Vertigo/dizziness and Syncope (चक्कर आना / बेहोशी)

Episodes of vertigo, dizziness, or fainting can be alarming—making you feel off-balance, spinning, or suddenly losing consciousness. As a neurologist with over 11 years of experience, I’m dedicated to pinpointing the cause, offering clear explanations, and guiding you to effective relief strategies.

Defining the Symptoms

  • Dizziness: A sensation of lightheadedness, unsteadiness, or wooziness.

  • Vertigo: The false feeling that you or your surroundings are spinning or moving.

  • Syncope: A brief loss of consciousness (“fainting”) due to reduced blood flow to the brain.

Common Causes

Inner Ear Disorders

Benign paroxysmal positional vertigo (BPPV) occurs when calcium crystals shift within the inner ear canals, triggering brief spinning episodes with head movements. Effective treatment often involves a simple series of head maneuvers (the Epley maneuver) to reposition the crystals.

Vestibular Neuronitis & Labyrinthitis

Inflammation of the vestibular nerve or inner ear—often following a viral infection—can cause prolonged vertigo, nausea, and imbalance. Short-term vestibular suppressants and early vestibular rehabilitation help the brain compensate.

Cardiovascular Issues

Syncope can result from sudden drops in blood pressure or heart rhythm disturbances. Situational triggers (such as pain or emotional stress) may lead to vasovagal syncope, while cardiac syncope signals underlying heart disease and warrants prompt evaluation.

Neurological & Systemic Conditions

Migrainous vertigo, multiple sclerosis, or cerebellar lesions can present with dizziness or imbalance. Low blood sugar, dehydration, and medications may also contribute.

How We Diagnose

  1. Detailed History: Timing, triggers, associated symptoms (nausea, palpitations), and eyewitness accounts.

  2. Physical Exam & Special Tests:
    – Dix–Hallpike maneuver for BPPV
    – Head-Impulse–Nystagmus–Test-of-Skew (HINTS) for acute vestibular syndrome

  3. Electrophysiology & Imaging:
    – Video-nystagmography or electronystagmography to record eye movements
    – MRI or CT scans to exclude stroke, tumors, or demyelination

  4. Cardiac Evaluation: ECG, echocardiography, or tilt-table testing for unexplained syncope

Treatment & Management

Repositioning Maneuvers

  • The Epley maneuver resolves BPPV in most cases within minutes.

  • Semont and Gufoni maneuvers are alternatives for specific canal variants.

Medications

  • Short-course vestibular suppressants (meclizine or dimenhydrinate) for acute vertigo

  • Antiemetics (ondansetron) for nausea

  • Fludrocortisone or midodrine for recurrent orthostatic hypotension

Vestibular Rehabilitation Therapy

Customized exercises retrain balance pathways and improve gait, stability, and confidence in daily activities.

Cardiac & Neurological Interventions

  • Pacemakers or ablation procedures for arrhythmogenic syncope

  • Migraine prophylaxis for vestibular migraine

  • Treatment of underlying neurological disorders as indicated

Practical Advice for Patients

  • Rise slowly from sitting or lying positions to prevent lightheadedness.

  • Stay hydrated and maintain a balanced salt intake if prone to orthostatic symptoms.

  • Use supportive footwear and clear pathways to reduce fall risk during dizzy spells.

  • When vertigo strikes, sit or lie down immediately and avoid driving or operating machinery.

  • Keep a symptom diary noting triggers, duration, and associated features.

When to Seek Help

Seek urgent care if you experience:

  • Sudden, severe vertigo with neurological deficits (weakness, slurred speech)

  • Fainting with chest pain, palpitations, or shortness of breath

  • Intractable vomiting or inability to sit upright

Early assessment leads to faster relief and prevention of complications.

To schedule a personalized evaluation:

—Dr. Rohit Anand
Consultant Neurologist, Jamshedpur

External References:

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