Unexplained Dizziness: A Three-Year Journey Through Neurology

Dizziness with no identifiable cause?

My father has been experiencing intermittent dizziness for about three years.
It tends to occur more frequently in the morning and after some physical exertion.
He has consulted several hospitals, including both ENT and neurology departments, but despite examinations and medications, the issue remains unresolved.
Blood tests showed no significant problems, except for slightly elevated cholesterol levels.

1.
The ENT department at Cathay prescribed medication for dizziness and blood circulation, which initially helped, but the dizziness returned after a while.
2.
The neurologist at Cathay stated that there was nothing significant, but if there is nothing wrong, why is he experiencing dizziness?
3.
The ENT and neurology departments at Mackay Hospital provided similar assessments.
4.
He visited a nearby ENT clinic for two months, but the dizziness persisted.
5.
This year, he went to the neurology department at Chang Gung Memorial Hospital in Keelung, where the doctor suggested that with so many hospitals in Hsinchu, there was no need to travel far.
The doctor prescribed cholesterol-lowering medication, which did help with the dizziness, but it only lasted for about three months.
Recently, the dizziness has started to occur occasionally again.

We are unsure where to seek further medical attention, as the results seem to remain the same.
Do we have to wait for an episode to determine the underlying cause?

Ci Ge, 30~39 year old female. Ask Date: 2011/11/04

Dr. Lan Shengxing reply Neurology

Hello, there are many causes of recurrent dizziness, including issues related to the brain, ears, heart, or autonomic nervous system.
Therefore, a comprehensive examination is necessary, as the effectiveness of treatments for these four systems can vary from person to person.
In particular, the efficacy of vasodilators can differ significantly among individuals.
I recommend consulting an otolaryngologist who specializes in dizziness to rule out any ear-related problems, and then follow up with a neurologist or cardiologist for further examination.
The medications for treatment may also need to be changed or combined with others.
I hope this provides you with some insight.
Thank you.

Reply Date: 2011/11/04

More Info

Unexplained dizziness can be a frustrating and debilitating condition, especially when it persists for an extended period, as in your father's case. The journey through various healthcare providers, including ENT specialists and neurologists, without a definitive diagnosis can be disheartening. Let's explore some potential causes of dizziness and discuss possible next steps for your father.

Dizziness can arise from a multitude of factors, including vestibular disorders, neurological conditions, cardiovascular issues, and even psychological factors. Given that your father has undergone multiple evaluations without a clear diagnosis, it may be beneficial to consider a few key areas:
1. Vestibular Disorders: These are among the most common causes of dizziness. Conditions such as Benign Paroxysmal Positional Vertigo (BPPV), vestibular neuritis, or Meniere's disease could lead to episodes of dizziness. An ENT specialist can perform specific tests, such as the Dix-Hallpike maneuver, to diagnose BPPV.

2. Neurological Causes: While your father has seen neurologists, it may be worth revisiting this specialty, especially if symptoms have changed or worsened. Conditions such as migraines (vestibular migraines), multiple sclerosis, or even transient ischemic attacks (TIAs) can present with dizziness. Advanced imaging studies like MRI may be warranted to rule out structural abnormalities.

3. Cardiovascular Factors: Dizziness can also be related to blood pressure fluctuations, particularly orthostatic hypotension, where blood pressure drops upon standing. A thorough cardiovascular evaluation, including monitoring blood pressure in different positions, may provide insights.

4. Medication Side Effects: If your father is taking medications for cholesterol or other conditions, it’s essential to review these with a healthcare provider. Some medications can cause dizziness as a side effect.

5. Psychological Factors: Anxiety and stress can manifest physically, leading to symptoms such as dizziness. If your father has experienced increased stress or anxiety, addressing these factors may help alleviate his symptoms.

Given that your father has experienced some relief with cholesterol-lowering medications, it may suggest a vascular component to his dizziness. High cholesterol can lead to atherosclerosis, which may affect blood flow to the brain and contribute to dizziness. Continuing to manage cholesterol levels through diet, exercise, and medication, as prescribed, is crucial.

Next Steps:
1. Comprehensive Evaluation: Consider seeking a comprehensive evaluation from a neurologist who specializes in dizziness or vestibular disorders. They may conduct additional tests, including balance assessments and vestibular function tests.

2. Keep a Symptom Diary: Documenting when dizziness occurs, its duration, associated activities, and any other symptoms can help healthcare providers identify patterns and potential triggers.

3. Lifestyle Modifications: Encourage your father to maintain a healthy lifestyle, including regular exercise, a balanced diet low in saturated fats, and adequate hydration. These changes can help manage cholesterol levels and improve overall health.

4. Follow-Up Appointments: Regular follow-ups with healthcare providers are essential. If symptoms persist or worsen, advocating for further testing or referrals to specialists may be necessary.

5. Consider a Multidisciplinary Approach: Sometimes, a team approach involving neurologists, ENT specialists, physical therapists, and dietitians can provide a more comprehensive understanding and management plan for dizziness.

In conclusion, while the journey to find the cause of unexplained dizziness can be long and challenging, persistence in seeking answers and exploring various avenues of care is essential. Encourage your father to remain proactive in his health management, and consider seeking a second opinion if necessary.

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