Dizziness: Neurological Insights and Treatment Options

Dizziness and Neurology

Hello, physician: My father is 53 years old and experiences significant dizziness, especially when getting up in the morning and before going to bed, without accompanying tinnitus.
He has a history of dizziness from May 1999, when he suddenly felt the world spinning while hiking, which was treated at a nearby otolaryngology clinic.
However, he has been experiencing dizziness again for the past three months.
He underwent examinations at a teaching hospital, but due to the physician's extensive questioning, the initial assessment suggested possible inner ear issues (which I couldn't understand), but later reports indicated that no such problem was found and instead mentioned vestibular imbalance, prescribing medication for two weeks.
Since there was no improvement, he was referred to a well-known specialist clinic by a friend, where the specialist diagnosed him with "cerebral ischemia," indicating he is at high risk for stroke.
My father has a history of hypertension and has been on medication to control his blood pressure, but this time he has experienced low blood pressure readings (measured with a home blood pressure monitor).
He also has a tendency to drink alcohol and consume coffee, along with the stress of working as an accountant.
I wonder if this phenomenon is related to work stress.
Would taking a long leave of absence be beneficial for his condition? As far as I know, dizziness falls under both otolaryngology and neurology.
Are there hospitals that offer joint consultations? Would you recommend that he see a neurologist or another specialist to determine the correct cause of his symptoms?

Yinlin, 20~29 year old female. Ask Date: 2001/06/20

Dr. Ye Boshou reply Neurology

The manifestations of dizziness can originate from peripheral sources (such as the inner ear organs, semicircular canals, Meniere's disease, etc.) as well as central sources, such as lesions in the brainstem or cerebellum.
Central ischemia, in addition to dizziness, may also present with other symptoms such as diplopia and speech difficulties.
It is recommended to first consult a neurologist for evaluation.

Reply Date: 2001/06/20

More Info

Dizziness can be a complex symptom with various underlying causes, and understanding its origins is crucial for effective treatment. In your father's case, the recurrent episodes of dizziness, particularly in the context of his medical history, warrant a thorough evaluation by a healthcare professional.
Given that your father is 53 years old and has a history of hypertension, it is essential to consider both cardiovascular and neurological factors. Dizziness can arise from issues related to the inner ear, neurological conditions, or even cardiovascular problems such as orthostatic hypotension, which can occur when blood pressure drops significantly upon standing or changing positions. This could explain the episodes of dizziness he experiences when getting up or before sleeping.

The initial assessment by the ENT specialist suggested an inner ear issue, possibly benign paroxysmal positional vertigo (BPPV), which is common and can cause brief episodes of dizziness. However, the subsequent diagnosis of "inner ear imbalance" indicates that the problem may not be as straightforward. The mention of "cerebral ischemia" as a potential cause is concerning, especially given your father's history of hypertension and the risk factors associated with stroke, including age, high blood pressure, and lifestyle factors such as alcohol consumption and stress from work.

It is advisable to pursue a comprehensive evaluation that includes both neurological and cardiovascular assessments. A neurologist can conduct tests to evaluate for any signs of cerebrovascular disease or other neurological conditions that could contribute to dizziness. Additionally, a cardiologist may assess his blood pressure regulation and overall cardiovascular health, particularly in light of his episodes of low blood pressure.

Regarding the impact of work-related stress and lifestyle factors, it is well-documented that stress can exacerbate various health conditions, including hypertension and potentially contribute to dizziness. Encouraging your father to take a break from work, manage stress through relaxation techniques, and maintain a healthy lifestyle could be beneficial. This includes moderating alcohol and caffeine intake, as both can affect blood pressure and overall health.

In terms of treatment options, if the dizziness is confirmed to be related to inner ear issues, vestibular rehabilitation therapy may be recommended. This therapy involves exercises designed to improve balance and reduce dizziness. If neurological issues are identified, treatment may vary based on the specific diagnosis, ranging from medication to lifestyle modifications.

Lastly, regarding the possibility of joint consultations, many hospitals offer multidisciplinary clinics where specialists from different fields collaborate to provide comprehensive care. It would be worthwhile to inquire about such options at your local medical facilities.

In conclusion, your father's dizziness should be evaluated by both a neurologist and a cardiologist to determine the underlying cause and appropriate treatment. Lifestyle modifications, stress management, and possibly vestibular rehabilitation may also play a role in his recovery. It is crucial to address these symptoms promptly to prevent any potential complications.

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