Dizziness causes on wavering ground health adviser tagesspiegel

Causes of dizziness : On shaky groundEvery fourth adult gets off balance at least once a year and experiences a dizziness attack. Because dizziness can have very many causes and also crosses subject boundaries, treatment is often not optimal.

Anyone who gets off a fairground carousel knows the feeling: no more grip, feet wobbly, the environment rushes by in a blur. The merry-go-round just keeps on turning. Many people experience dizziness-. Balance problems even without going to a funfair. About every tenth patient in German doctors' offices complains about it, every fourth adult experiences a dizziness attack at least once a year, experts estimate. Thus dizziness ranks among the most frequent complaints at all.

Causes of dizziness: Inner ear disorders and balance disorders

Vertigo occurs when a person no longer feels securely anchored in the world. "One of the basic functions that we are usually not aware of is missing: that we experience stability," says Thomas Lempert, head of the special outpatient clinic for dizziness and balance disorders at the Schlosspark-Klinik. Normally one knows that the environment does not simply whiz by, but that one has brought this about, for example, by a movement of the head. "When I have vertigo, that coordinate system is in jeopardy," Lempert said. This can have physical or psychological causes.

"From an informational point of view," explains Professor Dag Moskopp, director of the Department of Neurosurgery at Vivantes-Klinikum im Friedrichshain, "dizziness results from divergent sensory perceptions reaching the brain."There, messages from our equilibrium organ in the inner ear, visual impressions as well as information about the state of tension of muscles and tendons and the position of joints and head are permanently combined and compared with each other. Dizziness is an alarm signal from the brain that something is literally out of balance. "On a ship, for example, the visual and depth sensory impressions can no longer match," says Moskopp. Result: the typical seasickness.

Dizziness can have many causes. Lempert counts diseases of the inner ear among the most frequent ones. Disturbances of the vestibular center. In addition, there are age-related signs of wear and tear, migraine headaches, medication overdose, vascular problems, cardiovascular disorders and psychosomatic ailments. In most cases, this can be diagnosed without much technical effort. For vertigo differs in duration and accompanying symptoms. "If someone has ringing in the ears, I take a closer look. If someone has an accompanying movement or visual disturbance, it probably comes from the brain," says Lempert. The triggers can often be clarified by talking to the patient. If the dizziness occurs, for example, after standing up, this indicates a circulatory weakness. "Dizziness is not complicated at all. But it's unpopular with many doctors because it crosses disciplinary boundaries and you need time to talk to the patient – and that doesn't fit well into the rhythm of outpatient medicine," says Lempert. However, if the patient is seriously examined, the causes can be clarified in 95 percent of cases. Patients should see a doctor in any case of prolonged and recurring dizziness. If balance disorders or paralysis are added, this could even be a sign of a stroke, he says.

Tumor as the cause of dizziness

Pinrat Thiemicke didn't know for a long time why she suffered from recurring attacks of vertigo. Her suspicion: stress at work. At the beginning of the year, her symptoms suddenly worsened on the return flight from a vacation in Thailand. She lost consciousness. Fell to the floor. At home, she would go black when she stood up, moved her head, or washed her hair. When the dizziness was joined by violent vomiting, her partner could stand it no longer and drove her to the Vivantes Clinic in Friedrichshain. There, under MRI, doctors immediately discovered a mushroom-sized tumor pressing on the cerebellum, which processes all the information of the vestibular system. In the case of Pinrat Thiemicke, this was no longer possible. "The tumor has minimized the computing power, so to speak," explains Dag Moskopp. He had the patient transferred to the intensive care unit and operated to remove the tumor. All that remains is a scar behind the ear. The complaints are gone.

Dizziness attacks often have a much less threatening cause: tiny ear stones, also called otoliths. These calcium crystals, which in all vertebrates are located on small hair cells in the inner ear, are our orientation indicators. If we look up or tilt our head to the side, the crystals, which react as an inert mass, immediately transmit this to the brain. Only then do we register our position in space. However, the otoliths can also get lost in the semicircular canals of the inner ear. Patients then suffer from so-called positional vertigo. Especially when lying down and turning over in bed, they experience short attacks of dizziness, which can be violent but rarely last longer than 30 seconds. Until recently, skull injuries were considered. Diseases in the inner ear as the cause of this crystal confusion. Researchers at the Max Planck Institute for Chemical Physics of Solids in Dresden have discovered, however, that the otoliths decompose and become detached from their anchorage with increasing age. "The therapy for this positional vertigo is as simple as it is effective," explains Dag Moskopp. Through physiotherapeutic exercises and movements of the head, the crystals flow to a place in the organ of equilibrium where they can no longer trigger false alarms. A bit like pinball, where you have to move a ball back and forth to get it in the right place. Physiotherapy is also most promising for other causes of dizziness, says Thomas Lempert. For example, when one of the organs of equilibrium has been lost due to a viral infection. Medication, on the other hand, is seldom used for dizziness.

Purely a matter of the head are anxiety-related vertigo attacks such as fear of heights. Each perception then actively projects expectations onto the experience. When looking down, this is the fear of falling. "In human evolution, it was also useful to experience vertigo," says Dag Moskopp, "it keeps us from getting into life-threatening situations." So dizziness can also be our friend.

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