Persistent Dizziness for Over a Month: Vestibular Neuritis

Q: Persistent Dizziness for Over a Month: Vestibular Neuritis

Based on your description： Hello, you mentioned experiencing near-fainting episodes. <br>In addition to dizziness, it may be necessary to consider syncope. <br>First, we should evaluate the symptoms of syncope, with the most common causes being reflex syncope： excessive stimulati

Dizziness for over a month?

On the evening of August 25th, I experienced a bout of dizziness that nearly caused me to faint.
I went to the emergency room for a blood test, which showed no significant issues.
It might have been due to lack of sleep.
A few days later, I visited a clinic where the doctor suggested it was a problem with ear crystals.
After taking medication, my condition remained unchanged.
I then switched to another clinic where they conducted tests for ear crystals and concluded that it was not an issue with ear crystals but rather vestibular neuritis.
I took medication for a week, but there was no improvement, so I was referred to National Taiwan University Hospital.
The doctor there also diagnosed me with vestibular neuritis.
I had no issues with nose pointing, finger pointing, or walking in a straight line.
They prescribed steroids and a small amount of sleeping pills, advising me to allow my nerves to rest.
I experienced slight improvement, but now, about two weeks later, I still feel very dizzy.
During this time, I also took cold medication.
My current symptoms include persistent dizziness throughout the day, particularly a feeling of pressure at the back of my head accompanied by mild headaches.
I feel sleepy all day, and focusing my eyes is somewhat challenging, but my appetite is normal.
Throughout this month of dizziness, I have been going to bed before midnight and getting a full eight hours of sleep.
The doctor mentioned that I have taken all the available medications for dizziness, and I cannot think of any other reasons for my condition!

Cai Xiansheng, 20~29 year old female. Ask Date: 2019/09/26

Dr. Jiang Junyi reply Neurology

Based on your description: Hello, you mentioned experiencing near-fainting episodes.
In addition to dizziness, it may be necessary to consider syncope.
First, we should evaluate the symptoms of syncope, with the most common causes being reflex syncope: excessive stimulation of the vagus nerve, which can lead to bradycardia and decreased cardiac output.
Other factors include transitioning from a supine to an upright position, standing up suddenly after squatting, certain medications causing hypotension, significant blood volume reduction, peripheral vasodilation in a hot environment, and peripheral neuropathy.
Psychogenic syncope should also be considered, such as arrhythmias, valvular heart disease, cardiac myxoma, acute myocardial infarction, or coronary artery spasm leading to arrhythmias and hypotension.
Metabolic causes of syncope, such as hypoglycemia or hyperventilation, should also be distinguished from epilepsy and dizziness.
It is recommended that you discuss further evaluation and treatment with a neurologist.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Medical Center cares about you.

Reply Date: 2019/09/26

More Info

Persistent dizziness can be a distressing symptom, and it sounds like you have been through a thorough evaluation. Based on your description, it appears that you have been diagnosed with vestibular neuritis, which is an inflammation of the vestibular nerve that can cause significant dizziness and balance issues. Let’s break down the condition, its causes, symptoms, and treatment options.

Understanding Vestibular Neuritis
Definition: Vestibular neuritis is a disorder characterized by sudden, severe vertigo (a spinning sensation) due to inflammation of the vestibular nerve, which is responsible for sending balance information from the inner ear to the brain.
Causes: The exact cause of vestibular neuritis is often viral, typically following a viral infection such as a cold or flu. It is believed that the inflammation may be a result of the body’s immune response to the virus. In some cases, it can also be associated with other conditions, such as labyrinthitis, which involves inflammation of both the vestibular and auditory components of the inner ear.

Symptoms
The primary symptom of vestibular neuritis is intense vertigo, which can last for days. Other symptoms may include:
- Dizziness or a feeling of being off-balance
- Nausea or vomiting
- Difficulty focusing the eyes
- Headaches
- Fatigue
In your case, the persistent dizziness, pressure in the back of your head, and slight headaches suggest that the inflammation may still be affecting your vestibular system. The fact that you have normal hearing and can perform balance tests indicates that the vestibular system is functioning, but it may still be recovering from the inflammation.

Treatment Options
1. Medications: Corticosteroids are often prescribed to reduce inflammation and speed up recovery. Antihistamines or antiemetics may also be used to help alleviate dizziness and nausea. It seems you have been prescribed steroids and sleep aids, which can help manage symptoms.

2. Vestibular Rehabilitation Therapy (VRT): This is a specialized form of physical therapy aimed at helping your brain adapt to the changes in balance and reduce dizziness. A physical therapist can guide you through exercises that promote balance and coordination.

3. Rest and Recovery: It’s crucial to allow your body to heal. Adequate rest and avoiding sudden head movements can help manage symptoms.

4. Follow-Up: Since your symptoms have persisted for over a month, it’s important to follow up with your healthcare provider. They may consider additional tests or referrals to specialists if your condition does not improve.

Prognosis
Most individuals with vestibular neuritis experience significant improvement over weeks to months. However, recovery can vary, and some may continue to experience mild symptoms for an extended period. It’s essential to remain patient and adhere to your treatment plan.

Lifestyle Considerations
During your recovery, consider the following:
- Hydration: Ensure you are well-hydrated, as dehydration can exacerbate dizziness.

- Sleep Hygiene: Maintain a regular sleep schedule to support recovery.

- Avoid Triggers: Identify and avoid activities that worsen your dizziness, such as rapid head movements or certain visual stimuli.

- Stress Management: Stress can exacerbate symptoms, so practices like mindfulness, meditation, or gentle yoga may be beneficial.

Conclusion
Persistent dizziness can be frustrating, but with appropriate treatment and management, many individuals recover fully from vestibular neuritis. If your symptoms continue or worsen, do not hesitate to reach out to your healthcare provider for further evaluation and support. Your health and well-being are paramount, and it’s important to address any ongoing concerns with a professional.

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