Hi,

Thank you for your query,

1. The vertigo in cases of BPPV is triggered by changes in position against gravity and hence is maximum on lying down, getting up and on looking down or up (top-shelf vertigo). If you do have a component of mild or atypical BPPV, it may be easily controlled by Brandt Daroff exercises or the other liberatory maneuvers.

2. BPPV related vertigo does not occur on walking while the head is kept steady or with slow movements of the head. BPPV accounts for 20% of peripheral vertigo and hence should be ruled out.

3. Ask your doctor to do the following tests:
A. Dix Hallpike test
B. Head impulse test
C. Skew deviation test.
D. Cerebellar & Gait tests
E. Visual vertical estimation
This is besides the routine ear (including audiometry & caloric testing), eye (nystagmus & VNG: videonystagmography) besides routine general check-up (for example, BP, hemogram, cervical spondylosis, acid reflux and so on).

4. Vertigo may be multifactorial, however central (brain related) giddiness in not fatigueable hence is not sporadic.

5. If you can follow up with the results of the above tests, further treatment options may be discussed.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.

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Hi,

Thank you for writing back.

1. Yes, dizziness may seem like light-headedness.

2. Inner ear and vestibular disorders lead to a spinning vertigo were the environment spins around the patient. Other helpful points are that peripheral vertigo is usually:
a. episodic, severe,
b. short to medium duration,
c. usually accompanied by nystagmus (abnormal eye movements) which are in a fixed direction, decreased by visual fixation and fatigue-able on repetition.

3. Central vertigo tends to give the impression of the patient spinning with respect to a stable environment and is:
a. less intense
b. continuous,
c. may have no nystagmus or if the nystagmus is present, it may be direction changing, asymmetrical, increased by visual fixation and not fatigue-able on repetition.
d. may have other neurological symptoms.

4. The problem here is that around the severe episodes, there may be a light-headed feeling even in peripheral vertigo. However the feeling is groggy and cloudy. Feeling light headed with a clear head and thinking is usually a related to a central or general cause.

5. Dizziness and vertigo is such a complex topic that without the above-mentioned tests, it may not be possible for even a direct observer to pinpoint the cause. For example, it is not possible to see your own nystagmus, you need an observer.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.

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