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Dizziness men: 10 Health Symptoms Men Shouldn’t Ignore – Men’s Health Center


Why Am I Dizzy? 7 Possible Causes of Dizziness and How To Treat It

Many parts of your body — including your eyes, brain, inner ear, and nerves in your feet and spine — work together to keep you balanced. When a part of that system is off, you can feel dizzy. It can be a sign of something serious, and it can be dangerous if it makes you fall.

Your doctor will look at all your symptoms and overall health to figure out what’s going on and how to treat it.

Get medical attention immediately if you’re dizzy and you faint, fall, or can’t walk or have any of the following:

Is It Vertigo?

Does it feel like you’re spinning or the room is moving around you? That’s a classic sign of a particular type of dizziness called vertigo. It’s more than feeling off-kilter and usually gets worse when you move your head. This is a symptom that there is an issue in the inner ear or part of the brainstem governing balance. The most common kind is benign paroxysmal positional vertigo, or BPPV.

Your inner ear is a complicated system of canals filled with fluid. These let your brain know how your head is moving. With BPPV, tiny bits of calcium in part of your inner ear get loose and move to places they don’t belong. The system doesn’t work the way it should and sends your brain the wrong signals.

It’s often caused by the natural breakdown of cells that happens with age. A head injury can cause it, too.

You’ll feel it briefly when you tilt or turn your head, and especially when you roll over in bed or sit up. BPPV isn’t serious and usually goes away on its own. If not — or you’d like to help it along — it can be treated with special head exercises (“particle repositioning exercises”) called the Epley maneuver to get the pieces of calcium back in place. Most people feel better after one to three treatments.

There are other causes of vertigo both in and outside the brain. You can have Meniere disease (described below), labyrinthitis (described below), a tumor called an acoustic neuroma or side effects from some antibiotics. In the brain, it can be caused by a vestibular migraine, multiple sclerosis, malformations of brain structures or a stroke from lack of blood flow or bleed (hemorrhage) in the cerebellum.

Is It an Infection?

Inflammation of the nerves in your ears also can cause vertigo. It can be either vestibular neuritis or labyrinthitis. Vestibular neuritis refers to inflammation of your vestibular nerve only while labyrinthitis involved both your vestibular nerve and your cochlear nerve. Both conditions are caused by an infection. Usually, a virus is to blame. But bacteria from a middle ear infection or meningitis can make their way into your inner ear as well.

In this case, dizziness usually comes on suddenly. Your ears may ring, and it may be hard to hear. You also may be nauseated and have a fever and ear pain. Symptoms can last several weeks. 

If it’s caused by a virus and can’t be treated with antibiotics, medication can help make you feel better as the infection runs its course.

Is It Meniere’s Disease?

This condition brings on intense periods of vertigo that can last hours. You may feel fullness or pressure in one ear. Other symptoms include ringing in your ears, hearing loss, and nausea. You may feel exhausted after the attack passes.

People with Meniere’s disease have too much fluid in their inner ear. Doctors don’t know what causes it, and there’s no cure for it. It’s usually treated with diet changes (a low-salt diet) and medicine to control the dizziness.

Is It Your Circulation?

Dizziness can be a sign of a problem with your blood flow. Your brain needs a steady supply of oxygen-rich blood. Otherwise, you can become lightheaded and even faint.

Some causes of low blood flow to the brain include blood clots, clogged arteries, heart failure, and an irregular heartbeat. For many older people, standing suddenly can cause a sharp drop in blood pressure.

It’s important to get medical help immediately if you’re dizzy and faint or lose consciousness.

Is It Your Medication?

Several drugs list dizziness as a possible side effect. Check with your doctor if you take:

  • Antibiotics, including gentamicin and streptomycin
  • Anti-depressants
  • Anti-seizure medications
  • Blood pressure medicine
  • Sedatives


Is It Dehydration?

Many people don’t drink enough fluids to replace the liquid they lose every day when they sweat, breathe, and pee. It’s particularly a problem for older people and people with diabetes.

When you’re severely dehydrated, your blood pressure can drop, your brain may not get enough oxygen, and you’ll feel dizzy. Other symptoms of dehydration include thirstiness, tiredness, and dark urine.

To help with dehydration, drink plenty of water or diluted fruit juice, and limit coffee, tea, and soda.

Is It Low Blood Sugar?

People with diabetes need to check the amount of sugar (glucose) in their blood often. You can get dizzy if it drops too low. That also can cause hunger, shakiness, sweating, and confusion. Some people without diabetes also have trouble with low blood sugar, but that’s rare.

A quick fix is to eat or drink something with sugar, like juice or a hard candy.

Is It Something Else?

Dizziness can be a sign of many other illnesses, including:

  • Migraines, even if you don’t feel pain
  • Stress or anxiety
  • Nervous-system problems like peripheral neuropathy and multiple sclerosis
  • Tumor in the brain or inner ear

You may have other symptoms besides dizziness with any of these conditions. If your dizziness won’t go away or impacts your ability to function, make sure to discuss it with your doctor to find out the cause and treat it.

What It Is, Causes & Management


What is dizziness?

Dizziness can describe several different sensations. Dizziness is an impairment of spatial orientation. A dizzy spell doesn’t always indicate a life-threatening condition, but it can be unnerving. Dizziness can be associated with more serious conditions, such as a stroke or cardiovascular problems. Even on its own, though, if dizziness leads to a fall, it can be dangerous.

Dizziness can occur when you’re moving, standing still or lying down. When you’re dizzy, you may feel:

  • Faint.
  • Lightheaded.
  • Nauseous.
  • Unsteady.
  • Woozy.

What’s the difference between dizziness and vertigo?

Intense vertigo can make you nauseous or so unsteady you can’t drive or walk. It feels like you or objects around you are:

  • Floating.
  • Spinning.
  • Swaying.
  • Tilting.

How common is dizziness?

It’s common to experience dizziness. Almost half of people see their healthcare provider at some point because of feeling dizzy. The older you are, the more likely you are to have this symptom.

Possible Causes

The parts of your ear

What causes dizziness?

A number of conditions can cause dizziness because balance involves several parts of the body. The brain gets input about movement and your body’s position from your:

  • Inner ear.
  • Eyes.
  • Muscles.
  • Joints.
  • Skin.

Inner ear disorders are frequently the cause of feeling dizzy. The most common causes include benign paroxysmal positional vertigo (BPPV), Meniere’s syndrome and ear infections.

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) makes you dizzy when you change your head or body position (like bending over). It usually only lasts a few seconds or minutes. This harmless condition happens when calcium crystals in your inner ear move out of place.

You may have BPPV as a result of a head injury or simply from getting older. The good news is that the treatment is easy. Your healthcare provider can lead you through a series of simple moves, called canalith repositioning procedure (CRP). These movements get the crystals back to their proper position.

Meniere’s syndrome

Meniere’s syndrome involves having too much fluid in the inner ear. Experts aren’t sure why it accumulates. Anyone can develop Meniere’s, but it’s most common in people ages 40 to 60. If you have Meniere’s syndrome, you may also experience:

Meniere’s attacks usually happen suddenly. They can last from 20 minutes to 24 hours. Treatment methods include anti-nausea and anti-vertigo medications. Lifestyle changes may help, too, including:

If your condition doesn’t respond to simple measures, your healthcare provider may recommend more aggressive treatments. Those include injecting medication directly into the ear and surgery.

Ear infections

Viral or bacterial ear infections can cause inflammation (irritation) in the inner ear. The inflammation interferes with the messages your inner ear sends to your brain.

A nerve in the inner ear, the vestibulocochlear nerve, has two branches. Each branch communicates with the brain:

  • The vestibular nerve sends signals about balance. When the vestibular nerve is inflamed, you develop vestibular neuritis.
  • The cochlear nerve sends signals about hearing. If inflammation also affects the cochlear nerve, you develop labyrinthitis. Labyrinthitis also causes ringing in the ears and hearing loss.

Ear infection treatments include medications to relieve the symptoms of nausea and dizziness. You might also need antibiotics, antiviral drugs or steroids.

Other causes of dizzy spells and lightheadedness

There are many other factors that can cause dizziness. Within the heart and vascular system, conditions that can cause dizziness include:

Brain-related conditions that can cause dizziness include:

Additional conditions that can cause dizziness include:

Care and Treatment

How are dizziness and vertigo treated?

Treatment for vertigo and dizziness varies widely depending on the cause. Your healthcare provider may refer you to an audiologist for vestibular and balance assessment to help determine the cause for dizziness, and help determine next steps in management. If you have an ear infection, you may just need anti-nausea medication until the infection is gone. For long-term (chronic) conditions, your healthcare provider may recommend vestibular rehabilitation. It’s similar to physical therapy, with the goal of improving your balance through specific exercises.

What can I do to prevent falling?

If you have dizziness or vertigo, you should avoid several activities, including:

  • Driving (until your doctor gives you approval).
  • Standing in high places, such as climbing a ladder.
  • Walking in the dark.
  • Wearing high-heeled shoes.

Take these steps to reduce your risk of falling:

  • Always use handrails when walking up and down stairs.
  • Change positions or turn slowly. Have something nearby to hold onto.
  • Install hand grips in baths and showers.
  • Practice exercises that can improve balance, such as tai chi or yoga.
  • Remove floor clutter that you might trip over like throw rugs, loose electrical cords and stools. Be careful around small pets that might get underfoot.
  • Sit on the edge of the bed for several minutes in the morning before you stand up.
  • Use a cane or walker.

When to Call the Doctor

When should I see my healthcare provider?

If your dizziness won’t go away or keeps coming back, it’s important to talk to your healthcare provider about it. Seek emergency care if you also have any of the following symptoms:

  • Chest pain.
  • Double vision or blurred vision.
  • Fainting (syncope).
  • High fever.
  • Numbness, tingling or weakness in your face, arms or legs.
  • Slurred speech or a stiff neck.
  • Trouble walking.

A note from Cleveland Clinic

Your sense of balance is an intricate process that relies on many body parts. It’s easy to take it for granted until it goes haywire. Your ear, brain and heart can all affect your balance. It can take time to nail down the exact cause. But in most cases, dizziness and vertigo are symptoms of treatable conditions.

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Dizziness: Lightheadedness and Vertigo

Is dizziness your main problem?

How old are you?

3 years or younger

3 years or younger

4 to 11 years

4 to 11 years

12 years or older

12 years or older

Are you male or female?

Why do we ask this question?

  • If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
  • If your symptoms aren’t related to those organs, you can choose the gender you identify with.
  • If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Have you had a head injury?

Did you pass out completely (lose consciousness)?

If you are answering for someone else: Is the person unconscious now?

(If you are answering this question for yourself, say no.)

Are you back to your normal level of alertness?

After passing out, it’s normal to feel a little confused, weak, or lightheaded when you first wake up or come to. But unless something else is wrong, these symptoms should pass pretty quickly and you should soon feel about as awake and alert as you normally do.


Has returned to normal after loss of consciousness


Has returned to normal after loss of consciousness

Did the loss of consciousness occur during the past 24 hours?


Loss of consciousness in past 24 hours


Loss of consciousness in past 24 hours

Have you had any new neurological symptoms other than dizziness?


Other neurological symptoms


Other neurological symptoms

Do you have these symptoms right now?


Neurological symptoms now present


Neurological symptoms now present

Is the dizziness severe?

Severe means that you are so dizzy that you need help to stand or walk.

Have you had sudden, severe hearing loss?


Sudden, severe hearing loss


Sudden, severe hearing loss

Is vertigo a new problem?

Are your symptoms getting worse?


Dizziness is getting worse


Dizziness is getting worse

Did the symptoms start after a recent injury?


Symptoms began after recent injury


Symptoms began after recent injury

Have you recently had moments when you felt like you were going to faint?


Episodes of feeling faint


Episodes of feeling faint

Have you felt faint or lightheaded for more than 24 hours?


Has felt faint or lightheaded for more than 24 hours


Has felt faint or lightheaded for more than 24 hours

Are you nauseated or vomiting?

Nauseated means you feel sick to your stomach, like you are going to vomit.

Are you nauseated a lot of the time or vomiting repeatedly?


Persistent nausea or vomiting


Persistent nausea or vomiting

Do you think that a medicine could be causing the dizziness?

Think about whether the dizziness started after you began using a new medicine or a higher dose of a medicine.


Medicine may be causing dizziness


Medicine may be causing dizziness

Have you been feeling dizzy for more than 5 days?


Dizziness for more than 5 days


Dizziness for more than 5 days

Is the problem disrupting your daily activities?


Dizziness interfering with daily activities


Dizziness interfering with daily activities

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Vertigo is the feeling that you or your surroundings are moving when there is no actual movement. It may feel like spinning, whirling, or tilting. Vertigo may make you sick to your stomach, and you may have trouble standing, walking, or keeping your balance.

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Symptoms of serious illness may include:

  • A severe headache.
  • A stiff neck.
  • Mental changes, such as feeling confused or much less alert.
  • Extreme fatigue (to the point where it’s hard for you to function).
  • Shaking chills.

Heartbeat changes can include:

  • A faster or slower heartbeat than is normal for you. This would include a pulse rate of more than 120 beats per minute (when you are not exercising) or less than 50 beats per minute (unless that is normal for you).
  • A heart rate that does not have a steady pattern.
  • Skipped beats.
  • Extra beats.

Neurological symptoms—which may be signs of a problem with the nervous system—can affect many body functions. Symptoms may include:

  • Numbness, weakness, or lack of movement in your face, arm, or leg, especially on only one side of your body.
  • Trouble seeing in one or both eyes.
  • Trouble speaking.
  • Confusion or trouble understanding simple statements.
  • Problems with balance or coordination (for example, falling down or dropping things).
  • Seizures.

Many prescription and nonprescription medicines can make you feel lightheaded or affect your balance. A few examples are:

  • Antibiotics.
  • Blood pressure medicines.
  • Medicines used to treat depression or anxiety.
  • Pain medicines.
  • Medicines used to treat cancer (chemotherapy).

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

  • Passing out (losing consciousness).
  • Feeling very dizzy or lightheaded, like you may pass out.
  • Feeling very weak or having trouble standing.
  • Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Head Injury, Age 4 and Older

Head Injury, Age 3 and Younger

Brain fog, pain, fatigue, nausea, dizziness: Almost one-third of people with ‘mild’ COVID-19 still battle symptoms months later, study finds

It’s been almost a year since Michael Reagan, 50, came down with COVID-19.

“I woke up first thing in the morning and I felt really hot and out of breath,” he said, recalling the morning of March 22, 2020. “I went into the bathroom trying to catch my breath, and I immediately coughed up blood into the sink. … I ended up in the hospital that day and tested positive for COVID.”

Reagan said he spent two months in and out of the hospital last spring, with acute COVID-19.

US data shows a big decline in new COVID-19 cases. Here’s why it could be deceptive

But for as hard as that was, what he’s been through since could be considered just as bad, if not worse: His current symptoms include constant pain in his chest, painful nerve pain in his hands and legs, seizures, tremors, and the loss of vision in one eye.

“Since then it has been a roller coaster,” he said, with ups and downs, new symptoms, a whole series of doctors, medications and tests.

“I realized that I have a lot of damage from COVID and it’s changed my life completely,” he said. He has not been able to return to anything near the active life he enjoyed before.

Unlike Reagan, when 34-year-old Stephanie Condra got sick with COVID-19 last summer, she didn’t have to be hospitalized. Her symptoms were comparatively mild: fatigue, shortness of breath, stomach pain and cramping, and a low-grade fever.

Medical imaging shows how COVID attacks the body, new study finds

But, after it appeared she had recovered from her acute illness, Condra says she began developing a wide array of health problems that waxed and waned but did not clear up: terrible sinus pain, nausea and loss of appetite, bone-crushing fatigue, dizziness, a burning sensation in her chest, a dry cough, brain fog, confusion, concentration issues and problems with word retrieval.

“My symptoms are constantly evolving. I get the same symptoms again and again, and it’s like one will kind of disappear and then others will come up,” she explained.

While Condra said she started getting better at the beginning of 2021, she describes her progress as slow and halting. “I’m really only able to function for maybe, tops, like four hours during a day,” she said.

More than a year into the pandemic, what has become abundantly clear is that SARS-CoV-2 — the virus that causes COVID-19 — is a tricky virus: Some people aren’t aware they’re infected at all, while others are hospitalized and some die. And a growing group of people get sick and then never fully recover. In support groups, they sometimes refer to themselves as long-haulers; their condition is alternately called long COVID, continued COVID, post-COVID syndrome or post-acute COVID syndrome.

What we’re learning

Nobody is sure what percentage of people who’ve been infected with SARS-CoV-2 go on to develop post-COVID syndrome.

A new research letter published Friday in the journal JAMA Network Open is shedding new light on the condition. Researchers from the University of Washington followed 177 people with laboratory-confirmed SARS-CoV-2 infection for up to nine months — the longest follow-up to date. Notably, this group included 150 outpatients, who had “mild” disease and were not hospitalized.

They found that 30% of respondents reported persistent symptoms. The most common were fatigue and loss of smell or taste. More than 30% of respondents reported worse quality of life compared to before getting sick. And 14 participants (8%) — including 9 people who had not been hospitalized — reported having trouble performing at least one usual activity, such as daily chores.

US life expectancy drops 1 year during COVID pandemic, most since World War II

The researchers wrote that with 57.8 million cases worldwide, “even a small incidence of long-term debility could have enormous health and economic consequences.” There are now more than 110 million cases worldwide, according to the latest data compiled by Johns Hopkins University.

A much larger study, published in early January in The Lancet, found that of 1,733 coronavirus patients treated in the Chinese city of Wuhan, 76% were still experiencing at least one symptom six months after their symptoms began. But this group was made up entirely of hospitalized patients.

Treatment is a long and winding road

The Center for Post-COVID Care at Mount Sinai Health System, in New York City, was the first of its kind to open back up in May. So far, the center has seen more than 1600 patients — including Reagan and Condra — and there’s a months-long wait to get an appointment.

“It’s very hard to predict who will get these symptoms,” Dr. Zijian Chen, the medical director, told me when I interviewed him last summer. “The patients we’re seeing at the center are, you know, of all races. They span in age from the 20s to 70s and 80s. You have patients who are both male and female, of equal distribution.”

He said having mild illness or being healthy to begin with, is no protection from having persistent symptoms.

“I would presume that if … you had a pre-existing condition, that the infection with the virus can worsen that condition. But again, we’re also seeing patients who are previously healthy, had somewhat relatively mild illness,” Chen said.

Age, he said, isn’t a predictor either.

Another baffling aspect of post-COVID syndrome is the vast and seemingly random array of health issues that some patients face.

Dr. Christian Sandrock is a professor of medicine in pulmonary critical care and infectious diseases at UC Davis School of Medicine, in Sacramento, California. As director of critical care, he is one of the doctors who assesses patients at UC Davis’ Post-COVID-19 Clinic. It was the first such center in the region to open its doors, back in October.

“When we look at the long-term symptoms … the big things we see are fatigue, lethargy and sleep disturbance, and that makes up probably more than half of what we see. Loss of taste and smell is a very specific one that we will see. Shortness of breath is a very specific one, and chest pain as well,” he said. Many patients have multiple symptoms, and the symptoms can come and go.

Sandrock categorizes the symptoms into several buckets. Problems such as chest pain, shortness of breath and heart inflammation fall into the cardiovascular category. Chest pain and shortness of breath could, depending on the underlying cause, fall into the respiratory category, as does decreased exercise tolerance and pulmonary function abnormalities. He puts rashes, hair loss and even tooth loss into the dermatologic category. Fatigue, brain fog and not feeling like oneself belong to the constitutional category. The neurological category comprises loss of smell and taste, sleep dysregulation, altered cognition and memory impairment. Depression, anxiety and mood changes, he explained, all fall into the psychiatric category.

As for what is causing those symptoms, Sandrock points to several culprits. Some might be caused by the complications of an extended hospital or ICU stay, which is known to be hard on the body and have lasting effects. Some could be triggered by microvascular disease — damage to the capillaries, which Sandrock says is behind many symptoms, from chest pain to “COVID toes” to fatigue and even brain fog. Some symptoms could be set off by an autoimmune response triggered by high levels of inflammation, such as joint and body aches, sleep disturbances, depression and fatigue. And some could be as a direct infection by the virus, such as loss of smell and/or taste, according to Sandrock.

Treatment, Sandrock said, is very much individualized and depends on the symptoms and the underlying cause of those symptoms.

“Treatment needs to be customized,” he said. “We have to really spend our time seeing what our patients need. Some of them — they really just have chest pain, shortness of breath and low oxygen levels, and in that case we can manage that. Another person may have a lot of brain fog, difficulty concentrating and sleep disturbances — that’s a whole host of other things we then need to do.”

It can involve referral to other experts within the clinic, medications and rehabilitation. Medications such as immune-modulators, anti-inflammatories, anti-depressants, beta-blockers and/or steroids, he said. Rehab, such as cognitive, pulmonary and/or cardiac rehab. Sleep studies to root out the cause of any sleep disturbance.

But there is one constant. “The only treatment I’ve seen that’s consistent is a lot of what we would call supportive care. So that really involves better living and higher quality living, for lack of a better term. But that means you really need sleep. Sleep is going to matter a lot,” Sandrock said, noting that stress reduction, meditation and yoga are also part of the mix.

He said patients need to adjust their life to a less stressful and slower pace to allow the body to heal. “So, we want people to really be patient with themselves, know that it’s going to take a lot of time as they work through it. So that, I think, is key,” he said.

Dr. Dayna McCarthy, a team member at Mount Sinai’s Center for Post-COVID Care, agrees patients have to adjust their expectations of themselves and slow down.

“We’re like rubber bands. We just want to kind of snap back to the way that we were before. So, I think that has been one of the biggest challenges. But if people are not able to do that, and they keep pushing, that is when the symptoms just do not get better,” she said.

Improvements are hard-won and extremely slow. “Day to day it’s really hard to measure those improvements. As these symptoms wax and wane, the improvement is very stuttering. You know, three steps forward, two steps back,” said Sandrock, noting that he measures improvements in terms of months.

McCarthy, who calls the process “glacially slow,” says patients do get better with supportive care and time. “But a lot of it falls on the patient and having to understand and come to terms with the fact that their life needs to change for them to get better,” she said. “And when you’re young and healthy and you’re used to being in kind of fifth gear — you’re ‘full steam ahead’ and now we’re telling you, you really have to kind of shift back and shift down to allow your body what it needs to recuperate and recover. (It’s) a very difficult thing for patients to process and embrace,” she said.

More research is needed

Both Sandrock and McCarthy say much more research is needed to better understand post-COVID syndrome, including who gets it and best treatment practices. But they’re optimistic about the future, now that the condition has been recognized and “science is getting behind it,” as McCarthy put it.

“So, people are coming together both in systems, and then systems coming together nationally, and then internationally. So, there’s been this mass collaboration of scientists and health care professionals that are looking for answers. And that takes time. But I’m very happy to report that,” she said.

Sandrock said he was excited to learn that the National Institutes of Health recently announced it would be offering research grants as part of its “Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)” initiative.

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As for Michael Reagan and Stephanie Condra, they’re carrying on as best they can.

“Every day I make the conscious decision to be optimistic and to be positive. I can’t always control what circumstances life throws at me, but I can control how I carry myself. If I carry myself with grace and dignity that I’m going to be OK,” Reagan said. “I have a very supportive family. I have a supportive partner. I have job (and) coworkers that understand. I have excellent doctors. So, I try to look at things I am grateful for.”

Said Condra, “I really had to relinquish my sense of control in not knowing when this is going to end for me. But really being grateful for the improvements that are happening, and at least (getting) back some level of having a quality of life and being able to take advantage of the days, the weeks where I am feeling better … but it’s mind-blowing that it’s been so long.”



Dizziness can be described as a sensation or illusion of movement (such as spinning, rotating, tilting, or rocking), unsteadiness, or dysequilibrium. It is commonly accompanied by gait imbalance.

Dizziness is a symptom and not a diagnosis; it can be compared with pain in that respect. It is difficult to quantify because of its subjective nature. Dizziness is not exclusive to the vestibular system. Furthermore, it may be a component of a larger or more diffuse problem.

The nomenclature of dizziness can be divided according to the following list. This breakdown is arbitrary. These descriptions are not quantifiable, are not mutually exclusive, and can lead to further diagnostic dilemmas, yet this approach has persisted probably because of the complex nature of the symptom.

  • Lightheadedness: a vague sensation of floating or wooziness.
  • Presyncope: a more extreme form of lightheadedness. It might or might not precede actual syncope and can be accompanied by tachycardia, palpitations, or diaphoresis.
  • Vertigo: a sensation of movement, often described as a spinning, twisting, or turning.
  • Dysequilibrium: a sensation of unsteadiness.

Symptoms may be episodic or constant. If they are episodic, they can last anywhere from seconds to minutes or hours to months at a time.

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Dizziness is a common complaint in the medical environment. It is the third most common symptom presentation (combined with imbalance and falls) for outpatient medical consultation, behind chest pain and fatigue. In the adult population, 42% report dizziness at some time.1 Dizziness is common in all age groups; however, its frequency does increase with age. Dizziness and related vestibular symptoms are the main reasons for visiting a doctor after 75 years of age. Prevalence rates vary depending on the patient’s age and the cause of the dizziness.

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Essentially any and every part of the vestibular system can malfunction, potentially providing symptoms of dizziness. Typically, when discussing vestibular symptomatology, the dichotomy of peripheral vestibular dysfunction versus central vestibular dysfunction is discussed. This method is used here for discussion purposes, although it can be misleading in practice because there is often an overlap between the two. Systemic etiologies, which might or might not act via central vestibular pathways, can also be a helpful way to discuss these issues.

Peripheral Vestibular Disorders
Vestibular Dysfunction

Peripheral vestibular dysfunction refers to dysfunction of the vestibular end-organ (utricle, saccule, semicircular canals) and vestibular nerve.

Vestibular neuronitis (neuritis) can affect one or both vestibular end-organs and can involve them simultaneously or sequentially. The actual portion involved is believed to be the cell bodies of the hair cells that transduce movement within the end-organ and/or the vestibular nerve itself. The neuronitis can occur as a single attack or as multiple attacks. A quantifiable peripheral vestibular loss may be appreciated with caloric testing. The term neurolabyrinthitis may be used if there is an associated hearing loss.

Bilateral vestibular hypofunction (partial or complete loss) may be related to bilateral vestibular neuronitis or to toxic or immune mechanisms. Gentamicin and streptomycin are notorious for causing vestibular dysfunction (ototoxicity). In fact, this is exactly why they are used intratympanically to induce vestibular loss, particularly in the treatment of Menière’s disease.

Autoimmune ear disease is another cause of peripheral vestibular dysfunction. It is characterized by rapidly progressive, bilateral, sensorineural hearing loss within 3 months.2 In contrast, ototoxicity can manifest with sudden bilateral loss, whereas age-related and noise-induced hearing loss can develop over many months to years. The most common age at onset of symptoms is 20 to 50 years. Many older patients present with new symptoms when autoimmune ear disease might, in retrospect, have been present for many years. The disease can affect both sexes, but a female preponderance is noted when systemic immune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus) are present.

Central or systemic vestibular dysfunction includes the vestibular nuclei (superior, inferior, lateral, and medial) where they synapse with numerous pathways including the cerebellar, oculomotor, posterior column, proprioceptive, and vestibulospinal.

Menière’s Disease

Menière’s disease is a disorder that is often incorrectly diagnosed. It includes the tetrad of vertigo (lasting at least 20 minutes), unilateral tinnitus, low-frequency hearing loss (initial stages with progression to all frequencies), and aural fullness. The symptoms are believed to be associated with a change in fluid pressure within the endolymphatic space. Menière’s disease usually starts between the ages of 20 and 60 years (average, 40 years), and women outnumber men by 1.3 to 1. In most patients, only one ear is involved; it is bilateral in about 15% to 20%.

The cause of this disease is not known, although viral injuries of the inner ear and other factors affecting the homeostasis of the inner ear have been proposed. Sodium management is believed to be at the core of the disorder. The vertigo is treatable through either medical or surgical management, although the tinnitus is often difficult to control. Various case series have reported spontaneous resolution rates of up to 30%.

The term endolymphatic hydrops is often used to describe Menière’s disease. This is actually a misnomer. This term is the pathologic description of the inner ear, which can be seen in Menière’s disease. It discusses the physical appearance of the endolymphatic space and the way it is dilated. Other disorders can also lead to endolymphatic hydrops.

Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness, particularly in people older than 65 years. Its incidence is estimated at 6000 per million population in those whose illness persists longer than 30 days, although this is probably a gross underestimate. It is easily identifiable with bedside evaluation (Dix-Hallpike testing). All three canals (anterior [superior], posterior, and lateral [horizontal]) may be the source of BPPV, although the posterior semicircular canal is by far the most common source.

Various theories exist regarding the pathogenesis and localization of BPPV. Calcium carbonate is embedded in a proteinaceous matrix on the surface of the utricle, with otoconia as the building block. Through head trauma, infectious or inflammatory processes, or idiopathic mechanisms, the otoconia can dislodge and move to various areas within the endolymphatic space. This pathologic movement of otoconia within the endolymphatic space induces the sensation of movement out of proportion to actual head movement.

Variants of BPPV have been described in the literature, although their existence is controversial. These include cupulolithiasis, in which otoconia are believed to be attached to the cupula; ampullolithiasis, or short-arm BPPV, in which otoconia are within the ampulla of the semicircular canal on the other side of the cupula; and utriculolithiasis, in which otoconia are freely moving within the utricle outside of any of the semicircular canals.

Perilymphatic Fistulas

Perilymphatic fistulas represent a defect of the oval or round window that produces abnormal communication between the fluid surrounding the membranous labyrinth and middle ear space. Fistulas can be spontaneous (implosive or explosive) or acquired.

Implosive fistulas arise from increased pressure in the middle ear resulting from barotrauma; they include rapid airplane descent, external ear trauma, and scuba diving. In these cases, the membranes of the oval or round windows are driven inward to permit escape of perilymph into the middle ear space.

Explosive fistulas arise from increased intracranial pressure such as weight lifting, vigorous coughing, or straining, and it is believed that there is communication with the perilymphatic space by the internal auditory canal. In these cases, the membranes of the oval and round windows are driven outward. Treatment is similar for implosive and explosive fistulas. Acquired fistulas can result from stapes or chronic ear surgery.3

Drug-Induced Dizziness

Drug-induced dizziness is common. Given that medication use is ubiquitous and the mechanisms are complex, it is no wonder that so many drugs are implicated in causing dizziness. Certain antiseizure medications (carbamazepine, phenytoin, primidone) and alcohol can cause acute reversible dysequilibrium and chronic irreversible dysequilibrium as a result of cerebellar dysfunction. Sedating drugs (barbiturates, benzodiazepines, and tricyclic antidepressants) can cause a nonspecific dizziness that is believed to be related to diffuse depression of the central nervous system. Antihypertensive medications and diuretics can induce lightheadedness and presyncope by induction of postural hypotension and reduced cerebral blood flow.

A number of drugs can produce a characteristic drug-intoxication syndrome with disorientation, memory and cognitive deficits, gaze-evoked nystagmus, and gait and extremity ataxia. This can be confused with more serious disorders. Alcohol is one example of these drugs; it can cause central nervous system depression and cerebellar toxicity, and it can change the specific gravity of the cupula (motion sensor within the ampulla of the semicircular canal). This change in the cupula explains the positional vertigo and positional nystagmus that are noted with alcohol ingestion.

Drug-induced dizziness or imbalance can be caused by ototoxic drugs such as aminoglycosides (gentamicin, streptomycin) and cisplatin. Vertigo can ensue if hair-cell loss is asymmetrical. If injury is bilateral and symmetrical, oscillopia (the optical illusion that stationary objects are moving back and forth or up and down) and dysequilibrium may be experienced.

Motion-Related Dizziness

Mal de debarquement (MDD) syndrome is a disorder characterized by a persistent sensation of motion after a prolonged period of passive movement.5 It is commonly experienced after water travel, air travel, or prolonged train rides, although other modes of travel can induce this syndrome, including space flight. The sensation of motion persistence after prolonged travel is physiologic and often short-lived; it is arbitrarily considered pathologic when it remains for at least 1 month. MDD is often incorrectly described as motion sickness; instead, motion, by self-motion or driving, actually often reduces symptoms in MDD. Diagnosis of MDD is essentially made by history: a preceding period of prolonged travel with onset of a similar sensation of motion afterward. Patients often indicate improvement with self-motion (rocking) or while driving. Treatment of MDD is predominantly medical. Vestibular suppressants with diazepam or clonazepam may be helpful in some patients. Spontaneous recovery can occur.

Motion sickness begins with epigastric discomfort and may be accompanied by increased salivation and a feeling of bodily warmth. As discomfort progresses, gastric emptying is inhibited. Symptoms progress to nausea, pallor, sweating, and eventually to vomiting. Some researchers have suggested that there is an additional syndrome of motion sickness that lacks the gastrointestinal complaints and is characterized by drowsiness, headache, apathy, depression, and generalized discomfort. Motion sickness is exacerbated by further activity and movement.

Central Vestibular Disorders
Circulation-Related Causes

Cardiogenic dizziness results from ineffective cerebral or brainstem perfusion. Low cardiac output states include cardiac failure, cardiac tamponade, arrhythmia, and aortic stenosis.

Carotid occlusion rarely causes vertigo because the posterior circulation supplies the brainstem. Only when the posterior and anterior circulations are both severely compromised can carotid disease cause vertigo.

Cerebrovascular conditions such as posterior-circulation ischemia or stroke can cause dizziness because vestibular structures are involved. A number of small- and large-vessel syndromes can include dizziness. Small-vessel syndromes include the following:

  • Lateral medullary syndrome (Wallenberg’s) with vertigo, dysarthria, Horner’s syndrome, and hemiataxia
  • Anterior inferior cerebellar artery syndrome, consisting of vertigo and unilateral deafness from labyrinthine artery ischemia; facial weakness; and ataxia
  • Labyrinthine (internal auditory) artery syndrome

Large-vessel syndromes include the following:

  • Vertebrobasilar insufficiency
  • Basilar artery thrombosis
  • Vertebral artery thrombosis

Neurocardiogenic dizziness can result from a relative change in the tone of the peripheral vasculature and the heart as the system responds to feedback from the brainstem. Disorders of reduced orthostatic tolerance include neurally mediated syncope, postural tachycardia syndrome,4 postexercise syndrome, and so on.

Other Causes

Acoustic neuroma (vestibular schwannoma) is a nonmalignant tumor of the eighth cranial nerve and is commonly from the inferior vestibular nerve. Hearing loss is the most common symptom and is often high-frequency and sensorineural in nature. Tinnitus is also very common and tends to be unilateral and on the same side as the tumor. Despite the name vestibular schwannoma, dizziness is not common and occurs in less than 20% of patients with this diagnosis. However, unsteadiness may be present in as many as 70% of these patients.

Cervicogenic dizziness is difficult to classify (see discussion later).

Metabolic dizziness can be caused by hypoglycemia and can lead to a spectrum of symptoms that include mild fatigue, tremulousness, diaphoresis, confusion, or lightheadedness, to more-extreme symptoms of lethargy, amnesia, and seizures. It is usually a complication of diabetes mellitus or its treatment, although it can also occur with fasting or after meals. Hypomagnesemia and thyroid dysfunction (hyperthyroid and hypothyroid) can also be culprits of dizziness. Numerous other metabolic conditions can cause similar symptoms.

Migraine-associated dizziness is discussed later.

Psychophysiologic dizziness is the consequence of the integration of various subsystems that pertain to the sense of balance (visual, vestibular, proprioceptive, autonomic), and is not always pathologic. One robust example of this is the sensation of movement that a person might experience when standing at the ledge of a tall building versus just standing on the ground. It is the visual input that fools the brain into thinking that it is moving (visual-vestibular conflict), and the brain must then rely more on ankle proprioception (joint position sense).

Anxiety disorders, panic disorders, and phobias can also interact with disorders of balance and dizziness. Dizziness with anxiety and panic disorders are not related exclusively to hyperventilation. These symptoms may be primary to a psychological or psychiatric disorder or may be exacerbated by a vestibular syndrome. Phobic postural vertigo or phobic dizziness is a morbid fear of falling unassociated with postural or gait instability. It is often associated with panic disorder and agoraphobia, although the patient might focus on the physical symptoms. Patients have a fear of falling while sitting or standing, and this can provoke unpleasant sensations of body acceleration and acceleration of the environment. Neurocardiac disorders, particularly orthostatic intolerance, can mimic or contribute to these disorders. Tachycardia, palpitations, shortness of breath, and presyncope are not limited to disorders of the cardiovascular system.

Vestibular epilepsy may be vague dizziness or true vertigo that may precede the seizure (aura) or actually be or accompany the seizure event.

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Symptoms and Signs


On evaluation of the dizzy patient, the following issues should be considered:

  • Hearing: Reduced acuity, hyperacusis (increased sensitivity to sound), fluctuation, distortion, tinnitus
  • Gait and balance: Imbalance, falls, ataxia, retropulsion
  • Autonomic symptoms: Nausea, vomiting, diarrhea, diaphoresis, palpitations, presyncope, or syncope
  • General symptoms: Headache, neck pain, neck stiffness, state of hydration or dehydration
  • Neurologic symptoms: Focal weakness, numbness or tingling, visual field reduction or obscuration, mental status changes, photophobia, phonophobia, visual aura

On evaluation of the dizzy patient, the presence or absence of the following should be assessed:

  • Nystagmus: Spontaneous, gaze-evoked, post–head-shake, positioning (Dix-Hallpike testing)
  • Auditory: Rinne and Weber tests
  • Vestibular: Romberg’s sign (regular or sharpened), Fukuda step test, head-thrust test (Halmagyi)
  • Gait: Base, stability, ataxia, arm-swing
  • Cervical spine: Range of movement-extension, flexion, total rotation, upper cervical rotation, side bend; tenderness or pain, spasm, weakness

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Benign Paroxysmal Positional Vertigo

The diagnosis of BPPV is made on clinical grounds in a patient with complaints of episodic positional vertigo. It can be confirmed by Dix-Hallpike position testing of the involved ear. This test can be performed at the bedside, by trained physical therapists, or in the vestibular laboratory. Diagnosis is aided by visualization of the eyes, with either Frenzel or infrared video goggles. Both allow diminished visual fixation, although the infrared video goggles allow observation of the eye without light stimulation and allow review of the eye movements at a later time.

The provocation of paroxysmal nystagmus, after a brief delay, in the head-hanging position helps to identify the posterior semicircular canal that is involved. From the patient’s frame of reference, stimulation of the right posterior semicircular canal produces a clockwise torsional and upbeat nystagmus, and the left posterior semicircular canal produces a counterclockwise torsional and upbeat nystagmus. On return to a sitting position, the initial nystagmus often reverses. If both responses are seen, the specificity for BPPV is quite high. Dizziness that is out of proportion to the observed nystagmus may also be observed. Caution is advised if the dizziness is reproduced with no observed nystagmus; a diagnosis other than active BPPV should then be considered.6

Lateral (horizontal) canal BPPV can also be diagnosed. Symptoms of positional vertigo tend to come with rolling over in bed and are often more intense and more nauseating than posterior-canal BPPV. For diagnosis, the patient can be placed in the supine position with the head up 30 degrees to allow the lateral canal to be placed in the vertical plane. The Lempert, or barbecue roll, procedure may be used to treat this, with the direction of the roll away from the ear that exacerbates symptoms. In other words, if symptoms are produced when the patient rolls to the side that is involved, rolling 360 degrees in the opposite direction might help to reposition the stray otoconiae.

Menière’s Disease*

The following criteria may be used in the diagnosis of Menière’s disease.7

  • Recurrent, discrete episodes of spinning or rotation
  • Duration ranging from 20 minutes to 24 hours
  • Nystagmus associated with attacks
  • Nausea and vomiting possibly accompanying attacks
  • Absence of other neurologic symptoms
  • Fluctuating unilateral hearing deficits
  • Sensorineural hearing loss
  • Progressive unilateral hearing loss
  • Often low-pitched, and louder with attacks
  • Unilateral, on affected side

*Criteria for diagnosing Menière’s disease from American Academy of Otolaryngology-Head and Neck Surgery.

Superior Canal Dehiscence

Superior canal dehiscence was first described by Lloyd Minor in 1998.8 Dehiscence of the bone overlying the superior semicircular canal can result in a syndrome of vertigo and be induced by loud noises (Tullio’s phenomenon) or by maneuvers that change middle-ear or intracranial pressure. The symptoms are believed to occur because the dehiscence acts as a third mobile window into the inner ear. Diagnosis is made by high-resolution computed tomography (CT) of the temporal bone demonstrating the dehiscence or thinning of the bone overlying the superior semicircular canal. A low-frequency air-bone gap (at 500 Hz and 1 kHz) with or without a conductive hearing loss may be noted, despite normal middle-ear function. Vestibular-evoked myogenic potential testing may reveal abnormally reduced thresholds. Although both sides are not necessarily symptomatic at the same time, bilateral involvement is common.

Migraine or Migraine-Associated Dizziness

The term migraine is synonymous with headache for many people. Its manifestation is not limited to headache, however, and it often occurs without it.

The criteria of Neuhauser and colleagues9 for migrainous vertigo are:

  • Recurrent episodic vestibular symptoms (attacks)
  • Migraine headache meeting International Headache Society (1988) criteria10
  • At least one of the following migrainous symptoms during at least two of these attacks:
    • Migraine-type headache
    • Photophobia
    • Phonophobia
    • Visual or other auras
  • Other causes ruled out by appropriate investigations

These criteria should be considered a starting point. Controversy surrounds the issues of migrainous vertigo. Simply the coexistence of dizziness and migraine symptoms does not guarantee that the two are fully related. In many instances, a peripheral vestibular syndrome may actually be exacerbating an underlying migraine disorder.

Cervicogenic Dizziness

Cervicogenic dizziness is a disorder that the literature has alluded to for decades. Basic scientists have suggested for years that stimulation of afferents in the neck chemically, with electrical stimulation, or by ablation can induce a sensation of dizziness, although often not vertigo. The mechanics of the upper cervical spine (particularly C1-C2) and associated distortions of proprioception and kinesthetic function (sensation of relative movement as it pertains to joint function) are believed to be dysfunctional.11 This can occur with or without neck pain.

Symptoms tend to be vague and are often described as head fullness or heaviness or as lightheadedness. Symptoms may be worsened with computer use, reading, or sustained neck positions, and they are often worse with increased activity and later in the day. Cervicogenic dizziness can manifest in isolation or associated with headache (possibly cervicogenic headache), or it may actually be a factor in precipitating increased migraine activity or orthostatic intolerance. Undiagnosed cervicogenic dizziness can complicate vestibular rehabilitation, and an increase in dizziness with increased head movements is required for vestibular habituation.

Cervicogenic dizziness remains controversial because neck pain, bulging cervical disks, and whiplash remain ubiquitous. The lack of consensus on objective diagnostic criteria and the lack of a sensitive and specific test have only added to the controversy. Neck-vibration testing and vibration-induced nystagmus (nystagmus elicited from neck-vibration testing, which does not always parallel the presence or absence of symptoms) may be beneficial in identifying patients with cervicogenic dizziness.12 Neck-vibration testing is vibration of various head and neck muscle groups such as the suboccipital, masseter, and sternocleidomastoid, which might reproduce the dizziness; vibration-induced nystagmus is nystagmus elicited from neck-vibration testing, which does not always parallel the presence or absence of symptoms. Apparent risk factors for cervicogenic dizziness include head trauma, neck trauma (commonly whiplash), peripheral vestibular dysfunction, and focal paraspinal muscle weakness. Imaging of the cervical spine with plain films, CT, or magnetic resonance imaging [MRI]) is uninformative. The lack of neck pain does not rule out the possibility of cervicogenic dizziness.

No significant double-blinded studies have been undertaken regarding cervicogenic dizziness. Experience at the Cleveland Clinic Foundation (CCF) and case series in the literature13 suggest that advanced-level physiotherapy directed toward the upper cervical spine may be beneficial. Therapy modalities should target normalization of biomechanics, range of movement, tone, mitigation of pain or tenderness, strengthening, and resetting of proprioception. Clinical trials at CCF are under way to assess the potential benefit of botulinum toxin combined with neck physiotherapy in the treatment of cervicogenic dizziness. The hypothesis is that botulinum toxin may be beneficial in relieving spasmodic torticollis (neurally sustained spasm), allowing the physiotherapy to progress.

Commonly Performed Tests for Dizziness
Vestibular Test Battery


Rotational chair testing, video nystagmography (infrared video recording of eye movements) to analyze eye movement responses to various maneuvers including Dix-Hallpike test, and supine positional testing with the body supine and head up 30 degrees is helpful in identifying vestibular loss (unilateral and bilateral), active BPPV, otolith dysfunction, and central vestibular disorders (global and focal).

Audiologic Testing

Comprehensive audiometry (behavioral thresholds, pure tone audiometry, acoustic reflexes, tympanometry) and additional testing include auditory brainstem responses, otoacoustic emissions, and electrocochleography. Audiologic testing is helpful in quantifying associated or known audiologic deficits or for surveying for possible auditory pathway involvement.


Recommended imaging includes head MRI (internal auditory canal protocol), cervical spine MRI, and temporal bone CT (high-resolution). Temporal bone CT is particularly important for superior canal dehiscence.

Additional Testing

Tilt-table testing is used to assess blood pressure and heart rate function in response to change in position. Head-up tilt (70 degrees) for 10 to 45 minutes can diagnose forms of orthostatic intolerance, vasovagal responses, and postural tachycardia syndrome. Additional testing can assess intravascular volume, autonomic responses, and pulmonary circuit times.

Vestibular-evoked myogenic potentials test vestibular hypersensitivity, and possibly saccular function, by activating sternocleidomastoid muscle contraction. It is helpful in diagnosing Menière’s disease and superior canal dehiscence. This test is complementary to conventional vestibular testing.

Fistula testing consists of application of pressure waveforms (positive and negative constant pressure and sinusoidal pressure) to the external auditory canal to elicit nystagmus and vertigo in the absence of middle ear or mastoid disease (Hennebert’s sign).

Dynamic platform posturography assesses balance function under conditions in which sensory cues are modified. Conditions include eyes open or closed, visual surround stable or moving, and support surface stable or moving.

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Treatment and Outcomes

Specific therapies and associated outcomes depend on the diagnosis. A number of modalities are beneficial even when the specific diagnosis is not clear.


Vestibular suppressants are commonly used. These include antihistamines (e.g., meclizine), anticholinergics (e.g., scopolamine), and benzodiazepines (e.g., lorazepam, diazepam). These medications may be used on a short-term basis or as needed. When used chronically, their benefits can wane, however, and they are commonly used incorrectly. Furthermore, chronic use of these drugs can hamper vestibular adaptation. The side effects may also be deleterious, and they include fatigue, lethargy, and dry mouth.

Antinausea medications (e.g., prochlorperazine, promethazine) may also be prescribed.

Antianxiety medications (benzodiazepines such as alprazolam, diazepam, selective-serotonin reuptake inhibitors) may be provided to patients with associated anxiety.

Assistive devices such as canes and walkers can provide stability to those with balance or orthopedic issues. Canes seem to be carried at certain times, perhaps to provide a sense of security or proprioception (position cues). The use of these devices may be optimized in the hands of an experienced vestibular therapist.

Vestibular rehabilitation (balance therapy) is a discipline within physical therapy that evaluates sensory input (proprioceptive, vestibular, and visual) and how it is used to control static and dynamic balance. Goals are to decrease the risk of falls and increase activities of daily living and functioning at home, as well as managing symptoms, educating patients, and recommending and monitoring the use of assistive devices. In uncontrolled trials of vestibular rehabilitation, improvement in more than 80% of patients has been reported.

Neck physiotherapy is shown to be beneficial managing the vestibular patient (unpublished local experience). A common reason for failure of vestibular rehabilitation is previously unidentified derangements of upper cervical mechanics. Similarly, previously undiagnosed or undertreated migraine disorders have been noted to affect rehabilitation. Active trials of the use of botulinum toxin to manage cervical dysfunction are under way here at the CCF (off-label use).

Treatment for Some Common Causes of Dizziness
Benign Paroxysmal Positional Vertigo

When the involved canal and side have been identified by the Dix-Hallpike maneuver, particle repositioning maneuvers may be performed. Numerous treatments exist, the more common being the Epley canalith repositioning procedure, the Semont liberatory maneuver, and the Brandt-Daroff habituation exercises. The Epley maneuvers were developed by John Epley in the 1970s.15 Repositioning therapies should be directed to the semicircular canal involved. The goal of the repositioning maneuver is to return the stray otoconia to the utricular macula. The maneuvers may be performed repetitively. Canalith repositioning is more effective than observation alone, despite spontaneous resolution rates of one in three cases after 3 weeks of treatment.16 This is further supported by current AAN guidelines, which recommend canalith repositioning and the Semont maneuver in the treatment of BPPV; as both have been found to be safe and effective (or possibly effective in the case of the Semont maneuver).17

In Menière’s disease, medical management is targeted at sodium management. A combination of diuretic therapy and sodium restriction are the mainstays of management. Diuretics such as triamterene and hydrochlorothiazide are commonly used. Sodium restriction may be as simple as not salting foods, counting actual sodium, and adhering to a target sodium amount. Commonly, 1500 to 2000 mg of sodium per day may be recommended.

Symptomatic treatment with sublingual lorazepam (brand preparation only, because the carrier agent is different in the generic preparation and affects absorption) or diazepam may be used as needed to lessen the intensity and sometimes the duration of symptoms.

Numerous surgical approaches exist. The spectrum is wide, ranging from minimally invasive procedures such as endolymphatic sac decompression to vestibular nerve section to cochleosacculotomy to labyrinthectomy. The latter involves the complete removal of the vestibular and auditory apparatus, leaving the patient with deafness and without peripheral vestibular function.

Superior Canal Dehiscence

Surgical treatment is often beneficial. It involves capping the superior aspect of the superior semicircular canal with a foreign material; bone fragments alone may be ineffective because of the constant movement and pressure changes transmitted from the middle ear and the middle cranial fossa. Surgery is performed via a middle fossa approach.

Migraine-Associated Dizziness

Once this diagnosis has been established, treatment is similar to that for migraine headache. Avoidance practices, reduction of systemic medical issues, and abortive and preventive strategies should be used. Certain foods and additives (e.g., aged cheese and meats, red wine, caffeine) as well as hunger, dehydration, and sleep deprivation should be avoided. Reduction of systemic medical issues includes identifying certain disorders such as obstructive sleep apnea, overuse of analgesics (because of increased risk of rebound headaches), and generalized and regional pain syndromes and spine disorders (cervical, thoracic, and lumbar dysfunction). Intravenous infusion treatments with various medications, including metoclopramide, magnesium sulfate, and valproic acid, may be beneficial in managing chronic pain cycles, status migrainosus, and overuse of analgesics.

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Dizziness is a complex and often multicomponent symptom. Vestibular and nonvestibular etiologies should be considered, and often the two coexist.

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  • Dizziness is a symptom and not a diagnosis.
  • It is the third most common symptom manifestation (combined with imbalance and falls) for outpatient medical consultation. In the adult population, 42% report dizziness at some time.
  • Dizziness is a complex and often multicomponent symptom. Vestibular and nonvestibular etiologies should be considered, and often the two coexist.
  • Benign paroxysmal positional vertigo is a common and treatable form of dizziness. Head or ear trauma, viral ear infections, and age are risk factors.
  • Migraine-associated dizziness is quite prevalent and may occur without headache.
  • The cervical spine might play a role in dizziness (cervicogenic dizziness), although this theory is controversial. Cervicogenic dizziness may be amenable to neck physiotherapy.

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  14. Fife TD, Tusa RJ, Furman JM, et al: Assessment: Vestibular testing techniques in adults and children: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2000;55:1431-1441.
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  16. White J, Savvides P, Cherian N, Oas J: Canalith repositioning for benign paroxysmal positional vertigo. Otol Neurotol 2005;26:704-710.
  17. Baloh RW. Dizziness, Hearing Loss, and Tinnitus. Philadelphia: FA Davis, 1998.

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90,000 Vertigo: symptoms, diagnosis, treatment of vertigo

Dizziness is one of the most frequent complaints with which patients turn to a neurologist. Indeed, there is no person who has never experienced dizziness.

The term “dizziness” describes completely different sensations: from a feeling of faintness and impending loss of consciousness to the rotation of one’s own body or surrounding objects.
Dizziness is called this incorrect awareness of your body in space or a feeling of imaginary rotation or movement of the body in space.Dizziness is a symptom of various neurological and somatic diseases and occurs in almost 80 different pathologies. Dizziness can occur with diseases of the cardiovascular system, diseases of the eye and ear, with diseases of the blood, mental and neurological diseases. Dizziness is an extremely unpleasant subjective symptom that significantly reduces a person’s quality of life. It is customary to distinguish systemic (true) and non-systemic dizziness.

True vertigo is called the illusion of movement of your body or objects around (this happens if you quickly rotate, for example, on a carousel).True dizziness is accompanied by: nausea, vomiting, pale skin, sweating, anxiety. True, systemic vertigo is associated with irritation of certain areas of the vestibular analyzer and, depending on the level of the lesion, is peripheral and central. The most common causes of true dizziness are impaired blood supply to the brain and inner ear, inflammatory and degenerative processes in the organs of hearing and balance, and intoxication.

Non-systemic dizziness is a feeling of instability of the surrounding space, a feeling of instability.This type of dizziness occurs with lightheadedness, emotional disorders, with damage to the visual analyzer, cerebellar disorders.

Dizziness occurs most often in neurological practice in vascular diseases of the brain, pathology of the cervical spine and emotional disorders.

Pathology of the cervical spine . The vestibular system is very sensitive to a lack of blood supply. The inner ear and vestibular centers of the brain receive their blood supply from the vertebral artery system.The vertebral arteries pass through narrow channels in the cervical spine. Instability, trauma, osteochondrosis of the cervical vertebrae often lead to spasm or compression of these arteries; and consequently – to a deficiency of blood flow in them and to dizziness. The main symptoms in such diseases are: dizziness, unsteadiness, aggravated by turning or tilting the head; flies and “ripples” in the eyes, decreased vision in the dark; pain, tension or discomfort in the neck, lower back of the head, temples; fatigue, irritability; possibly an increase in blood pressure, accompanied by nausea and vomiting.

Emotional disorders . Neurotic disorders, depression, and just overwork can mimic almost any symptoms of “bodily” diseases. Moreover, the only symptom may be dizziness, noise or “fog” in the head, ringing or noise in the ear. Dizziness in these diseases is accompanied by a constant fixation of attention on one’s well-being, severe fatigue, bad mood and tearfulness, combined with increased anxiety, impaired appetite and sleep.

With vascular lesions of the brain , dizziness can occur, both as a result of hypertension, and in atherosclerotic lesions of the arteries. Prolonged increases in blood pressure damage small-caliber arteries in the brain. The arteries become narrow and not elastic. As a result, the flow of arterial (oxygenated) blood to the brain is limited, leading to dizziness, noise in the head and ears. With atherosclerosis, plaques appear on the inner walls of the arteries – bulges that gradually block the blood flow.Plaques in the arteries of the brain are especially dangerous. In the area of ​​plaques, the movement of blood can be turbulent, which limits the flow of arterial blood to the brain, auditory nerves, receptors that perceive auditory stimuli. Dizziness with CVP is characterized by a combination with noise in the head or ear, the presence of pre-syncope and imbalance, increased fatigue, memory loss. With impaired cerebral circulation, dizziness is the first and sometimes the only complaint.

Diagnosis of dizziness. If dizziness occurs, you should consult a neurologist and an otolaryngologist. When a dizziness attack occurs for the first time, hospitalization is indicated to clarify the diagnosis and select therapy. The diagnostic program includes computer or magnetic resonance imaging of the brain, X-ray examination of the cervical spine, Doppler ultrasound of the brachiocephalic arteries and Doppler scanning of the head vessels, vestibular tests (caloric test, rotational tests).To diagnose a possible disease of the hearing aid, tone threshold audiometry and acoustic impedance measurement can be performed.

Treatment. Treatment of vertigo depends on its cause, and only after its clarification is the choice of a treatment strategy for the disease. If dizziness has arisen against the background of a current somatic illness, then first of all it is necessary to treat it. Treatment of dizziness itself, as a phenomenon, includes drug therapy and exercise (special sets of exercises for vestibular training).

It is worth contacting a specialist if any alarming symptoms appear – immediately! If necessary, qualified diagnostics and treatment invites for a consultation with a neurologist in Moscow at the clinic of the Central Clinical Hospital of the Russian Academy of Sciences. An appointment with a neurologist is made on the website, as well as by telephone.

Dizziness and nausea – a: care

Dizziness, nausea, weakness … At first glance, these symptoms do not seem too dangerous, so we often try to just ignore them and continue to live as before.In some cases, they really aren’t that scary. For example, if discomfort has arisen due to lack of sleep or prolonged fasting, it is easy to get rid of them: it is enough to get a good sleep and eat. But what if the symptoms recur or “attack” suddenly and with unprecedented force?

In this situation, it is important to see a doctor as soon as possible, undergo all the necessary examinations and, of course, a full course of treatment. However, more on that later. First, let’s try to understand what nausea is and what causes it most often.

The main causes of vertigo in the elderly are:

Nausea is an unpleasant sensation in the epigastric region and pharynx, which often leads to vomiting. Both nausea and vomiting are the body’s defense mechanisms, which, with their help, is trying to “get rid” of what prevents it from working normally. [1] In addition, nausea can be a reaction to the inconsistency of information coming to the vestibular analyzer from different senses. Such nausea, for example, appears when traveling on a ship or with injuries and diseases of the inner ear and eyes.[2]

The field of medicine that studies nausea and vomiting is called emetology.

The main causes of nausea are:

Diseases of the gastrointestinal tract (GIT). This can be, for example, gastritis, gallbladder disease, ulcer, pancreatitis or appendicitis. Usually, in addition to nausea, they are accompanied by heartburn, weight loss, abdominal pain, belching, vomiting, etc. [3]

  • Pregnancy, especially in the early stages, is often accompanied by nausea.Most often it is provoked by hormonal changes, increased sensitivity to aromas and tastes, or a lack of B vitamins.
  • Infectious diseases. Nausea is one of the symptoms of many infectious diseases. It can occur due to irritation of the walls of the gastrointestinal tract directly by infection or due to the circulation of microbes and other products of inflammation in the blood. [1]
  • Food and alcohol poisoning. Almost everyone, probably, felt nauseous after hectic holiday feasts (especially those that last several days).Nausea in this case occurs due to the ingress of toxic substances into the body: these are not fresh products, and an excess of ethyl alcohol, which the liver cannot cope with. [3] It can also be caused by overeating, which overloads the liver and the digestive tract.
  • Taking medications. Nausea and dizziness are, alas, side effects of many drugs. Unpleasant sensations are especially often associated with polypharmacy, i.e. taking several medications at the same time. [2] [3]
  • Injuries and tumors of the brain also provoke nausea.Other symptoms include dizziness, weakness, impaired sensation and speech, headache, and vomiting. By the way, the vomiting center is located in the human brain. [3]

If nausea is accompanied by dizziness, then among the causes of these symptoms include cervical osteochondrosis, Meniere’s disease, stroke, migraine, benign paroxysmal positional vertigo (BPPV) and other diseases and conditions. Both of these symptoms can also be caused by disturbances in the functioning of the vestibular apparatus and disturbances of a psychogenic nature (stress, anxiety disorders, panic attack, etc.).etc.). [1] [4] [5] [6] [7]

What to do if an attack of dizziness and nausea caught you

First of all, try to lie down, or at least sit down. Provide fresh air, as heat and stuffiness can exacerbate symptoms. Drink a few sips of weak tea or water (but be sure not to gas, as carbonated drinks contribute to bloating).

If a drug is causing your nausea, be sure to tell your doctor.Perhaps together you can find a similar drug that does not cause such unpleasant symptoms. [2]

If you feel an upcoming vomiting attack, do not try to contain it. And do not hesitate to call an ambulance, especially if the bouts of vomiting are repeated and worse. Severe vomiting is life-threatening! [3]

Antiemetics may be prescribed to relieve your condition. They will help to cope with the attack, but, unfortunately, they will not cure the cause.This can only be done by a qualified specialist after examination and diagnosis. Be attentive to your health and make an appointment with your doctor in a timely manner!

List of used literature:

1. Syndrome of nausea and vomiting // Medical portal Eurolab. – https://www.eurolab.ua/encyclopedia/565/43596/ (Access date: 10.07.2016).

2. Nausea // Medical portal toshno.net. – https://toshno.net/toshnota (Access date: 19.07.2016).

3.Yakovenko EP et al. Vomiting and nausea: pathogenesis, etiology, diagnosis, treatment // Farmateka. – 2005. – No. 1. – https://medi.ru/doc/143603.htm (Access date: 19.07.2016).

4. Drapkina O.M., Chaparkina S.M., Ivashkin V.T. Dizziness in the practice of an internist // Cardiovascular therapy and prevention. – 2007. – No. 6 (4). – S. 107-114.

5. Manvelov L. Do you feel dizzy? // Science and life. – 2012. – No. 10. – S. 56-61.

6. Markova T.P. Actual problems of prevention and treatment of influenza // BC.- 2004. – No. 1. – https://www.rmj.ru/articles/obshchie-stati/Aktualynye_problemy_profilaktiki_i_lecheniya_grippa/?33 (Access date: 10.07.2016).

7. Tolmacheva VA Causes of dizziness // Neurology, neuropsychiatry, psychosomatics. – 2010. – No. 4. – 18-24.

Co-author, editor and medical expert:

Volobueva Irina Vladimirovna

Born on 17.09.1992.


2015- Sumy State University, specialization “General Medicine”.

2017 – Graduated from an internship in the specialty “Family Medicine” and also defended her master’s work on the topic “Features of the development of antibiotic-associated diarrhea in children of different age groups.”

90,000 reasons for women and men, treatment in St. Petersburg, reviews

One of the most frequent complaints at a neurologist’s appointment is dizziness, which is expressed in a wide variety of sensations: from a feeling of lightheadedness and impending loss of consciousness to the apparent rotation of one’s own body or surrounding objects.This symptom cannot be ignored, since it may indicate the presence of serious neurological and somatic diseases.

In medical terms, dizziness, or vertigo, is a false awareness of one’s body in space. It is customary to distinguish two types of this phenomenon: systemic (true) and non-systemic.

True and non-systemic vertigo: symptoms and causes

True dizziness manifests itself as an illusion of movement of one’s own body or objects surrounding a person (it often occurs, for example, when spinning rapidly on carousels).Usually this phenomenon is accompanied by such unpleasant sensations as:

  • nausea and vomiting;
  • blanching of the skin;
  • increased sweating;
  • unreasonable alarm;
  • tinnitus.

The emergence of true vertigo can be provoked by:

  • disorders of the blood supply to the brain or inner ear;
  • inflammation or degenerative processes in the organs of hearing and balance;
  • various kinds of intoxication.

Non-systemic vertigo is a feeling of instability or instability in the surrounding space. This type of vertigo often accompanies:

  • light-headedness;
  • emotional disorders;
  • damage to the visual analyzer;
  • cerebellar disorders.

At the origins of non-systemic vertigo may be:

  • vascular diseases of the brain;
  • pathology of the cervical spine;
  • emotional disorders.

Methods for the diagnosis and treatment of dizziness in the clinic “Longevity”

A neurologist or otolaryngologist can determine the causes of dizziness and tinnitus. The following methods are used to diagnose the problem:

  • Ultrasound examination of the cervical spine;
  • Ultrasound of the thyroid gland;
  • duplex scanning of the vessels of the head and neck;
  • MRI of the brain;
  • electroencephalogram;
  • laboratory research and so on.

For the purpose of accurate diagnosis in our clinic, specialized specialists are involved in the examination of a patient – therapists, ultrasound diagnostics, ENT surgeons and so on – candidates of medical sciences, doctors of the highest category.

The treatment strategy for vertigo is determined based on the diagnostic results. If in the course of research any somatic disease is revealed, the patient must first of all be cured of it. Therapy of vertigo, as an independent phenomenon, includes taking appropriate medications, physiotherapy, osteopathy and the implementation of a special set of exercises for training the vestibular analyzer.

Dizziness is serious! Find its cause and start treatment with the Longevity Clinic. To make an appointment with the specialist you need, call the call center number: 8 (812) 561-49-82 ..

90,000 Adrenal disease: description of the disease, causes, symptoms, cost of treatment in Moscow

The adrenal glands are a paired organ that plays an important role in the functioning of the human body. The main role is the synthesis of hormones responsible for the functioning of all systems.Failure in the work of the adrenal glands causes the development of serious diseases, up to and including death.

Anatomically, the adrenal glands are located just above the kidneys, which is what gave them their name. The right one has a triangular shape, the left one is a crescent shape.

The structure and function of the adrenal glands

At the heart of the adrenal glands are two structures:

They are regulated by the nervous system.


The brain substance is the main source of catecholamine hormones in the body – adrenaline and norepinephrine.

Adrenaline is the main hormone in the fight against stress. An increase in its production occurs with positive and negative emotions, for example, with trauma, stressful situations.

When exposed to adrenaline, the body uses the reserves of the accumulated hormone, which is manifested by the following reactions:

  • a sharp surge of strength;

  • increased breathing rate;

  • pupil dilation.

The person feels stronger than usual, the pain threshold is significantly reduced.

Norepinephrine is also a stress hormone, but its production occurs before the production of adrenaline. The effect is much weaker. Its function is to regulate blood pressure, which stimulates the work of the myocardium – the heart muscle.


The adrenal cortex consists of several layers, each of which has a specific function.

  • Mesh area.

  • Beam zone.

  • Glomerular zone.

Androgens – sex hormones – are synthesized in the reticular zone. They are responsible for the development of secondary sexual characteristics and affect:

  • state of libido – sexual desire in men and women;

  • blood cholesterol and lipid levels;

  • fat deposition;

  • increase in strength and muscle mass.

Regardless of gender, both male and female sex hormones are produced in every body. The difference is in their quantity. For example, women synthesize estrogen and progesterone, which are responsible for reproductive function – conception and childbirth, but also testosterone in a small volume, which is considered a male hormone.

Beam zone

This area is responsible for the synthesis of glucocorticosteroids. They are responsible for protein, carbohydrate and fat metabolism in the body.Closely related to the production of insulin and catecholamines.

Glucocorticosteroids reduce the immune response, inhibit inflammatory processes, gradually suppressing them.

One of the hormones of the bundle zone is cortisol. It takes part in carbohydrate metabolism, preserves the body’s energy resources. The level of cortisol in the body is constantly changing – in the morning it is more than in the evening or at night.

Glomerular zone

The glomerular zone of the adrenal cortex is responsible for mineral metabolism in the body.The hormones produced here normalize the functioning of the renal tubules, so excess fluid leaves the body, which, in turn, keeps blood pressure normal.

The following hormones are secreted in the glomerular zone:

  • Aldosterone. Its function is to maintain the balance of sodium and potassium ions in the blood. The hormone takes part in water-salt metabolism, improves blood circulation, increases blood pressure.

  • Corticosterone – a hormone with low activity, is involved in the mineral balance.

  • Deoxycorticosterone – also regulates the water-salt balance, gives strength to the skeleton and muscle tissue.

How do adrenal diseases manifest?

When the balance of hormones in the body is disrupted, it malfunctions. Symptoms appear according to the dependence pattern, that is, a specific substance produced in the adrenal glands is responsible for a symptom inherent only to it.For example, with a deficiency of aldosterone, sodium is excreted from the body along with urine, which lowers blood pressure, significantly increases the potassium content in the blood.

To avoid serious consequences, you must consult a doctor at the first sign of adrenal disease. These include:

  • muscle weakness;

  • constant fatigue;

  • strong weight loss due to decreased appetite;

  • low stress resistance;

  • high irritability;

  • fast and constant fatigue;

  • sleep problems;

  • dizziness, headaches.

Further – the most common diseases of the adrenal glands, which have their own symptoms and causes, require specific treatment tactics.

Addison’s disease

Other names for Addison’s disease are primary adrenal insufficiency and hypocorticism.

A rare pathology, which accounts for 50 – 100 cases per million per year. Diagnose in both women and men. The average age is from 20 to 40 years old.

With the disease, all three zones of the adrenal cortex are affected. It is characterized by a deficiency in the production of corticosteroids. Violation of the synthesis of hormones causes serious complications in the body.

The cause of the destruction of the adrenal cortex is pathogens that have entered the body – viruses, bacteria, fungi, as well as immune disorders.

Manifestations of Addison’s disease:

  • decrease in blood pressure indicators;

  • fatigue, weakness, lack of physical strength;

  • lack of appetite;

  • disruption of the digestive system;

  • pigmentation of the skin, the appearance of dark spots on the mucous membranes;

  • chills;

  • increase in body temperature.

To detect the disease, it is necessary to take tests for the level of cortisol in the blood. An examination of the state of the adrenal cortex, the functioning of the glands is carried out.

Treatment – taking medications containing corticosteroids throughout life. Perhaps the introduction of hydrocortisone intramuscularly.

Itsenko-Cushing’s disease

Refers to neuroendocrine pathologies. The reason is a malfunction of the hypothalamic-pituitary system as a result of brain injury or infections transmitted by a person.It is characterized by the production of an excess volume of corticosteroids by the adrenal glands.

Itsenko-Cushing’s disease is a rare pathology. Diagnosed mainly in women aged 30 to 45 years.

A malfunction of the hypothalamic-pituitary system provokes disturbances in the body. The connection between the adrenal glands, hypothalamus and pituitary gland is lost. Signals going to the hypothalamus provoke excessive production of hormones that release adrenocorticotropic hormone (ACTH) in the pituitary gland, which stimulates the release of the substance into the blood.Excessive amounts of ACTH affect the adrenal glands, which begin to increase the production of many corticosteroids.

With the progression of the pathology, there is a visible increase in the pituitary and adrenal glands in size.

Signs of Itsenko-Cushing’s disease:

  • headaches, migraines;

  • progressive hypertension;

  • muscle atrophy;

  • shaping the moon-shaped face;

  • absence of menstruation in women;

  • development of osteoporosis;

  • Facial hair growth in women.

To identify the disease, blood and urine tests are prescribed, in which an excess amount of ACTH and cortisol is determined. Additionally, instrumental examination is carried out.

The goal of therapy is to restore impaired metabolism, normalize the hypothalamus, and normalize the synthesis of corticosteroids.

Nelson’s syndrome

It develops as a result of surgery to remove the adrenal glands with progressive Itsenko-Cushing’s disease.


  • regular headaches;

  • decrease in the sensitivity of taste receptors;

  • decrease in visual acuity;

  • skin hyperpigmentation.


A pheochromocytoma is a tumor that develops in the adrenal medulla.It is based on chromaffin bodies, which contribute to the synthesis of a large number of catecholamines.

The reason is arterial hypertension and catecholamine crises.

Pheochromocytoma symptoms:

  • high blood pressure, hypertensive crises;

  • headache;

  • increased sweating;

  • shortness of breath;

  • dehydration of the body;

  • convulsions;

  • cardiomyopathy;

  • high blood sugar.

To diagnose the disease, tests are prescribed to determine the metabolites of catecholamines in the urine and blood. To identify education, hardware methods are used – MRI and ultrasound scanning.

Drug treatment is aimed at reducing the severity of paroxysmal attacks.


Another name for the pathology is Cohn’s syndrome. A condition in which excessive amounts of aldosterone and deoxycorticosterone are produced in the adrenal cortex.

The causes of hyperaldosteronism are a malignant formation in the adrenal cortex or hyperplasia of the cortex tissues.

Cohn’s syndrome has primary and secondary degrees of development. Symptoms of the primary degree of the disease:

  • increased blood pressure;

  • headaches;

  • heart rhythm disturbance;

  • cardialgia – pain in the left side of the chest;

  • decrease in visual acuity.

Secondary symptoms result from excess potassium and sodium deficiency:

  • edema;

  • chronic renal failure;

  • deformation of the fundus;

  • arterial hypertension.

Diagnostic measures include determination of the level of potassium and sodium, aldosterone in the blood and urine.

Therapy depends on the results of the examination. Most often it is drug treatment with the appointment of hormonal drugs. In the presence of a tumor, surgery is possible.

Hyperplasia of the adrenal cortex

This is an increase in the size of the adrenal cortex leading to increased androgen synthesis. The main reason is genetic, that is, the disease is congenital.

There are three main forms of hyperplasia:

  • Simple virilizing.There is an increase in the synthesis of androgens, as a result, the genitals, muscle tissue increase, hair grows rapidly throughout the body, regardless of the sex of the sick person.

  • With salt loss syndrome. It is characterized by an excess of potassium and a deficiency of other hormones.

  • Hypertensive. Excessive production of androgens and corticosteroids occurs, as a result of which arterial hypertension develops, and visual function deteriorates.

Symptoms of adrenal hyperplasia:

  • early growth of body and genital hair;

  • growth is less than normal;

  • rough voice;

  • memory problems;

  • frequent psychoses;

  • Weakness of the muscular system.

Signs appear in childhood. To clarify the diagnosis, they prescribe the delivery of tests, laboratory tests.

Medication treatment, includes the constant intake of hormonal drugs. In severe cases of the disease, surgical intervention is indicated.

Insufficiency of the adrenal cortex

This is a violation of the functioning of the adrenal glands of an autoimmune nature. There are two types – acute and chronic.

Chronic insufficiency of the adrenal cortex occurs as a result of destructive changes in the glandular tissues of the organ. The main reasons are past infectious diseases, pituitary tumor or macroadenoma, necrosis or oppression of the anterior lobe of the pituitary gland.

The acute form develops against the background of the chronic one. Almost does not arise on its own, the exception is sepsis or sudden hemorrhage in the adrenal glands.

Symptoms of adrenal insufficiency:

  • weakness, constant loss of strength;

  • loss of appetite, resulting in a sharp decrease in body weight;

  • skin hyperpigmentation;

  • arterial hypotension;

  • decrease in blood sugar levels;

  • frequent urination;

  • nausea turning into vomiting;

  • uncharacteristic stool.

Inflammation of the adrenal glands

Inflammatory processes in the adrenal glands occur most often against the background of tuberculous lesions of their cortex. The peculiarity of the pathology is in its slow development.

Typical symptoms of inflammation:

  • feeling of constant fatigue;

  • low stress resistance;

  • regular aching headaches;

  • bad breath;

  • nausea turning into vomiting.

With an advanced form, the likelihood of developing a chronic inflammatory process is high.

Adrenal tuberculosis

Adrenal tuberculosis is a rare pathology. It is characterized by the accumulation of calcifications in the tissues of the adrenal glands.

Most often diagnosed in childhood and adolescence. The reason is the penetration of the tubercle bacillus from the infected lungs into the adrenal glands through the general bloodstream.

Symptoms of adrenal tuberculosis:

  • low blood pressure;

  • disruption of the gastrointestinal tract, expressed by diarrhea, nausea with vomiting;

  • hypoglycemia;

  • constant weakness, feeling of tiredness;

  • myocardial dystrophy.


This is a benign formation in the tissues of the adrenal glands. The tumor appears rarely and becomes dangerous only when it degenerates into a malignant one. A dangerous condition in which there is a rupture of the adrenal cyst.

Tumor symptoms:

  • pain in the lower back, back, sides;

  • impaired renal function;

  • an increase in the adrenal glands in size;

  • Increase in blood pressure as a result of compression of the renal artery.

Diagnosis of an adrenal cyst is difficult due to its small size. It is possible to identify pathology only with the progression and growth of the tumor.

Dangerous tumors

If the cyst is benign, then there are a number of tumors prone to malignancy.

The most common ones are:

  • aldosteromes;

  • andosteroma;

  • glucocorticosteroma;

  • corticoestroma.

It is difficult to establish the exact reasons for the development of formations, but the likelihood of their hormonal activity is high against the background of the following provoking factors:

  • cell hyperplasia and proliferation of adrenal tissues;

  • excessive amount of hormones produced;

  • oncological diseases of the thyroid gland;

  • diseases associated with congenital pathologies of the skin, ocular membrane, cerebral vessels.

The localization of tumors is different. They can form both in the medulla and in the cortical layers. Typical symptoms:

  • high blood pressure readings;

  • delay in the process of sexual development;

  • frequent nausea, turning into vomiting;

  • pain in the abdomen, in the chest area;

  • discoloration of the skin on the face – turns pale, reddens, acquires a bluish tint;

  • a sharp change in blood glucose levels;

  • dry mouth;

  • convulsions;

  • limb tremor;

  • increased irritability, irritability;

  • increased anxiety, constant feeling of fear.


The possibilities of modern medicine make it possible to identify diseases of the adrenal glands in a short time. When contacting an endocrinologist, an examination will be scheduled.

Basic laboratory methods include:

  • general blood test;

  • general urinalysis;

  • taking samples for hormones (testosterone, aldosterone, cortisol, DEA-s, ACTH).

Instrumental diagnostic methods that are used to identify pathologies of the adrenal glands:

  • MRI or computed tomography;

  • ultrasound examination;

  • X-ray examination of the brain to determine the size of the pituitary gland;

  • phlebography;

  • radiation examination, which allows you to get a complete picture of the state of the organ.

Retroperitoneal tumors

Most of the oncological tumors of the small pelvis have a local form of occurrence and development, that is, they appear in certain organs located in the small pelvis. These organs include the rectum, the uterus in women, the bladder, and the prostate gland in men.


retroperitoneal tumor, etidemiology Retroperitoneal tumor occurs in people of any age, but, as a rule, such diseases occur in people aged 40 to 60 years.Moreover, in men, a retroperitoneal tumor is diagnosed less often than in women.

Tumors affecting multiple organs are the most difficult to treat. However, such diseases are extremely rare. The pelvic space contains a large number of embryogenetically diverse tissues. This is what contributes to the development of various forms of malignant tumors.

Malignant tumors that are not associated with organs occur much less frequently. As a rule, such formations are classified as different types of sarcomas.This type of neoplasm is diagnosed at the stage when the tumor begins to affect the organs: the rectum, urogenital organs, bones and blood vessels.

Symptoms of pelvic tumors

Symptoms of pelvic tumors Various symptoms occur with the appearance and development of cecum cancer and its location in the rectosigmoidal part. The manifestation of symptoms depends on the size of the formation, the presence of complications such as bleeding, intestinal obstruction, perforation.The most common symptom is anemia caused by bleeding from the tumor. In addition, a person with cecum cancer may feel frequent dizziness and general weakness. Pallor and tachycardia are noted. In more difficult situations, aching incessant pains in the lower right abdomen are noted.

Early symptoms of cecum cancer: lack of appetite, weight loss, digestive upset. With a significant decrease in weight, we can talk about the progressive development of malignant formation.

Retroperitoneal tumor of the sigmoid colon is characterized by the appearance of intestinal obstruction. In most patients, there is a change in the consistency of feces, blood and mucus clots can be observed in it.

If a malignant formation has arisen in the rectum, the symptoms are very invisible to humans. Among the early manifestations of the disease, a feeling of incomplete release of feces from the intestines can be answered. Bleeding occurs. Patients may indicate pulling and grasping pains in the lower abdomen.As a rule, such pains are not severe.

Causes of tumors in the small pelvis

Causes of tumors in the small pelvis Types of tumors can vary depending on the age of the man or woman. In girls, in the first weeks of life, the influence of placental estrogens from the mother is observed. In this condition, they can cause cysts on the ovaries. At the age of puberty, a pelvic tumor in women can occur due to stagnation of blood during the menstrual period, if the hymen is overgrown.Because of this, malignant formations can form in the uterus and ovaries.

From the age of 18, women may experience enlargement of the uterus during pregnancy and in the presence of fibroids. A pelvic tumor in women can occur in the ovarian region if abnormal pregnancy is observed. In addition, cancer can develop in the fallopian tubes due to frequent inflammation.

Pelvic tumor in women occurs most often at the end of reproductive function.

Pelvic tumor in men can occur in the form of diseases of the prostate gland. Prostate cancer is considered the most common malignant neoplasm in males.

Diagnosis of pelvic cancer

Diagnosing cancers of the small pelvis In women and men, a retroperitoneal tumor manifests itself with the same symptoms. As a rule, these are pains in the lower abdomen, constipation, detection of blood in the stool.Some patients have anemia associated with intra-abdominal bleeding.

A pelvic tumor in women, arising in the uterus, manifests itself in the form of bleeding from the internal genital organs, pain in the pelvic organs, less often the occurrence of ectopic pregnancy and trophoblastic disease.

With a disease such as endometriosis, pain occurs during menstruation. In young girls with an early onset of the menstrual cycle, a hormone-producing ovarian tumor may be diagnosed.In girls with a delayed onset of the menstrual cycle, the development of masculinizing neoplasms of the ovaries is possible. During the period of the end of menstruation in females with menometrorrhagia, a malignant tumor of the small pelvis may begin to develop in women.

Methods for examining patients

If a pelvic tumor in women is not detected during clinical examination, then special examination methods are prescribed. The same examination is prescribed if a pelvic tumor in men is not detected during a general examination.Tests are ordered when symptoms are present.

Ultrasound is prescribed as the initial research method. If ultrasound does not give a complete picture of the situation, then MRI and CT can be used to detect malignant neoplasms. When performing an MRI, a retroperitoneal tumor, even small in size, will be detected.

If a retroperitoneal tumor of dense composition, irregular shape with inclusions is detected, it is very important to make tissue studies for cancer cells. A pelvic tumor in women, namely malignant formations in the ovaries, is diagnosed by tumor markers.


Treatment A retroperitoneal tumor in the pelvic tissue can only be cured with surgery. If a pelvic tumor in men has involved several organs, then surgical intervention is extremely difficult. Unfortunately, many doctors are not able to carry out an intervention of such complexity, and even experienced doctors refuse to perform operations. Such an intervention can result in partial or complete cutting off of the bladder, rectum, and reproductive organs in women.If a tumor of the small pelvis in men and women has affected the bones and large vessels, then the disease is considered incurable.

Pelvic tumor in men and women, affecting the large intestine, is treated by cutting off the diseased part of the intestine. The method of cutting off depends on the location of the primary formation and the presence of metastases. Before the appointment of the operation, the abdominal organs are carefully examined. The size of the part of the intestine that is cut out depends on the size of the tumor. If the retroperitoneal tumor comes from the caecum or sigmoid colon, then removal of the diseased part of the intestine is required, leaving and joining the healthy parts.

Pelvic tumor in men in the sigmoid colon requires cutting off the sigmoid colon itself, the lower part of the colon, vessels.


Any retroperitoneal tumor requires a certain number of chemotherapy drips. Even after the retroperitoneal tumor has been removed, chemotherapy continues for the required amount of time.

Everyone should remember that if early symptoms appear, immediate medical attention is recommended.With early diagnosis of the disease, the retroperitoneal tumor can be completely cured without major surgical intervention.

Do not forget that a retroperitoneal tumor, although a serious disease, is treatable, so you should not delay the trip to the oncologist. At the same time, a retroperitoneal tumor is quite easily diagnosed using ultrasound, MRI and CT.

Treatment of dizziness, staggering, loss of balance in Nizhny Novgorod at the Tonus clinic

The central departments of the vestibular analyzer are responsible for maintaining balance, stabilizing gaze and coordinating movements.These are the vestibular nuclei in the brain stem and their numerous connections with the cerebellum, cerebral cortex, and spinal cord. With damage to the brain stem (stroke in the vertebro-basilar basin, multiple sclerosis, etc.), in addition to dizziness, loss of balance and staggering, the patient has numerous symptoms of involvement of the central nervous system – visual impairment, speech, weakness or numbness in the limbs, and even loss of consciousness. In only 3-5% of cases, dizziness can be the only manifestation of these formidable diseases.

Differential diagnosis between potentially dangerous “central” and more common “peripheral” vestibular vertigo is based on a thorough history taking, patient complaints, in-depth neurological examination with special diagnostic techniques and tests and, of course, the results of additional examination methods.

Non-vestibular vertigo

Often patients call dizziness feelings of “lightheadedness”, “fog in the head”, “impending loss of consciousness.”In such cases, they speak of non-vibular dizziness.

The causes of non-fibular dizziness can be: a decrease in blood pressure, anemia, a drop in blood sugar and other somatic diseases. However, the most common cause of non-fibular vertigo is psychogenic vertigo.

“Psychogenic” dizziness occurs in patients with neuroses and personality disorders. It often occurs in certain circumstances – in public places, confined spaces, etc.e. Such patients take for dizziness the feeling of “sinking”, “lightness” or “emptiness” in the head, “inability to concentrate.” In severe cases, psychogenic dizziness is accompanied by a feeling of “lack of air”, fear, panic.

Blood test for sugar, the norm of blood glucose levels in women, men by age | Blood sugar table, high sugar, diabetes, hyperglycemia, hypoglycemia

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Blood sugar

When we talk about blood sugar, we mean the level of glucose – the main source of energy, which ensures the normal functioning of organs and muscles.

The concentration of glucose deviates from the norm in the presence of certain hormones in the body. Insulin, which is produced in the pancreas, is responsible for the decrease. And an increase in glucose levels can be triggered by several active substances: glucagon, adrenaline, norepinephrine, cortisol and corticosterone.

Such deviations cause certain pathological conditions, which are discussed below.

Symptoms of high sugar

High blood sugar can be recognized by the following symptoms:

  • thirst and dry mouth;
  • Constant hunger;
  • slow wound healing.

Subsequent increase in sugar content leads to hyperglycemic coma, ketoacidosis and hyperosmolar coma.

Symptoms of low sugar

With low sugar, the patient has the following problems:

  • weakness and trembling hands;
  • nausea and dizziness;
  • increased sweating;
  • irritability;
  • constant hunger.

The lower the indicator, the higher the risk of developing hypoglycemic coma.

Blood sugar test: norms

If the patient has the above symptoms, the doctor gives a referral for a blood sugar test. The norm when taking from a finger on an empty stomach is from 3.3 to 5.5 mmol / l, and after a meal – 5.6-6.6 mmol / l. If the second indicator is reached when the biomaterial is taken on an empty stomach, then insulin sensitivity is impaired.

Indicator 6.7 mmol / l after fasting analysis indicates hyperglycemia – increased blood sugar. If the symptom manifests itself chronically, then there is a high probability that the patient has diabetes.Hyperglycemia may be a sign:

  • endocrine diseases;
  • disorders of the liver and hypothalamus;
  • development of inflammatory processes.

A mark below 3.3 mmol / l, on the contrary, is a signal of the development of hypoglycemia – a decrease in glucose levels, which can lead to seizures, headaches, disorders of the pancreas, liver, kidneys and adrenal glands.

An analysis to determine blood sugar helps to detect existing pathologies.

How to prepare?

Preparation methods differ depending on the type of analysis:

  • Glucose tolerance test. Allows you to understand how the body reacts to the sugar load. Before the analysis, you need to drink a sweet drink;
  • Glycated hemoglobin assay. Determines the average sugar level over several months. Doesn’t require any special training;
  • Determination of plasma glucose levels. For rent in the morning on an empty stomach. 8 hours before the procedure, you must not eat or drink anything other than water.

Where to do it?

You can take a blood sugar test at the Unimed multidisciplinary clinic in Izhevsk. To consult and ask questions, call one of the phones listed in the “Contacts” section. The administrator will guide you on prices and appoint a time to visit.