DR. HOOK- Un-merry-go-round: When the spinning won't stop

Eighties music will live in my heart like a Celine Dion song. Okay, ix-nay on the eline-Cay ion-Day part. My mother sang opera before she went to medical school, and so I was raised on classical music. Rock and roll music made my mother swoon– while singing a high C– aaaaaah! So I didn't really get to listen to dance music until I was in college, in particular at Delta Chi fraternity. (No, I wasn't a fraternity person, but my other pre-med friends were.) Prince was a king to me, "Let's go crazy!! Da-da-da-da..." 

One of my favorite songs to dance to was Dead or Alive's, "You spin me right round baby, right round. Like a record, baby, right round round round..." Just saying the words makes me dizzy! Everyone would be spinning around like a whirling dervish (as the nuns would say in The Sound of Music).

What happens if you feel like you're dancing to "Spin me..." but there isn't any music?

Benign Positional Vertigo (BPV) causes the sensation of spinning as if you were Shirley Jones on a merry-go-round in Carousel. It occurs when the head moves, in particular looking over the shoulder or side to side. In peripheral BPV, the spinning sensation occurs because the inner ear has a balance center with fluid in tubes (semicircular canals). If calcium crystals get in these tubes and are thrown around when the head changes position, these crystals can stimulate the balance center to say, "Spin me right round, baby, right round...." (Central BPV involves the cerebellum or brainstem, but that's out of the scope of today's topic.)

Vertigo usually lasts less than a minute, such as when one is lying on one side vs. the other side in bed. "Stumble out of bed and stumble into the kitchen, pour myself a cup of ambition..." 

A bout of BPV can last a couple of months, but usually it subsides over weeks. For those who get recurrent episodes of BPV (me included– see, I'm not just a dizzy person. I have BPV!) springtime is the most common season.

Because it feels like spinning in the Disneyland Tea Cups, nausea and even vomiting can result. Otherwise there really aren't any other associated symptoms. But if tinnitus (ringing in the ear), a popping sensation in the ear, and hearing loss occur with vertigo, Meniere's disease is possible. Other conditions related to peripheral BPV include head trauma, previous ear surgery, vestibular neuritis (that's what I have), a stroke to the inner ear, and giant cell arteritis. 

When I have a medical student visiting my office, I love to teach the Dix-Hallpike maneuver to diagnose BPV. Basically you throw the head down like a WWF wrestler– just kidding. If the patient doesn't have neck arthritis, you do position the head down and twisted to see if there is nystagmus (a rapid eye movement going back and forth; sometimes twisty-twervy).

When I was at UVA vestibular clinic during a severe bout of vertigo around 2003, the students and residents all ooo'd and ahh'd at the severe nystagmus I had. Can you imagine how difficult it was to take out my contact lenses? Ouch!

MRI of the brain and hearing tests might be needed to make sure there isn't a bad boy somewhere causing the vertigo. The Epley maneuver might help treat calcium crystals in the inner ear's balance center, but otherwise symptomatic medications are used until the vertigo spins away.

BPV is no fun; trust me. I don't even do spin class because of it. But when I feel like my life is spinning out of control, I just do the Ellen DeGeneres thing and dance. "You spin me right round, baby..." Okay, that's enough.
