I feel dizzy, is it vertigo?

When patients come into the Emergency department at Community Hospital of the Monterey Peninsula, they don’t always know what’s wrong, and they don’t always have the language to describe how they feel. But they tend to be very clear that they don’t feel well.

"A common phrase patients use when seeking emergency medical attention is that they feel dizzy. Yet 'dizzy’ doesn’t mean anything medically," says Dr. Casey A. Grover, emergency medicine specialist and vice chief of Community Hospital's medical staff.

"Dizziness is simply a sensation," he says, "but when broken down into one of four syndromes, it can give us an idea of what we’re dealing with. Perhaps the patient’s balance is off, they feel like they’re going to faint, they feel light-headed, or maybe they have vertigo, a sense of spinning when the body’s not moving."

A patient may feel off balance because they stood up too quickly. They may feel light-headed because they are dehydrated, or they feel faint because they haven’t eaten enough. Yet maybe the room seems to be spinning because they have vertigo, a condition of the inner ear. It’s caused by infection, a build-up of fluid affecting pressure, a blow to the head which dislodged tiny crystals or, less often, brain problems related to a tumor or stroke.

"Since dizziness is not a diagnosis," says Grover. "We have to dig deeper to figure out what the patient really means. When faced with the challenge of interpreting the sensation, we can bring in a vestibular physical therapist to tell us if the patient has vertigo, caused by symptoms peripheral to the ear, or if the patient has suffered a stroke in an area of the brain that affects balance."

Because the eyes are a critical resource in evaluating both vertigo and stroke, says Grover, lead vestibular therapist Lindsay Clark can video eye movement to quickly determine the cause and appropriate therapy. Sometimes it’s a matter of applying therapy maneuvers to help crystals float back into place within the inner ear, providing patient relief within minutes. Or maybe the inner ear is inflamed, requiring medication and outpatient follow-up.

Other times, resolving the dizziness is more complicated.

If the vestibular therapist determines the vertigo is related to an abnormality in the brain, the doctor acts quickly to mitigate the effects of a stroke.

"Not every emergency department patient experiencing dizziness needs an evaluation by a vestibular therapist," says Grover, "and not every patient with vertigo has had a stroke. But when needed, a vestibular therapist is an incredibly useful, helpful, amazing resource. It’s such an important skill in diagnosing vertigo, its cause, and how to address it. I’ve never worked with another hospital that has them."

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