(PHILADELPHIA) – Approximately 9 million
to 15 million people in the U.S. suffer from recurrent bouts of
dizziness and 3 million experience symptoms of dizziness nearly
every day. According to a paper that appears in the February
issue of Archives of
Otolaryngology–Head & Neck Surgery,
researchers at the University of Pennsylvania School of
Medicine found that chronic subjective dizziness (CSD)
may have several common causes, including anxiety
mild traumatic brain
injuries, and neurally mediated dysautonomias – disorders
in the autonomic
nervous system, which controls involuntary actions.
Among the various forms of dizziness, clinicians have found CSD
to be particularly vexing. “Patients with CSD experience
persistent dizziness not related to vertigo, imbalance, and hypersensitivity
to motion, which is heightened in highly visual settings, such
as walking in a busy store or driving in the rain,” says Jeffrey
P. Staab, MD, MS, Assistant Professor, Departments of
Psychiatry and Otorhinolaryngology at Penn, and coauthor of the
Staab and coauthor, Michael
J. Ruckenstein, MD,
Associate Professor, Department
of Otorhinolaryngology at Penn, studied 345 men
and women age 15 to 89 (average age 43.5) who had dizziness for
three months or longer due to unknown causes. From
1998 to 2004, the patients were tracked from their referral to
Penn’s Balance Center through multiple specialty examinations
until they were given a diagnosis.
“All but six patients were diagnosed as having psychiatric or neurologic conditions, including primary or secondary anxiety
disorders, migraine, traumatic brain injury and neurally mediated
dysautonomias,” said Ruckenstein. Most patients (59.7%)
had CSD with anxiety, 38.6% had CSD and illnesses of the central
nervous system (migraine, traumatic brain injuries, or dysautonomias),
and 1.7% had CSD and irregular
Two-thirds of patients had medical conditions associated with
the onset of dizziness, whereas one-third had anxiety disorders
as the initial cause. Therefore, CSD may be triggered by
either neurologic or psychiatric conditions.
Key diagnostic features were identified in the clinical history
for each illness. For example, those with migraines often
had nausea or vomiting, anxiety disorders were associated with
fear and worry, and those with dysautonomias tended to become dizzy
when they exerted themselves. “Careful inquiry about
these key features during exams may lead to better diagnoses and
more specific treatment recommendations for the many patients with
chronic dizziness who have not found a cause for their symptoms
and those who have been given diagnoses that have not brought them
relief,” says Staab.
This study was not supported by commercial funding.
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Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.
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