4 Uncommon Causes of Chronic Dizziness

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Many forms of dizziness can occur suddenly, causing disorientation for minutes, hours, and even days, before disappearing just as quickly. Oftentimes, we will have no idea why they happened, and the experience itself will usually have no long-term consequence.

Others types are far more distressing. They may be persistent and require ongoing management for a person to function with even relative normalcy. While many such cases have no clear cause, there are certain medical conditions in which chronic dizziness is, in fact, characteristic.

Mal de Debarquement Syndrome

Mal de debarquement, which means "sickness of disembarkment" in French, was originally described by sailors who, after having come ashore, felt as if they were still aboard a rocking ship.

The sensation is quite common in perfectly healthy people who have just stepped off a boat or plane. For most, the condition will resolve in a day or so.

For others, however, it can last for months and even years. The persistent rocking sensation can be made worse when in confined passageways (such as a grocery store aisle) or viewing contrasting movements (such as turning the head while crossing a busy intersection).

No one quite knows why mal de debarquement persists in some people, although it is believed to be linked to anxiety, migraines, and certain hormonal changes. While it may take time, the disorder will usually go away on its own.

To date, no study has offered a qualifiable treatment. Some doctors have anecdotally found benefits in using Klonopin (clonazepam), a sedative, or selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety. Motion sickness drugs such as meclizine, scopolamine, and promethazine appear to be less effective.

Bilateral Vestibulopathy

The vestibular system is responsible for regulating balance by relaying information to the brain that helps inform us about our body's position in space (known as proprioception). The signals come from the inner ears on both sides of the head which then travel along the vestibular nerve to the brainstem.

If an inner ear is damaged, those signals may be impeded and lead to symptoms of dizziness. More often than not, the body will be able to compensate for this as it gradually adapts to the imbalance.

However, if both inner ears are damaged, profound instability can occur for which the body is less able to compensate. Bilateral vestibulopathy can result from illnesses like meningitis, encephalitis, or Meniere disease or with the use of certain drugs like aminoglycoside antibiotics. Bilateral ear surgery can also cause the condition as can deafness and certain inherited vertigo disorders.

Acute Cerebellar Ataxia

Acute cerebellar ataxia (ACA) occurs when a portion of the brain, known as the cerebellum, becomes inflamed or damaged. The cerebellum is responsible for regulating motor control and muscle coordination. Damage to this part of this brain can cause instability, loss of coordination, and persistent dizziness.

ACA most commonly affects children under six but can also be caused by a stroke or diseases affecting the cerebellum (such as multiple sclerosis). Treatments can vary based on the cause and may include steroids, antibiotics, antivirals, or intravenous immunoglobulin therapy.

Vestibular Schwannoma

Vestibular schwannoma, also known as acoustic neuroma, involves the abnormal growth of the Schwann cells of the vestibulocochlear nerve. The condition is extremely rare, affecting only around one of every 100,000 people each year, making it one of the least likely causes of chronic dizziness.

Vestibular schwannoma can affect movement and stability and trigger true rotational vertigo in which the world seems to be spinning in circles. Hearing loss or tinnitus (ringing in the ears) is also common. The condition is rarely life-threatening.

Depending on the location of the tumor, treatment may involve surgery or radiation therapy.

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