MEDICAL NOTES.

Auckland Star, Volume LXIV, Issue 308, 30 December 1933, Page 6 (Supplement)

MEDICAL NOTES.

GIDDINESS. VARIETIES AND SIGNIFICANCE (By PERITUS.) A physician of Guy's Hospital has made a careful analysis of a group of cases in which vertigo or giddiness was a leading symptom, and with the assistance of patients' descriptions classified them and apportioned the cause. Commonly giddiness is attributed to (a) one too many at a friend's house, or at the public bar; (b) liver; (c) faintnees; (d) ;a baby—if a woman; (e) imagination. I I have heard that the sudden marriage of ; one's best girl, or the winning of a first prize in a lottery have been quoted as causing vertigo. The doctor skips most of these causes, and traces his specimen cases to ocular, auditory or cerebral disturbances. His first type is that in which objects, really still, appear to move. The direction of the apparent movement is sometimes diagnostic. The movement may be horizontal, to left or to right, or it may be vertical (as if the sky fell, or the ground rose up) and this usually results in a fall of the affected person. It is unusual for objects to appear to advance and recede. Patients say "everything faded away," or "everything wont." When euch attacks pass there may be vomiting, a noise in the ears, and weakness of the legs. In the next group there is a false sense of movement of the patient. People complain of feeling as if they were spinning round, or falling down, sinking through the bed or the floor, or sinking through space, and these sensations are of serious import, more so than when the motion seems external. In epilepsy transient giddiness is quite common, and often precedes a fall, which seems due rather to a loss of muscular control than of ocular origin. The symptoms in the first group of cases are usually associated with migraine, and what is known as Meniere's disease, and the accompanying pallor, sweating, vomiting, and uncontrolled action of the bowel connected with the latter increases its unpleasant features. Migraine, of course, includes headache and vomiting, and various indescribable brain sensations, any one of which may be alarming to the already nervous patient. When the disturbance is due to trouble in the ear (Meniere's) the head is sometimes turned to the affected side, and there may be numbness of the arm on the same side. The order of the typical symptoms in Meniere's disease is not constant.

Sometimes deafness, or noises in the ear, are first mentioned; sometimes giddiness and staggering gait. The deafness, being one-sided, may not be much noticed, and noises in the ear not very troublesome, but when there is a severe attack of giddiness, followed by exhausting vomiting, tho lighter symptoms are noticed. Between attacks the patient seems quite well, and months may elapse before a second attack, dramatically sudden, sends the patient to ear specialist or general practitioner. Simple obstruction in the ear will produce giddiness, but if it is due to Meniere's tlie attack will probably become more frequent and more severe, the deafness on one side increasing, until the irritation is balanced by toleration and almost complete deafness on one side follows. In cases of high blood pressure there may be giddiness, and it is quite possible that a yielding bloodvessel in the inner ear may be responsible for the whole train of symptoms in Meniere's. The noise in the ear is circulatory, and not in any sense necessarily alarming. These things are discussed in a book, "The Borderland of Epilepsy." There appears to be a connection, between migraine, Meniere's and epilepsy, for in a few cases one of those diseases has been exchanged for another, and in all there is a definite brain irritation quite different in character from that set up by external injury. In most cases of giddiness it is wise to ask the patient if there is any history of inherited disease or any knowledge of a fall, or blow upon the head, or hcful injury at birth. There is intimate connection between the nerves of the ear and the brain, the ear taking the responsibility for maintaining the upright balance of the body, but it is not always responsible for that balance being upset or disordered. An epileptic can have also Meniere's and migraine separately, with the usual giddiness and head noises.

1 There is giddiness due to nervous causes not associated with tho definite forms given above, and one is quoted which I add here, for lack of better words to illustrate such cases. Vertigo, or at least vertiginous sensations, may be the leading complaint in those minor states of mental depression usually called neurasthenic. It is described as an almost continuous sensation of unsteadiness. A married woman, aged 28. without cause became depressed and. frightened, and from the first complained of giddiness, "as if T'm swaying and as if my legs were going to give way and let me down." These complaints continued for one year without intermission. She then became quite well and ceased to attend hospital. Fourteen months later she returned, stating that she had "felt lovely" until a week previously, when again without cause she became frightened, dazed and irritable. On her father's side an aunt died in a neurasthenic state, an uncle was certified in a state of depression, and a cousin after childbirth had passed through an illness similar to the patient's. Vertigo in this setting is not uncommon, and is complained of by patient after patient in terms which show little variation. It must surely be regarded as a physical symptom of the illness.