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Vertigo/Dizziness and Homoeopathy

© Dr. Rajneesh Kumar Sharma M.D. (Homoeopathy)

Dr. Swati Vishnoi B.H.M.S.

For well formatted, illustrated and complete article, pl. see attached pdf.

Dizziness-vertigo and Homoeopathy.pdf

Article outline

Article outline. 1

Introduction. 2

Etymology. 2

Definition. 2

Classification. 3

Dizziness of vestibular origin. 3

Dizziness of nonvestibular origin. 3

Causes and types of vertigo. 4

Dizziness due to peripheral causes. 4

Dizziness due to central causes. 5

Diagnosis. 6

EVALUATING THE DIZZY PATIENT. 6

TREATMENT OF VERTIGO.. 7

Homoeopathic Treatment 8

Repertory of Vertigo. 8

Bibliography. 37

 

Introduction

The perception of our head and body positions and motions in space depend on fundamental types of information provided by five sensory systems-

  1. Vision
  2. Vestibular sensation
  3. Joint position sense
  4. Touch-pressure sensation
  5. Hearing

These inputs are incorporated in central nervous system. Disturbances of any of these inputs or of their integration causes abnormal sensations called as dizziness.

Medical terms for dizziness include vertigo, or feelings of spinning or whirling; disequilibrium, or feeling instable and off-balance; and pre-syncope, which is characterized by faintness and is typically cardiovascular-related.

However, it is possible to group these complaints into four types; a rotational sensation, impending faint, disequilibrium, and vague lightheadedness.

Etymology

Giddy, fainting, Vertiginous, floating, light-headed, Unsteady, Clumsy, off- balance, Swaying, Spinning.

Definition

Vertigo and dizziness are so intermingled that it is difficult to study them separately.

Vertigo can defined as a hallucination of rotational sensation of surrounding or itself (Psora). It is a disorder of the vestibular balance system comprising of the inner ear, vestibular nerve, brain stem, and cerebellum and often including the eyes and the neck proprioceptors. The most important character is its ‘movement’ or its dynamic aspect. This alone distinguishes between two major groups of disorders - the vestibular system disorders-VSDs and the non-vestibular system disorders- NVDs.

Classification

Dizziness is a term which is used to describe a variety of sensations. Dizziness can be grouped in to two categories- dizziness of vestibular origin and dizziness of nonvestibular origin.

Dizziness of vestibular origin

It may be peripheral or central and it includes-

Type I 

The rotational sensation

It is characterized by a feeling of movement relative to one’s surrounding. Vertigo often nausea, vomiting, and a straggering gait, oscillopsia, as concomittants.

The onset of vertigo is often instantaneous, and patients sometimes describe a sensation of being hurled to the ground. Whenever the patient’s dizziness is exclusively rotational, it is due to a disorder of the vestibular system: either the peripheral labyrinth or its central connections (Psora/ Syphilis/ Sycosis).

Dizziness of nonvestibular origin

This group includes benign positional vertigo, acute peripheral vestibulopathy, Menieres’ disease, toxic damage to labyrinths (Psora/ Syphilis), perilymph fistula (Pseudopsora), cerebrovascular disease (psora/ Sycosis), multiple sclerosis (Syphilis), cerebellopontine angle tumors (Psora/ Sycosis/ Syphilis), basilar migraine (Psora), vestibular epilepsy (Psora/ Pseudopsora), cervical vertigo (Sycosis/ Syphilis) and phobic postural vertigo (Psora). There are two other forms of NVDs –

The first is cervical vertigo. It is associated with movements of the neck body. It is too common and is due to any form of loss of balance caused by cervical spondylosis especially in older patients on the belief that vertebro-basilar insufficiency occurs in these individuals due to compression of vertebral arteries in the neck (Sycosis). In this case dizziness mostly results from abnormal proprioceptive stimuli from diseased neck joints resulting in a mismatch at the final integrative level. Such a situation also arises following neck injuries especially after a whiplash (Causa occasionalis).

Second one is a syndrome of phobicpostural vertigo (Psora) which is distinguishable from agoraphobia (fear of open space) and acrophobia (fear of heights) (Psora). It is characterized by the combination of initial vertigo with subjective postural and gait instability and the fear of impending death (Psora). Patients complain of vertigo rather than anxiety and feel physically ill.

Type II

Impending faint (Psora)

Pallor, dimness of vision, roaring in the ears, and diaphoresis, with recovery upon assuming the recumbent position, are common, it may be cardiovascular origin is of abrupt onset and short duration (Psora). When faintness is gradual in onset or persists despite lying down, hypoglycemia (Psora/ Syphilis) or other disorders of cerebral metabolism (Psora) should be sought.

The complaint of impending faint usually implies an inadequate supply of blood or nutrients to the entire brain, such as occurs in postural hypotension.

Type III

Disequilibrium is loss of balance without an abnormal sensation in the head. This experience occurs only when the patient is walking and disappears upon sitting down. It is due to a disorder of motor system control (Psora/ Syphilis).

Type IV

Dizziness and vague lightheadedness (Psora)

It often has rocking sensation instead of spinning. It may be due to hyperventilation symptoms or a psychiatric disorder, particularly depression, anxiety, panic states or agoraphobia (Psora). Peripheral neuropathy, cervical spondylosis, or visual impairment in an elderly or diabetic patient may also be the cause (Psora/ Pseudopsora).

Causes and types of vertigo

Based on causes, the dizziness can be divided into two groups-

Dizziness due to peripheral causes

BPPV (Benign paroxysmal positional vertigo)

It is the most frequent cause of vertigo. There is a sensation of spinning when worse by rolling over in bed or during other sudden head movements (Causa occasionalis/ Psora). Symptoms are worse on lying on the affected side. It may accompany nausea and vomiting and last for less than five minutes, and between episodes the patient is free of symptoms (Psora). This condition, occur only on change of position, differs from other vestibular disorders in which vertigo is increased by head motion but is present at other times as well.

Acute Peripheral Vestibulopathy

It includes acute Labyrinthitis and Vestibular Neuronitis (Psora/ Sycosis). It causes a single bout of spontaneous vertigo, lasting for hours or days. Symptoms of vertigo, nausea, and vomiting usually improve within 48 hours, but may persist for seven to fourteen days (Psora). The patient appears acutely ill, pale and diaphoretic, resisting motion of the head (Psora). Nystagmus accompanies the vertigo (Psora/ Sycosis). After recovery the patient may feel off balance for several weeks due to unilateral impairment of vestibular function. Hearing is not impaired in this condition.

Acute and Recurrent Peripheral Vestibulopathy

It consists of repeated attacks of vertigo occurring over a period of months or years. This condition occurs in an older age group than acute peripheral vestibulopathy, and is associated with less severe vestibular impairment (Psora/ Syphilis).

Meniere’s Disorder

Meniere’s disorder is most frequent causes of dizziness (Psora). It usually occurs in adults and consists of recurring sessions of vertigo associated with hearing loss and tinnitus (Psora). Severe impairment of balance, nausea, and vomiting accompany it (Psora). Patients often complain of fullness in the ears (Psora). Vertigo lasts from hours to days.It may recur every week or as infrequently as every ten years. Hearing loss is usually unilateral (Psora/ Syphilis). It may develop chronic impairment of vestibular function, resulting in the syndrome of vestibular imbalance (Psora/ Syphilis). These patients are dependent on visual clues to maintain balance, and are unable to walk in the dark (Psora). After several months, adaptation to the loss of vestibular sensation develops and patient may havenormal life.

Perilymph Fistula (PF) and Superior Canal Dehiscence Syndrome

It may lead to episodic vertigo and sensorineural hearing loss (Psora) and is due to pathological elasticity of the otic capsule or leakage of the perilymph, usually at the oval or round window (Psora/ Sycosis). The fistula and the partial collapse of the membranous labyrinth permit the abnormal transfer of a deal of pressure changes to the maculae or capolae receptors (Pseudopsora). It may be caused by barotraumas (Causa occasionalis) or cholesteotoma (Sycosis). Vertigo is precipatated with straining and can be simulated by the valsalva maneuver.

Dizziness due to central causes

Cerebrovascular Disease

Cerebrovascular disease produces vertigo when basilar-vertebral artery ischemia damages the vestibular nuclei or their connections (Psora/ Syphilis).

Transient ischemic attacks

Transient ischemic attacks (Psora/ Syphilis) producing vertigo may be particularly difficult to diagnose, because at the time of examination the patient may have recovered completely. Only history may reveal brainstem symptoms, such as diplopia, dysarthria, weakness or clumsiness of the limbs.

Multiple sclerosis

Multiple sclerosis (Syphilis) may produce vertigo in young patients.

Ocular motor disorders

Vertigo may also be caused by ocular motor disorders (Psora/ Syphilis).

Cerebellopontine angle tumors

This is rare cause of vertigo. These tumors are often benign acoustic neuromas (Psora/ Sycosis) arising in the internal auditory meatus and develop in middle-aged persons. There is vague unsteadiness progressing over a period of years. Hearing loss, tinnitus, facial numbness or weakness and cerebellar ataxia (Psora/ Syphilis) are the common symptoms. Unilateral or bilateral acoustic neuromas are especially common in von Recklinghausen’s disease or neurofibromatosis (Psora/ Sycosis).

Basilar Migraine

In vertiginous migraine, vertigo may occur preceding the headache, during the headache phase, or as a migraine equivalent in place of the headache (Psora).

The diagnosis is considered only when vertigo is accompanied by other brainstem signs and symptoms (e.g. diplopia) and associated with headache (Psora).

Vestibular Epilepsy

This is a rare cortical vertigo syndrome secondary to focal epileptic discharges in either the temporal lobes or the parietal association cortex (Pseudopsora). Its clinical sign is skew deviation of eyes with nystagmus during attacks (Psora/ Syphilis).

Diagnosis

EVALUATING THE DIZZY PATIENT

The history should explore four major questions that distinguish the disorders producing dizziness-

  1. The type of dizziness (I to IV)
  2. The abruptness of attacks or continuity of symptoms.
  3. Modalities of dizziness for position or motion (standing/ sitting/ lying, sudden change in position, walking)
  4. Age
  5. A complete neurological examination
  6. BP measurement, orthostatic change, cardiac irregularity and neck bruits are often detectable.

A sharpened Romberg test is often very useful to exclude organic neural disease. This test comprises of standing tandem with eyes closed on either leg with arms folded across the chest for 30 seconds. If an individual can perform this test it almost excludes organic neurologic disease.

Syndrome of phobic- postural vertigo, which is different from agoraphobia (fear of open space) and acrophobia (fear of heights) may also be there. It is characterized by the combination of initial vertigo with subjective postural and gait instability and the fear of impending death. Patients complain of vertigo rather than anxiety and feel physically ill.

Electronystagmography (ENG) may help to identity and distinguish disorders of the peripheral (labyrinth, eighth nerve) and central vestibular systems.

Audiometric studies are used to evaluate lesions of the middle ear, labyrinth, and cochlear nerve, particularly in Meniere’s disorder and cerebellopontine angle tumours.

If symptom decreases with exercise or distractions, it is likely to be of psychological origin.

Pure hypoperfusion of the brain-stem due to any cause secondary to hypotension can cause true vertigo. This is usually associated with altered levels of consciousness and fall under the category of NVDs. Relation of the giddiness to meals may reveal hypoglycaemia or the early postprandial dumping syndrome.

Dizziness Simulation Battery

This is a series of eight bedside maneuvers that helpful in distinguishing the various types of dizziness. Some produce dizziness in all patients, whereas others induce it only in patients with underlying disorders. Identification of a provoked sensation as identical to the patients dizziness is often more reliable than a verbal description, particularly if a single maneuver exclusively reproduced the symptoms.

  1. Orthostatic hypotension- Blood pressure is measured supine, immediately on standing, and after three minutes.
  2. Potentiated Valsalva maneuver- The patient squats for 30 seconds, then stands and strains against a closed glottis, or blows into a mercury sphygmomanometer, raising the column to 40 mmHg for 15 seconds.
  3. Carotid sinus stimulation- The carotid sinus is unilaterally massaged for 15 seconds without continuous compression of the artery.
  4. Neck twist- The patient rotates the head in each direction for 15 seconds. Dizziness may result from vestibular disorder or cervicogenic dizziness.
  5. Walking and turning- The patient walks in one direction and then quickly turns, reversing direction. This test reproduces dizziness occurring with multisensory deficits, gait apraxia, and disorders of balance.
  6. Hyperventilation-The patient breathes deeply for three minutes.
  7. Nylen-Barany maneuver- The examiner carries the patients head backward from a seated position, so that it is hanging 45 degrees below the horizontal and turned 45 degrees to one side. Vertigo accompanied by nystagmus indicates positional vertigo. The characteristics distinguishing a “benign” from a “malignant” form of condition.
  8. Barany rotation- The patient is seated in a rotating chair, head tilted 30 degrees forwards from the vertical. The examiner spins the patient in one direction ten times within 20 seconds, then abruptly stop this rotation.

TREATMENT OF VERTIGO

Treatment of vertigo consists of symptomatic relief and treatment of the underlying disease. Central causes of vertigo like cerebrovascular disease, multiple sclerosis or cerebello- pontine angle tumours require urgent institution of specific treatment. In vertigo due to peripheral causes, symptomatic treatment tends to get more importance. This is usually done only with drugs and less attention is given to other treatment modalities. In a patient with acute or recurrent vertigo due to peripheral cause it is important to see that appropriate symptomatic treatment is advised and potentially treatable causes are not missed.

Any patient with vertigo should be advised to take bed rest and avoid sudden head movement in the initial stage.

Homoeopathic Treatment

Homoeopathy has a wonderful role in treatment of vertigo and dizziness as it has holistic approach. After keen evaluation of condition and constitutional analysis similimum remedy is ascertained and it does miracles.

Here is given a short repertory of vertigo.

Repertory of Vertigo

ABDOMEN - ABSCESS - Liver - accompanied by - vertigo and nausea ther.

ABDOMEN - COMPLAINTS of abdomen - accompanied by – vertigo calc. coloc. petr. spig. stram.

ABDOMEN - COMPLAINTS of abdomen - Pelvic organs - accompanied by – vertigo aloe con.

ABDOMEN - PAIN - accompanied by – vertigo asaf. coloc. hell. petr. spig. stram.

ABDOMEN - RUMBLING - Umbilicus - Region of umbilicus - vertigo; during ptel.

BACK - PAIN - Lumbar region - vertigo; during Ambr.

BACK - PAIN - vertigo; after ign.

calc. tarent. visc.

CHEST - HEART; complaints of the - accompanied by – vertigo adon. aml-ns. eucal. kali-c. kalm. lach. lil-t. naja ol-an. phos. plat. Spig. sulph. verat.

CHEST - PALPITATION of heart - vertigo; with adon. aeth. aml-ns. bell. bov. cact. cocc. coron-v. dig. eucal. iber. Kali-br. kali-s. lap-la. nux-m. plat. senec. sep. sil. spig. spong. sulph. tritic-vg. tub. vanil.

CHEST - TREMBLING - Heart - vertigo; during Cocc.

CHILL - CHILLINESS - vertigo; after nat-c.

CHILL - VERTIGO – after corn-f.

DIZZINESS - VERTIGO etc... abel. abies-c. abies-n. abrom-a-r. abrom-a. absin. Acet-ac. acetan. acon-c. acon-f. acon-l. ACON. aconin. act-sp. adam. adon. adox. adren. aesc-g. Aesc. aeth. aethyl-n. agar-cpn. agar-em. agar-pa. agar-pr. agar-st. AGAR. agath-a. agav-t. agn. agro. Aids. AIL. alco. alet. all-c. all-s. allox. aloe alst. alum-p. alum-sil. Alum. alumin-s. Alumn. Am-c. Am-m. Ambr. aml-ns. amph. amyg. Anac. anag. anan. anders. androc. androg-p. Ang. anh. anil. anis. Ant-c. ant-t. Anth. anthraci. anthraq. antip. APIS apoc. apom. aq-mar. aran-ix. aran-sc. Aran. Aren. ARG-MET. Arg-n. arge-pl. argon arist-cl. arizon-l. ARN. Ars-h. Ars-i. ars-s-f. ARS. art-v. arum-m. arum-t. arund. asaf. asar. asc-c. asc-t. aspar. Aster. atha. atp. atra-r. atro. aur-ar. aur-i. aur-m-n. aur-m. aur-s. AUR. bad. Bamb-a. BAPT. bar-act. Bar-c. bar-i. bar-m. bar-s. bell-p-sp. bell-p. BELL. Benz-ac. benzo. benzol. Berb. bism-sn. Bism. bit-ar. Boerh-d. bond. BORX. both-a. both-ax. both. botul. bov. brach. brass-n-o. Brom. bros-gau. bruc. brucel. BRY. bufo buteo-j. buth-a. Cact. cadm-met. cadm-s. cain. caj. calad. calam. calc-act. CALC-AR. calc-caust. calc-f. calc-i. Calc-p. CALC-S. calc-sil. CALC. calo. Camph. CANN-I. Cann-s. cann-xyz. Canth. Caps. carb-ac. Carb-an. Carb-v. carbn-dox. carbn-h. carbn-o. CARBN-S. carc. card-m. cardios-h. carl. cartl-s. cass. cassia-s. castn-v. Castor-eq. Caul. Caust. cean. Cedr. cench. cent. cephd-i. cer-s. cere-b. cerv. CHAM. CHEL. chen-a. chim. chin. chinin-ar. chinin-m. CHININ-S. Chinin-sal. chir-fl. CYCL. cypr. cypra-eg. cystein-l. cyt-l. daph. dat-a. dat-f. dendr-pol. der. des-ac. Dig. digin. digox. dios. diosm. dirc. dor. dream-p. Dros. dub. dubo-h. Dubo-m. duboin. DULC. echi. Elaps eos. ephe-si. equis-h. erech. ergot. ery-a. eryth. eucal. eug. euon-a. euon. Eup-per. eup-pur. euph-ip. euph. euphr. eupi. fago. fagu. falco-pe. Ferr-ar. Ferr-c. Ferr-i. ferr-m. ferr-ma. Ferr-p. ferr-s. FERR. ferul. fic-m. fl-ac. flor-p. Form. formal. fuma-ac. galeoc-c-h. galla-q-r. galph. Gamb. gard-j. gast. GELS. genist. gent-c. gent-ch. gent-l. ger-i. ger. gink-b. gins. Glon. glycyr-g. gnaph. goss. Gran. granit-m. Graph. GRAT. Guaj. guar. Guare. guat. gymno. ham. hed. helia. helium Hell. helo-s. helo. helon. Hep. hera. heroin. hipp. hippoc-k. hir. hist. hura hydr-ac. hydr. hydrang. Hydrc. hydrobr-ac. Hydrog. hydroph. hygroph-s. Hyos. hyosin. Hyper. iber. Ign. ina-i. Ind. Indg. indol. interf. inul. Iod. iodof. IP. irid-met. iris iris-fl. Iris-foe. ix. Jab. jac-c. jatr-c. jug-c. jug-r. Kali-ar. Kali-bi. kali-br. Kali-c. kali-chl. kali-cy. Kali-i. kali-m. Kali-n. kali-ox. kali-p. Kali-s. kali-sil. Kalm. ketogl-ac. kola kou. kreos. krypt. lac-ac. LAC-C. lac-cp. Lac-d. lac-del. lac-e. lac-h. lac-loxod-a. lac-mat. LACH. lachn. Lact. lap-la. lappa lat-h. lat-m. lath. Laur. lavand-a. lec. Led. lepi. lepr. lept. Lil-t. linu-c. lipp. lith-br. lith-c. Lith-m. lob-p. lob-s. Lob. lol. luf-op. luna lup. LYC. lycps-v. lys. Lyss. m-ambo. M-arct. M-aust. mag-c. Mag-m. Mag-p. mag-s. magn-gr. maias-l. maland. malar. manc. mand. mang-m. mang-p. mang. marb-w. Med. melal-alt. meli. mentho. meny. meph. Merc-c. merc-cy. merc-i-f. merc-i-r. merc-n. merc-sul. Merc. merl. Mez. mill. mim-h. mim-p. mom-b. moni. morg-p. morg. morph-m. morph-s. Morph. Mosch. mucs-nas. Mur-ac. murx. musca-d. Mygal. myos-a. myric. myris. nad. naja narcot-m. narcot. Nat-ar. nat-bic. nat-br. NAT-C. Nat-hchls. NAT-M. nat-n. nat-ox. Nat-p. nat-pyru. Nat-s. Nat-sal. nat-sil. neon nept-m. nicc. nicot. nicotam. Nit-ac. nit-m-ac. nit-s-d. nitro-o. Nux-m. NUX-V. oci-sa. oena. oeno. ol-an. ol-j. Olib-sac. Olnd. ONOS. OP. Oreo. orot-ac. ox-ac. oxal-a. oxeod. oxyt. ozone paeon. pall. pana. par. parathyr. past. paull. pen. penic. petr-ra. PETR. Ph-ac. phal. phasco-ci. Phel. PHOS. Phys. physala-p. PHYT. Pic-ac. pieri-b. pilo. pimp. pin-con. pin-s. Pip-m. pitu-a. pitu-gl. pitu. plac-s. plan. plat. Plb. plumbg. plut-n. pneu. Podo. polyg-h. polys. pop-cand. pop. positr. pot-e. prim-v. propl. Prot. prun. psil. Psor. Ptel. PULS. pycnop-sa. pyrus querc-r-g-s. querc-r. querc. rad-br. rado. Ran-b. ran-s. raph. Rauw. rham-cal. rham-f. rheum Rhod. rhodi. rhus-g. rhus-r. RHUS-T. Rhus-v. ribo. ric. rob. rosm. rumx. ruta sabad. sabal Sabin. sacch-a. sacch. SAL-AC. sal-fr. sal-p. salam. salin. samb. SANG. sangin-t. Sanguis-s. Sanic. santin. sapin. sarr. Sars. scol. scop. scroph-n. scut. sec. SEL. senec. seneg. SEP. Ser-a-c. SIL. sin-a. Sin-n. sinus. sol-a. sol-ecl. sol-ni. sol-t-ae. sol-t. solin. SPECT. sphing. spig-m. SPIG. spira. spirae. Spong. squil. stach. Stann. Staph. stict. still. STRAM. strept-ent. streptoc. streptom-s. Stront-c. stroph-h. Stry. strych-g. suis-em. suis-pan. Sul-ac. sul-h. sul-i. sulfa. sulfon. sulo-ac. Sulph. Sumb. suprar. symph. Syph. TAB. tanac. tang. taosc. tarax. tarent. tart-ac. tax-br. tax. tell. tep. Ter. tere-la. term-c. teucr. thal-xyz. thea THER. thioc-ac. thiosin. thlas. thres-a. Thuj. thymol. thyr. til. titan. trach. trad. tril-p. trinit. trios. tritic-vg. Trom. tub. tung-met. tus-p. ulm-c. upa. uran-met. uran-n. urol-h. Urt-u. Ust. v-a-b. Valer. vanad. vanil. vario. Ven-m. Verat-v. VERAT. verb. verin. vero-o. vesp-xyz. vesp. vib. vichy-g. vinc. Viol-o. viol-t. vip. Visc. voes. wies. wye. x-ray xan. zinc-i. zinc-m. zinc-p. zinc-s. Zinc. zing. ziz.chlam-tr. Chlf. chlol. chlor. chr-ac. cic-m. Cic. CIMIC. Cina cinch. Cinnb. cist. cit-v. clem. cob-n. cob. coc-c. Coca cocain. cocc-s. COCC. cod. coff-t. Coff. coffin. Colch. coli. coll. Coloc. colocin. com. CON. conch. conin-br. conin. convo-d. convo-s. Cop. cor-r. cori-r. corian-s. corn-f. corn. coron-v. cortico. cortiso. cot. crat. croc. crot-c. Crot-h. crot-t. cub. culx. cund. cupr-act. Cupr-ar. cupr-s. Cupr. cur.

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Comment by Dr Rajneesh Kumar Sharma MD(Hom) on April 16, 2015 at 10:00am

Thanks sir.

Comment by Dr. Wequar Ali Khan on April 16, 2015 at 9:51am

A very informative article indeed. It shows in detail the causes and relevance of Homeopathy in such condition.

Thank you Dr Rajneesh.

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