Aug 18, 2017

Announcer: Is it bad enough to go to the emergency room or isn't it? You are listening to "ER or Not" on The Scope.

Interviewer: All right. It's time to play along. Dr. Troy Madsen is going to give us the answer to our scenario here today of whether or not you should go into the ER for this particular condition or situation. Today, dizziness. So once again, not caused by anything else, just seemingly out of nowhere, all of a sudden I feel pretty dizzy. I have to sit down, ER or not?

Dr. Madsen: So this one depends a lot on how high a risk you have for a stroke and this is what I think about with dizziness. So young person, otherwise healthy, they feel dizzy, probably not a big deal. If you're 65, you've got high blood pressure, high cholesterol, maybe you've had a previous heart attack or a previous stroke, someone like that comes in and says to me, "I just feel dizzy. I feel like the room is spinning. I can't walk in a straight line," I get really concerned about a stroke.

So there are some blood vessels that feed the brain, the back part of the brain. That's what controls your balance. So if you get a stroke there, people will often describe a feeling like the room is spinning, they say they can't walk in a straight line, they're falling to one side. So that's when I get really concerned and I say, "Well, let's get our neurologist down here right now. We may need to give you a clot busting medication to treat the stroke." So really it's a time dependent thing if you're in that category.

Interviewer: All right. And does that usually come with the other stroke symptoms, slurred speech, facial droop?

Dr. Madsen: Sometimes but sometimes not.

Interviewer: It can just come isolated?

Dr. Madsen: That's the tough part of it. I mean, typically, it will come with balance issues. That's the big thing we see, persons falling to one side or they just say they cannot walk in a straight line. But oftentimes with these types of strokes, they don't have a facial droop. They don't say, "My arm's weak." They don't say, "I'm having trouble speaking," because it's a different part of the brain. So that's why I get really concerned when I hear that, and that's why we kind of jump right on top of it in terms of getting them treatment if they're within that window where we can treat them.

Interviewer: If it's a younger healthier person that you don't believe that it's a stroke, then what do you tell them?

Dr. Madsen: So if someone comes in the ER and they say, "I feel dizzy," you know, we'll typically do some tests like an EKG to look at their heart. Certainly full physical exam, neurologic exam. Say, "Is anything else going on?" But quite often what this ends up being is what's called benign positional vertigo. So you've got like these canals in your ear that help you keep your balance and these little stones. And if one of these little stones gets out of place, it feels like the room is spinning and anyone who's been through this knows how miserable that feeling is.

You know, most cases it's going to go away after a week or so. We can give medication to kind of calm that sensation down and there are actually repositioning maneuvers you can do to try and get this little stone back in the right place. You know, it sounds kind of funny but it's . . . Yeah, it's one of the more common things we see in younger people, otherwise healthy people, who come in with this symptom.

Interviewer: And for that person, no immediate danger. Would they be able to just go to their regular physician to get some of these things that would offer them relief for that two-week period while they're recovering?

Dr. Madsen: Exactly. I think most of these cases, you know, if you're otherwise healthy you can probably wait, get in to see your doctor. One medication that can help in the short term is meclizine. It's an anti seasickness, anti motion sickness medication. It's kind of the non drowsy form of Dramamine. You'll see it right there next to Dramamine. I recommend taking it if you have that. It can help out with some of those symptoms.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

For Patients