FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

KEEP WORKING WITH DOCTOR TO FIND THE CAUSE OF "DIZZY SPELLS"

Question: For the last 12 years I've had spells where I get dizzy, disoriented and break into a sweat. I sometimes also have blackouts that last less than one minute and leave me feeling extremely fatigued. I've gone to numerous specialists who have tested my heart, blood sugar, brain activity and other things. After my last episode I had a CAT scan that showed I have a severe sinus infection. I know that this is a long shot,
but could sinusitis possibly cause my blackouts?

Answer: You probably already know that sinusitis is an infection of the mucous membrane lining of the sinus areas. This creates pressure and discomfort in the face or behind the eyes, but it doesn't cause dizziness or
episodes of passing out.

Your blackout spells may also be described with other terms that mean the same thing. Passing out, drop attacks and fainting are common terms, but doctors prefer to call it "syncope." Regardless of the label applied to it, the temporary loss of consciousness is both frightening and potentially dangerous. Your doctor would probably call the dizziness you experience "near-syncope" since no other explanation of it has been found. This line of reasoning implies that both your mild dizzy spells and your more intense episodes, when you lose consciousness, are produced by the same underlying disorder.

Syncope is a common complaint. It is the reason for about 1 percent of hospital admissions and 3 percent of emergency department visits. Its frequency increases with age, as it affects about 6 percent of those 75 or older. Syncope is actually only a symptom, and as you know, symptoms can have many causes. Syncope can occur when there is an abnormality of the brain. Seizures -- that is, epilepsy -- are a good example of this cause of syncope. During the seizure the normal predictable electrical impulses of the brain are disrupted. This can cause dizziness or a loss of consciousness. The "brain" test you mentioned was testing for this disorder, and apparently that isn't the cause of your symptoms.

Syncope commonly results from a momentary lack of sufficient oxygen reaching the brain. This can happen from a lung problem such as a pulmonary embolism, but this is unlikely in your situation because of the many repeated episodes you have experienced over the last 12 years. If your lungs were the culprit, you would show signs of lung injury, too. A more likely cause is a lack of oxygen to the brain as a consequence of a momentary disruption in the blood supply to it. This is the most common cause of syncope, and it's often due to an irregular heartbeat or as a consequence of medicine, particularly heart or blood pressure ones. Since your many tests have failed to show this as the cause, it's probably wise to continue our search.

Coughing, laughing, sneezing, urinating or having a bowel movement can trigger what is called vasovagal syncope. It is a momentary loss of oxygen to the brain produced by a complex physiologic mechanism related to these activities. When this same physiologic event is the consequence of extreme fright or excitement we call it fainting. This could be what is happening to you. Another possibility is that you have a momentary drop in blood pressure when you stand up. This condition -- called orthostatic hypotension -- is seen in some neurologic diseases and as an undesirable effect of some medicines.

I know that this is beginning to seem like an unmanageable list of possibilities. We doctors feel somewhat overwhelmed by the task of sifting through the possibilities, too. This is compounded by our knowledge that people with syncope are often discovered to have some subtle disturbance of heart rhythm -- but this abnormality may or may not be the cause of the syncope.

I know you want answers ASAP, but so does your doctor. Keep working with him or her until the solution is found. Frequent doctor shopping will probably result in rehashing the most common three causes -- the ones you've already ruled out.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.