A 42 year old woman named Sue wakes up one morning with a sickening feeling of severe dizziness and nausea. She tries to get up, but can barely walk, because she feels so unsteady. A feeling of fear and helplessness also fills her as she sees the world around her spinning whenever she moves. Her husband calls 911 and she is taken to the hospital. There she is given intravenous medications and a CT scan of her head is performed along with a bunch of other tests. Multiple doctors examine her during her two day stay. By the time she is discharged from the hospital she is still dizzy, but can move around slowly. She is told that her brain was fine, her heart was fine and that she “probably had vertigo” and is sent home with a prescription for medication and told to follow up with her primary physician.
The following week she sees her primary physician who recommends that she see an ear, nose, throat physician (ENT). By the time she can see the ENT it is another two weeks later and she is still having daily dizziness. The medication that was prescribed does nothing to help. The ENT performs a bunch of tests for her inner ear which causes severe dizziness again, however all of the testing is normal. She is then referred to a neurologist. The neurologist also can’t find anything wrong with her and tells her to see a psychiatrist. “WHAT!?!” she thinks to herself, “I’m not crazy, I’m truly dizzy and wobbly!” she thinks to herself as she still has dizziness every day and holds on to objects as she walks for stability. She can’t go into large busy stores, lie flat or use the computer much, because all these activities make her symptoms worse. HOW CAN THERE BE NOTHING WRONG!?!
The answer is that there was something wrong and there continued to be something wrong. She is an example of someone who had benign paroxysmal positional vertigo (BPPV) which resolved on its own, but subsequently developed chronic subjective dizziness (CSD). For most people the feeling of spinning uncontrollably, nausea, and being unbalanced are horrible feelings Anytime there is a problem with the systems of your brain and inner ear (the vestibular system) that control your equilibrium you can have those symptoms and feel those terrible feelings. When this happens your body finds ways to adapt to help you feel more stable. This can include changing the way the brain uses balance signals from the body such as relying more on vision for balance. You may also associate certain activities with the horrible feeling of the dizziness. Once the disease that caused the dizziness in the first place clears up then the balance pathways in the brain should return to their normal state and the dizziness should go away. Sometimes, however, they don’t and you are left with persistent dizziness for months or years even though all of the brain scans, blood work, heart tests, and inner ear tests are normal. That is the CSD. This condition is more likely to happen in people who are more prone to anxiety, but it could happen to anyone. In people with a certain degree of depression or anxiety it can even happen without an inner ear disease.
Unfortunately, many healthcare providers including ENT’s, neurologists, and physical therapists aren’t aware of this phenomenon. The good news is that there are physicians, physical therapists, and other healthcare professionals
with interest and training in this area that can help you overcome this dizziness. Once a proper examination is done and it is determined that this is the cause of the dizziness, then the right treatment can begin. The treatment may consist of specialized vestibular rehabilitation therapy (VRT), a temporary course of psychiatric medications, psychotherapy or a combination of these treatments. The treatments work to help the brain and mind restore normal interactions between the parts of the brain that deal with balance and fear. The result is no more dizziness and improved balance allowing you to feel normal doing the things you need to do in life.
If you have been having trouble getting a diagnosis for your dizziness when all of the testing you had was normal or think you have CSD, make an appointment at NPBTC. We have a neurologist, psychiatrist, and a physical therapist with special interest in this area who will work together with each other and you to help you overcome your dizziness.
Special thanks to Jeffery P. Staab, MD and Michael J. Ruckenstein, MD, for their research and publications on CSD. Please see their works for more information.
Where can i look to find a doctor in san antonio tx who specializes in chronic subjective dizziness? So far my google searches have come up with nothing!
Sorry for the late reply. I haven’t been able to check this site very often. Unfortunately, I don’t know anyone in San Antonio that specializes in chronic subjective dizziness. Your best bet would be to go to http://vestibular.org/finding-help-support/provider-directory or http://www.neuropt.org/map_Vestibular/map.html and call vestibular specialists in your area and see if they have experience treating this condition. I hope this helps,
James R. Barsky, PT, DPT
Reading this story is like reading the step-by-step events of my life for the past 5 weeks. Woke up on a Tuesday morning, sat up in bed and felt very woozy and hard to stay sitting up. As I put my feet on the floor and proceeded to stand, I discovered that I had absolutely no sense of balance ( the only way I can describe it is like putting a dead body in a standing position and expecting it to be able to stand). That’s exactly what it felt like, no control, zero balance, and extremely light headed. So I called an ambulance and went to the hospital for 3 days, diagnosed with Vertigo, and was given meds and sent home with a walker as, at that time I could at least kind of walk very slowly with that assistance. All of the testing they did looked normal (CT Scan, MRA of the head and neck, blood work). So I went home that Thursday, and 3 days later (Sunday) I was taken back to another hospital, I was back to square one, zero balance, couldn’t walk. This hospital stay was 4 days, again with tests looking normal. Sent home again with more of the same meds. I was referred to and ENT and they did an ENG test, came back normal. I was referred to a Neurologist who has now done several tests and I have an appointment with him tomorrow to get all the results. What I find interesting that none of the doctors so far seem to share my interest in, is that the day prior to the onset of all this, I’d had a coughing fit that lasted more than 5 minutes and was extremely exhausting and made me light headed (I’d been battling a URI for two weeks). All of the tests so far are normal, and it is incredibly frustrating that the cause has not yet been identified. My symptoms are very real, it’s been 5 weeks. Even if someone hadn’t had any history of anxiety disorder, this would certainly qualify as a trigger for such. And this has lead me to searching the Internet for answers or at least considerations of what might be going on. I was actually relieved to find this site and read this story, at least I don’t feel like I’m the only one that has gone through these symptoms for this long and gone through the same long process of going from one specialist to the next looking for answers. I hope this “conditions” gains more attention and progress can be made to help identify the cause(s) and alleviate the symptoms. I feel like everyone is throwing band aids (meds) at the problem but no one knows how to actually find the cause and fix it. Very frustrating. But I’m relieved that I found this site. I’m not alone in this and that is about my only comfort so far. I live in Houston, Texas by the way. I will be mentioning this CSD to my Neurologist at my appointment tomorrow if he tells me all the tests came back normal and see if he has any insight to this condition and can offer any help.
I’m 35 yr old male. This describes my life for over 2 years. I’m in and out hospital for tests, they can’t find anything. ENT ,MRI, EKG , blood work ext. They thought I had a stroke. I’m scared to death. I constantly feel like im going to die specially when i do any exercise it makes it wrose. I live in Ottawa Ontario Canada. No one knows CSD 🙁 supposed to go for ENG test in 3 weeks but I’m nervous as they said its rough.
I have had so many patients tell me that they would rather have the worst pain imaginable then feel dizzy. I’m sorry to hear how severe this is for you. Keep in mind when you are getting the caloric test of the ENG (the hot and cold in the ear) that it should cause you to feel a slow spin if your vestibular system is working normally. If it doesn’t cause any vertigo, then there could be a problem with you vestibular nerve or end organ. Ear wax and poor technique can cause an abnormal result on the caloric test also. The good news is that the more normal tests you have, the less chance there is for it to be caused by anything life threatening. Your best bet is to find an ENT, neurologist, physical therapist, or psychiatrist who is passionate about helping people with dizziness to work with you to find the cause of your dizziness and get you the best treatment. The Vestibular Disorders Association (http://www.vestibular.org/) can be a good resource to find healthcare providers and to connect with other people who are going through similar issues. I hope this helps to put your mind at ease some as you are going through this process.