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Dizziness And Vomiting. Has Pacemaker And Vertigo. What Could Be The Cause?

Posted on Wed, 13 Jun 2012

Question: Hi, My Grandmom is 86 years old and recently she has started vomiting and complains of about head spinning, she is currently in a hospital but all her tests like city scan, blood pressure, ultra sound, heart monitor are normal. Doctors are not able to pin point the direct cause.
She has a pacemaker and already taking medicines for Vertigo. What could be the real Cause ?
Would you be able to help me with this as to what is her actual problem so that we can get are diagnosed in that area.

Answered by Dr. Naveen Kumar Nanjasetty (2 hours later)

Hi,

Thanks for the query.

Considering the age of your grandmother there are various reasons to cause dizziness, to mention a few:

1. Cervical spondylosis - giving rise to cervical vertigo
2. Benign paroxysmal positional vertigo (BPPV) - inner ear problem
3. Neurological - arising from brain
4. Cardiac cause - improper heart rhythm
5. Gastritis – acid reflux from the stomach can cause dizziness with vomiting, this happens occasionally

The most common ENT cause for dizziness is BPPV, this is a condition of inner ear wherein there is dislodgement of the otoliths (small stone like things present in the semicircular canals of the inner ear) into the semicircular canal causing dizziness. Usually this lasts for few seconds to few minutes and it is noticed on getting up from the bed or rolling over on the bed.

The second most common cause is cervical vertigo secondary to cervical spondylosis. It so happens that the blood vessels passing through the vertebra gets compressed on turning the head/bending forward, leading to reduced supply of blood to the brain and causing dizziness.

Irregular heartbeats also known as arrhythmia can also cause dizziness because of improper blood supply to the brain.

To sum it up, any of these above causes could be inducing dizziness and performing physical tests to rule out the BPPV or Neurological causes (related to the brain and the nerves) is not possible considering age. Hence the best approach is to manage the dizziness symptomatically with Betahistine (vertin), vitamin B-complex and domperidone (to reduce vomiting).

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Radhika

Follow up: Dr. Naveen Kumar Nanjasetty (2 hours later)

Thank You Doctor XXXXXXX

Just one more query, is there any tests possible to ensure that this was the case of BPPV? Vomiting has reduced but the spinning of head and shaking of limbs continues.

Its been 5 days now since she reported this problem.

Hoping to hear from you.

Regards,
Indra Chatterjee

Answered by Dr. Naveen Kumar Nanjasetty (11 hours later)

Hello again Mr XXXXXXX

Thanks for writing back.

Yes, there is one test called Hallpike's Maneuver to detect the affected ear followed by a correction procedure called Epley's maneuver. Unfortunately, it will be difficult to perform in case of your grandmother, as it involves bending of the neck in various positions and considering her age it would be wise to avoid it.

As she is improving with the present medications, I feel it would be better to continue with the same without causing any physical strain which can affect her health.

I wish her good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Yogesh D