Question: I am 59 years old. About a month ago I rolled over during the night and felt a sensation of vertigo. The next morning I awoke and upon sitting up, I suffered a serious bout of vertigo. This went away within 10 seconds. That night when I went to bed, the same thing happened and has continued both morning and night. There are no symptoms any other time of the day.

I saw my doctor within three days, and he prescribed medication which doesn't help. My blood pressure was normal and the doctor found no abnormalities such as pupil enlargement, slurred speech, balance, etc. I have found that if I sit up or lie down in stages, I do not suffer the vertigo. Any suggestions?

Dr. Hibberd's Answer:

You may have a very common cause of dizziness called benign positional vertigo (BPV). It usually clears by itself in several seconds and attacks tend to disappear over the ensuing weeks or months regardless of medication.

Positional vertigo when rising could be a symptom of vertebro-basilar insufficiency (VBI), which may be associated with underlying vascular disease. VBI does not always respond well to the often prescribed medicine, Antivert. A skilled physician will usually be able to identify BPV from VBI on a simple physical examination.

If VBI is a consideration, it is important you have your carotid and vertebral arteries assessed for stenosis or narrowing. This is usually performed by ultrasound. Contrasted studies using CTT or MRA angiography are available for more detailed imaging of these vessels and the vertebro-basilar arterial system to the brain, especially when corrective procedures such as stenting or surgical clearing of vascular plaque are anticipated.

Symptoms of VBI are often precipitated by medications that alter blood pressure, cardiac function, or blood vessel tone. This may also herald more serious arterial problems, and you should be under the direct supervision of a medical doctor.

If your VBI symptoms progress or persist, request a referral to a neurologist and a vascular surgeon. Refractory BPV symptoms (relating to disorders of the inner ear) are usually managed by ENT specialists. Refractory BPV very rarely requires interventional surgery.