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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey, guys. It's Leah B here from Prestige Veteran Medical Consulting. I'm a US army veteran physician assistant and former compensation and pension and compensation pension examiner. So why dizziness and vertigo are so complex is the video we're gonna talk about today or the video we're gonna do today. So have you ever felt like the room is spinning, lightheaded when you stand up, off balance for no clear reason, like your body is just not syncing with your surroundings, and maybe your imaging was normal, your labs were normal, your heart workup was normal, yet the dizziness continues.
Leah Bucholz:Today, we're gonna talk about why dizziness and vertigo are medically complex and why they're often misunderstood. So a lot of veterans suffer from different types of vertigo, mirrors, BPPV, you know, central vertigo. So this this video is gonna be educational only. It's not medical advice. It's not legal advice.
Leah Bucholz:So let's break down what's actually happening in the body. Alright? Dizziness is not a symptom. I'm sorry. Dizziness is a symptom.
Leah Bucholz:It is not a diagnosis. Okay? One now it can be part of a diagnosis. Like I said, BPVV, Meniere's, things like that. But dizziness can just occur you know, if I spin around in a circle 25 times, I could be dizzy.
Leah Bucholz:That doesn't mean I have a diagnosis. I just I'm dizzy. Right? So one of the reasons this topic is so confusing is because dizziness can mean very different things. Patients may describe spinning, lightheadedness, unsteadiness, floating sensations, near fainting, brain fog with, some imbalance.
Leah Bucholz:Those are not the same, physiologic processes. Understanding which type of dizziness someone is experiencing is the first step in understanding the cause. Right? So the vestibular system is, it's your internal balance sensor. True vertigo, you know, like the spinning sensation often involves the vestibular system.
Leah Bucholz:This system includes things like the inner ear, the semicircular canals, which are part of that system as well, the part of the ear, vestibular nerve, brainstem processing centers. The inner ear, detects head movement and position. It sends signals to the brain about motion and orientation. If those signals are disrupted even slightly, the brain perceives movement that isn't actually happening. That's vertigo.
Leah Bucholz:Right? So common vestibular causes include things like benign paroxysmal positional vertigo. Like, I I already mentioned that. Right? So BPPV, vestibular neuritis, labyrinthitis, inner ear injury, post traumatic vestibular dysfunction can also occur.
Leah Bucholz:In veterans, things like head injury and blast exposure can play a significant role, right, if you have, history of TBI. So lightheadedness is a sort of a different mechanism. Lightheadedness, especially when standing, often involves blood pressure regulation. That's controlled by the autonomic nervous system. When you stand up, blood shifts downwards.
Leah Bucholz:K? So it tries to recalibrate and and meet the needs of the body. So your body should constrict blood vessels and increase your heart rate slightly so it can pump that blood around the body where it needs to go, and it can maintain brain perfusion. If that regulation is delayed or impaired, you might feel dizzy. You might feel like you're gonna faint, or you might even faint.
Leah Bucholz:You might feel weak. You can, kinda get this gray vision or this sort of this blacking out. This can be related to things like dehydration, medication effects, autonomic dysfunction. Like, look. I, you know, even with my old broke down self and my busted shoulders and back and neck, I, you know, I do train some martial arts with my kids to the extent that I can.
Leah Bucholz:I almost got choked out the other day by somebody. And what happened was, you know, when that happens, you are constricting those blood vessels. Right? So when you're cutting off that oxygen supply, if your blood vessels aren't working properly, you can feel lightheaded. Right?
Leah Bucholz:So, again, you can you can have dehydration. You can have medication effects. You can have autonomic dysfunction, chronic stress physiology. Again, this is completely different from inner ear vertigo. The brain plays a role in balance.
Leah Bucholz:Balance requires integration of three systems, the vestibular or inner ear system, vision. Right? Your your eyes are gonna play a big role in what, it's telling your brain and, you know, your brain is processing. Proprioception, that's your body position awareness. If one system is impaired, the others will try to compensate.
Leah Bucholz:But if multiple systems are strained, symptoms can worsen. Alright? So for example, if you have a neck injury, it it can impair your proprioception. PTSD can increase things like sympathetic activation. TBI can disrupt vestibular processing.
Leah Bucholz:Sleep deprivation can reduce neurologic resilience. The brain becomes overloaded trying to reconcile conflicting signals. That can create persistent dizziness even if imaging looks normal. So the cervical spine, connection, the neck. Right?
Leah Bucholz:So this this one actually surprises a lot of people that the upper cervical spine contains, mechanoreceptors, right, that can help signal head position. Right? If someone has a chronic neck strain, history of whiplash, things like degenerative, cervical changes, muscle guarding. It can distort proprioceptive input. The brain receives inconsistent position signals.
Leah Bucholz:That mismatch can also contribute to dizziness. This is sometimes called cervicogenic dizziness. It doesn't, show up clearly on an MRI, but the mechanism is biomechanical and neurologic. Stress and sympathetic sympathetic nervous system overdrive can also play a role. So chronic stress affects balance in in subtle ways.
Leah Bucholz:When the sympathetic nervous system is over activated, the heart rate is gonna increase, you know, that fight or flight. Blood vessel tone shifts. Muscle tension increases. Breathing patterns can change. Hyperventilation can occur alone, and that can cause dizziness.
Leah Bucholz:Anxiety driven breathing changes alter carbon dioxide levels, which directly affect, cerebral, like, brain blood flow. So dizziness can be physiologic and not just imagine. So post traumatic brain injury or TBI, that's a big topic we've touched on quite a bit and affects a lot of you guys. In veterans with TBI history, dizziness can be multifactorial. TBI can affect those vestibular pathways, brain stem processing.
Leah Bucholz:It can affect visual tracking, autonomic regulation, and even mild TBI can result in persistent post concussive dizziness. Again, imaging can look totally normal. Functional disruption doesn't always produce structural abnormalities. Why why is testing often normal? So many standard tests rule out things like stroke, k, tumors.
Leah Bucholz:We can rule out things like severe structural abnormalities, cardiac arrhythmias. That's important, but normal imaging does not mean vestibular function is perfect. Autonomic tone is stable. Cervical proprioception is intact. Stress physiology is balanced.
Leah Bucholz:Dizziness often involves regulation problems, not catastrophic damage. That makes it harder to see in routine testing, and it can feel really frustrating. Dizziness is is super unsettling. It affects things like driving, working, walking confidently. It's just it it can impact so much, feeling just feeling safe.
Leah Bucholz:And when tests are normal, people can feel dismissed. But the absence of structural findings does not equal absence of dysfunction. The body's balance systems are delicate and highly integrated. Subtle dysregulation can cause significant symptoms. So dizziness and vertigo are complex because they involve things like inner ear signaling that you know, this is the final takeaway I want for you guys.
Leah Bucholz:So it can it can involve things like inner ear signaling, brain processing, autonomic regulation, cervical spine input, stress physiology. Multiple systems interact. When one or more becomes dysregulated, symptoms can persist even if imaging and labs appear normal. Understanding the complexity helps explain why this symptom is often misunderstood. So if you've experienced persistent dizziness or vertigo, I hope this provides clarity about how complex the balance system truly is.
Leah Bucholz:This video is for educational purposes only, of course, and is not medical advice. If you are experiencing new severe or worsening dizziness, please follow-up with your primary care provider or a qualified medical professional for individualized evaluation and care for sure. Every case is unique, and proper assessment is essential. If this was helpful, please consider liking and subscribing. I regularly break down these types of medical topics related to VA disability and try to stay clear in an evidence based way.
Leah Bucholz:Please drop some comments if you have any, if if vertigo has affected you. I read the comments every day. So, thank you for watching, and I'll talk to you guys soon. Alright. Bye.