Dizziness Specialist in Palamu
Dizziness can be a symptom of something as simple as dehydration — or as serious as a brainstem stroke. Dr. Yuvraj Lahre, DM Neurology (AIIMS), provides expert evaluation to pinpoint the cause and deliver effective treatment at Palamu Neuro & Eye Care, Palamu.
When to Worry
- !Acute onset of severe vertigo with any neurological symptom — double vision, slurred speech, facial numbness, limb weakness or incoordination, difficulty swallowing, or gait ataxia. This constellation raises high concern for a posterior circulation stroke (brainstem or cerebellar infarction). Cerebellar strokes can cause rapid swelling and brainstem compression within 24 to 48 hours, requiring emergency neurosurgical decompression. Never dismiss acute vertigo with neurological signs as 'just an ear problem.'
- !Dizziness or vertigo with sudden hearing loss in one ear — sudden sensorineural hearing loss is considered an otological emergency. When accompanied by vertigo, labyrinthine infarction or viral labyrinthitis is possible. Early treatment with corticosteroids can improve hearing recovery rates. An acoustic neuroma (vestibular schwannoma), though typically slow-growing, can also present with unilateral hearing loss and vertigo.
- !Dizziness causing recurrent falls, especially in an older person — falls are a major cause of morbidity and mortality in the elderly. When dizziness is the underlying cause, it is essential to identify and treat it — whether it is orthostatic hypotension from medications, BPPV (which is highly treatable even in the elderly), or a neurodegenerative disorder affecting balance. Recurrent falls should never be accepted as 'just old age.'
- !Vertigo episodes lasting minutes to hours with unilateral hearing loss, tinnitus, and aural fullness — this is the classic Meniere's disease tetrad. While Meniere's itself is not life-threatening, it requires diagnosis and management because recurrent episodes cause progressive, permanent sensorineural hearing loss, and the disabling unpredictability of attacks severely impacts quality of life.
- !Dizziness with syncope (actual loss of consciousness) — true syncope is not a neurological cause of dizziness; it indicates a cardiovascular problem (arrhythmia, structural heart disease, vasovagal syncope, orthostatic hypotension). The patient may need a cardiology evaluation, Holter monitoring, and echocardiography rather than neurological testing. Dr. Lahre identifies syncope on history and refers appropriately.
- !Chronic progressive imbalance with parkinsonian features (tremor, rigidity, bradykinesia, shuffling gait) — this can indicate Parkinson's disease or one of the atypical parkinsonian syndromes (multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration), which often present with prominent postural instability and dizziness. Early neurological evaluation can establish the correct diagnosis and initiate disease-specific treatment.
Possible Causes
Benign Paroxysmal Positional Vertigo (BPPV)
The single most common cause of vertigo across all age groups, caused by displaced otoconia (calcium carbonate crystals) from the utricle entering one of the semicircular canals, most commonly the posterior canal. Head position changes (rolling in bed, looking up, bending forward) trigger brief but intense episodes of spinning lasting under a minute, often with nausea. The Dix-Hallpike maneuver is diagnostic — it reproduces vertigo and a characteristic torsional-upbeating nystagmus. Treatment with canalith repositioning maneuvers (Epley for posterior canal, barbecue roll for horizontal canal) is curative in the vast majority of patients in one to two sessions.
Vestibular Neuritis and Labyrinthitis
Acute unilateral vestibular failure, typically viral or post-viral in etiology, causing severe, continuous vertigo lasting days to a week with nausea, vomiting, and severe imbalance. Patients lean toward the affected side. Unlike BPPV, the vertigo is constant (not positional), and unlike stroke, there are no brainstem signs. Vestibular neuritis affects the vestibular nerve only; labyrinthitis affects both vestibular and cochlear components, causing hearing loss as well. Treatment is symptomatic (vestibular suppressants like meclizine or dimenhydrinate for the first 48 hours only — prolonged use delays central compensation) plus early vestibular rehabilitation exercises.
Vestibular Migraine
One of the most underdiagnosed causes of recurrent vertigo. Vestibular migraine can present with spontaneous vertigo lasting minutes to days, positional vertigo (mimicking BPPV), or head motion intolerance — with or without a concurrent headache. The key to diagnosis is the association with migrainous features (photophobia, phonophobia, visual aura) and a personal or family history of migraine. Unlike Meniere's, hearing loss is not a feature. Treatment includes migraine trigger avoidance, vestibular suppressants for acute attacks, and migraine preventive medications (beta-blockers, tricyclic antidepressants, antiepileptics like topiramate, or CGRP antagonists).
Meniere's Disease (Endolymphatic Hydrops)
A disorder of the inner ear characterized by increased volume and pressure of endolymph fluid within the membranous labyrinth, causing the classic tetrad of episodic vertigo (lasting 20 minutes to 12 hours), fluctuating sensorineural hearing loss (initially low-frequency, later involving all frequencies), tinnitus, and aural fullness. Attacks are unpredictable and disabling. Diagnosis is clinical with audiometry confirmation. Treatment includes dietary sodium restriction, diuretics, and in refractory cases, intratympanic steroid or gentamicin injections. Over time, repeated attacks cause permanent hearing loss.
Posterior Circulation Stroke or TIA
Ischemia in the vertebrobasilar territory involving the brainstem or cerebellum can present with isolated vertigo, mimicking peripheral vestibular disorders — a well-known stroke mimic. The HINTS exam (Head Impulse test, Nystagmus, Test of Skew) is a critical bedside tool: a normal head impulse test with direction-changing nystagmus or skew deviation strongly suggests a central cause. Vascular risk factors (advanced age, hypertension, diabetes, atrial fibrillation, smoking) increase pre-test probability. MRI with diffusion-weighted imaging is the confirmatory test, though it can be falsely negative in the first 24 to 48 hours of a small brainstem stroke.
Which Specialist Should You See?
Dizziness and vertigo can originate from the inner ear or the brain. A neurologist like Dr. Yuvraj Lahre is uniquely equipped to differentiate between harmless inner ear crystal displacement (BPPV) and serious central nervous system issues like a stroke or multiple sclerosis.
Diagnostic Approach
Dr. Lahre carefully assesses your eye movements (nystagmus), balance, and coordination. He frequently performs specific positional tests, such as the Dix-Hallpike maneuver, right in the clinic to diagnose and often immediately treat the most common causes of intense vertigo.
Experiencing Dizziness?
Don't ignore your symptoms. Get expert evaluation from Dr. Yuvraj Lahre at Palamu Neuro & Eye Care, Palamu.
Frequently Asked Questions
What is the difference between dizziness, vertigo, and lightheadedness?
These terms are often used interchangeably by patients but have distinct clinical meanings that point to different underlying systems. Vertigo is the illusion of movement — a sensation that you or your surroundings are spinning, tilting, or swaying when neither is occurring. It indicates dysfunction in the vestibular system (inner ear, vestibular nerve, or brainstem/cerebellum). Lightheadedness is a sensation of feeling faint, about to pass out, or 'woozy,' and typically indicates cerebral hypoperfusion from cardiovascular causes (orthostatic hypotension, arrhythmia, vasovagal episodes). Dizziness (non-specific) is a vague sense of spatial disorientation, unsteadiness, or floating that can arise from multiple systems. Dr. Lahre carefully characterizes the nature of your symptom at the first consultation, because the word you use determines which diagnostic pathway he follows.
What causes vertigo and how is it treated?
Vertigo has two broad categories: peripheral (inner ear) and central (brain). By far the most common cause is BPPV (Benign Paroxysmal Positional Vertigo) — tiny calcium carbonate crystals (otoconia) become dislodged and float into the semicircular canals, causing brief (seconds) intense spinning triggered by head position changes like rolling over in bed or looking up. BPPV is treated at Palamu Neuro & Eye Care with canalith repositioning maneuvers (Epley or Semont maneuver) — a simple, non-invasive bedside procedure that is curative in over 80 percent of cases in one or two sessions. Other peripheral causes include Meniere's disease (episodic vertigo with hearing loss, tinnitus, and ear fullness), vestibular neuritis (acute severe vertigo lasting days, often after a viral illness), and labyrinthitis. Central causes — stroke, TIA, multiple sclerosis, brainstem tumor — are less common but potentially life-threatening and are why a neurological evaluation is crucial when vertigo does not fit a typical peripheral pattern.
How does a neurologist evaluate dizziness differently from an ENT specialist?
An ENT (ear, nose, and throat) specialist focuses on the peripheral vestibular system — the inner ear and its mechanical components. This is appropriate for typical BPPV, Meniere's disease, or hearing loss-associated vertigo. A neurologist like Dr. Yuvraj Lahre evaluates dizziness through a broader lens: the vestibular nerve, brainstem, cerebellum, and their connections throughout the central nervous system. The neurological examination includes the HINTS exam (Head Impulse test, Nystagmus, Test of Skew) — a bedside protocol that is more sensitive than early MRI for detecting posterior circulation stroke in acute vestibular syndrome. Dr. Lahre also evaluates for non-vestibular neurological causes: brainstem TIA, vestibular migraine, demyelinating disease, and neurodegenerative disorders. If a patient with acute vertigo has vascular risk factors (age over 60, hypertension, diabetes, smoking), neurological evaluation is essential.
What tests are done to diagnose the cause of dizziness?
The choice of tests depends on whether the dizziness pattern suggests peripheral vestibular, central neurological, cardiovascular, or metabolic causes. At Palamu Neuro & Eye Care, Dr. Lahre's evaluation includes: a detailed positional testing with Frenzel goggles or direct observation for nystagmus, the Dix-Hallpike maneuver (diagnostic for posterior canal BPPV), the HINTS exam, comprehensive neurological examination including cerebellar testing (finger-nose, heel-shin, tandem gait), and orthostatic vital signs (blood pressure lying and standing). Depending on findings, further investigations may include: pure-tone audiometry (for Meniere's or acoustic neuroma), MRI brain with dedicated cuts through the internal auditory meatus (to rule out cerebellopontine angle tumors, stroke, or demyelination), electroencephalography (EEG) if seizures are suspected, and 24-hour Holter monitoring or tilt-table testing for cardiovascular dizziness.
Can dizziness be caused by neck problems?
Yes, cervicogenic dizziness is a recognized but controversial entity where dizziness is attributed to abnormal afferent input from the cervical spine. The cervical spine contains a rich network of proprioceptive receptors, especially in the upper cervical segments (C1-C3), that feed into the vestibular nuclei and help maintain spatial orientation and postural control. When these receptors are disrupted by cervical spondylosis, whiplash injury, or muscle spasm, there is a sensory mismatch between cervical, vestibular, and visual inputs — causing dizziness. Cervicogenic dizziness is typically described as a floating, unsteady sensation rather than true spinning, is worsened by neck movements or sustained neck positions, and is associated with neck pain or stiffness. Dr. Lahre makes this diagnosis only after carefully excluding more common peripheral and central causes, and treatment focuses on addressing the cervical pathology with physiotherapy and postural correction.