Vertigo, dizziness can point to life-threatening conditions

2015-06-25 10:27:27 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

Jason Day struggled with vertigo throughout the recent U.S. Open Championship. Jason Day struggled with vertigo throughout the recent U.S. Open Championship.

During this past weekend’s U.S. Open Championship, Jason Day visibly struggled with vertigo as he competed for the top spot. He even collapsed from dizziness in the 2nd round.

When you hear about these symptoms in young athletes, they may be pointing to life-threatening conditions, such as a tumor or heart problem. A complete workup is necessary to rule these things out before a diagnosis of vertigo can be made.

This week, I spoke with 1590 WAKR morning show host Ray Horner about this topic. Luckily for the 27-year-old Aussie, he was diagnosed with benign paroxysmal positional vertigo, which is treatable with vestibular physical-therapy maneuvers.

Below is an audio file and transcript of our discussion.



HORNER: Our next guest here, Dr. Joe Congeni from Sports Medicine Center at Akron Children’s Hospital, is onboard with us. Dr. Joe, thanks for joining us this morning. What do you have for us today?

CONGENI: Hey, Ray. How ya doin’ this week?

HORNER: I’m doing well, my friend.

Dr. Joe Congeni

CONGENI: Good. Uh … I’ve been involved in the International Concussion Symposium downtown in Cleveland, Ohio, at the Global Health Center for, uh, Health Innovation. Have you seen that new center in downtown Cleveland?

HORNER: I have not, Joe.

CONGENI: … It’s a beautiful center. Gosh, I hope we utilize it. Being in downtown Cleveland, there’s a lot of growth going on, a lot of beautiful new things going on down around the lakefront.

But, um, the topic I wanted to talk about is a little bit off that topic of, uh, concussion and moving into the area of dizziness in athletes. Um, I was asked a lot of questions this week about Jason Day, and a couple points I wanted to make about Jason Day’s dizziness at the U.S. Open.

I think it was probably at its worst on Friday. He was very dizzy and he came pretty close to passing out. Did you see that, Ray?

HORNER: I did not. No, Joe.

CONGENI: Yeah, and so he’s been battling this for a while. I’m just concerned that the wrong message out there. He’s had quite an extensive workup and they’ve made sure that he doesn’t have something else going on.

He has a condition that is called benign paroxysmal positional vertigo. It means that when his head is in certain positions he can get very dizzy, and he battled it the rest of the round.

People were comparing it — as he was competing for the top spot — to things like Ken Venturi back in the ’60s or, uh, Tiger Woods playing with a torn ACL, you know … because he was visibly, noticeably dizzy throughout the round, the 3rd round and 4th round.

And, the concern for me is in young athletes. They don’t usually get this benign positional vertigo right off the bat. It’s not a diagnosis you would jump to.

When we hear in young athletes about dizziness and passing out, or near passing out episodes that can be one of those life-threatening signs or symptoms that really needs a complete workup.

The two areas of the workup are gonna be the heart to make sure that this isn’t a heart problem, and very often an EKG, maybe an echocardiogram, which shows the chambers and the large vessels coming off the heart, and also a neuro exam . An EEG, some sleep studies may need to be done, .

I know it’s a pretty complete workup, but we have to rule out things like, a uh, tumor, and we have to rule out things like a seizure. And so, it can really be a serious thing and then in the diagnosis of exclusion, we will find that it is this benign vertigo.

And vertigo, as part of dizziness, has been in the news a lot in sports medicine because it’s now a part of concussions. About a third of concussions have this vertigo, which is this sudden sensation that you’re spinning or your head is spinning.

There are ways to treat it. You’ve heard me mention before about some of the maneuvers and vestibular-type physical therapy that can help cure or treat vertigo. So, it’s treatable.

Jason Day battled with it, but I want people to know that when you have an athlete, a high-school athlete, particularly, or a college athlete, with dizziness and near passing out episodes, there’s a lot that needs to go into the workup. Life-threatening things first need to be ruled out before we come to the diagnosis of vertigo.

HORNER: Joe, educate me ’cause I’ve known some people who have vertigo. How do you heal vertigo, or does it heal on its own or never?

CONGENI: Well, it used to be that we used a lot more medicines, but nowadays we use a lot more hands-on, positional physical-therapy maneuvers that really help a lot.

In the middle ear, uh, there are these crystals that actually, uh, assess where you are in space. And as the head moves, there’s a very close contact between the eyes and the middle ear as to, uh, being able to see the world around you.

And when that is dysfunctional; when it’s not working well as the head moves, like for Jason Day as he looked down at his score card, or went to try to get his ball out of the hole, he would get dizzy on virtually every hole.

So these movement patterns cause people to be very dizzy when they have vertigo. And it is treatable by physical therapy. The medicines we used to use before were not very good, so this is a new change in medicine. … There are positional maneuvers and therapy that can be helpful for people with vertigo.

HORNER: Alright, great stuff, Joe. Thank you for the insight, as always, in sports medicine. We’ll talk to you next week.

CONGENI: Alright, Ray. Have a great week. Thanks.

HORNER: You too. Dr. Joe Congeni, Sports Medicine Center at Akron Children’s Hospital.

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