck pain Brain tumour Craniotomy (leaflet) CT Scan (leaflet) Dizziness & balance problems Epilepsy Face Pain Headache Head injury & concussion Meningitis & Encephalitis Motor neurone disease I I I I I I I I I I I I I MRI Scan (leaflet) Multiple sclerosis Neurophysiology Paralysis – the loss of muscle power Parkinson’s disease Speech.org.uk Website: www. London SW9 6EJ Telephone: 020 7793 5900 Fax: 020 7793 5939 Email: info@brainandspine. tick the appropriate box/es. Kennington Park. Additional copies cost £5 each for booklets and £3 each for leaflets.00 post and packing). Please complete your name and address below. Cranmer Road.Publications from the Brain and Spine Foundation We can supply one copy of each relevant publication free to patients and carers affected by neurological disorders. it will help us to cover our costs.brainandspine. language and communication difficulties Stroke Sub-arachnoid haemorrhage Transient ischaemic attacks and mild strokes I I I I I I I I I Transverse myelitis I Vascular malformations of the brain I Brain and Spine Foundation.

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