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Q: Balance problems while driving ( Answered 3 out of 5 stars,   6 Comments )
Subject: Balance problems while driving
Category: Health
Asked by: pennylane100-ga
List Price: $25.00
Posted: 28 Sep 2005 13:33 PDT
Expires: 28 Oct 2005 13:33 PDT
Question ID: 573909
I have had an ongoing problem while driving.   When driving on a road
that curves to the right, I feel like am an going to lose my balance
and fall over.
It only occurs when the road curves to the right.   I have seen a
neurologist and had an MRI and other tests.   He thought it might be
some kind of positional vertigo and gave recommended a treatment
called epply maneuver (sp).
I have had this done twice and it did not help.  Not sure where to go
now and any help would be appreciated.

Request for Question Clarification by umiat-ga on 28 Sep 2005 17:04 PDT
Hi, pennylane-ga!
 Do you notice this only when driving, or does it occur in other
situations as well?
Subject: Re: Balance problems while driving
Answered By: crabcakes-ga on 29 Sep 2005 00:26 PDT
Rated:3 out of 5 stars
Hello Pennylane100, ,

   With no more than you have told us, I am posting several
?possibilities?, and possibilities only. This answer is for
informational purposes only, and is not intended to replace sound
medical advice from a physician.

   It appears your doctor thinks you have a form of vertigo, and the
Eppley maneuver is one of several treatments for the condition.Drugs
such as Antivert or Librium are also prescribed, as well as surgery
and even exercise!

?Vestibular rehabilitation therapy is designed by a physical therapist
under the direction of a physician. In most cases, patients visit the
therapist on a limited basis and perform custom-designed exercises at
home, several times a day. As the patient progresses, difficulty of
the exercises increases until the highest level of balance is attained
during head movement, eye movement (i.e., tracking with the eyes), and

Ear infections (e.g., otitis media, labyrinthitis) caused by bacteria
may be treated using antibiotics (e.g., amoxicillin, ceftriaxone).
Myringotomy is a surgical procedure that may be used to treat chronic
ear infections. In this procedure, which is performed under
anesthesia, an incision is made in the eardrum and a small tube is
placed in the opening to prevent fluid and bacteria from building up
inside the ear.

Benign paroxysmal positional vertigo may be treated with meclizine
(Antivert®), an oral antiemetic that can be taken up to 3 times a day,
or only as needed. Meclizine may cause drowsiness, dry mouth, and
blurred vision.?

?The most reliable treatment for BPPV is a fairly simple, non-surgical
procedure called canalith repositioning.12 This is done by changing
the patient's head and body position in a series of steps that are
thought to dislodge the calcium crystals within the vestibular
labyrinth that caused the problem.

Canalith repositioning is usually done under expert supervision, but
it is easy enough that doctors often teach it to BPPV sufferers and
their families.

Many doctors also prescribe drugs called vestibular suppressants.
Because of unwanted side effects, such as lethargy and impaired
balance, they are given sparingly and only for more severe and
long-lasting attacks. The elderly are particularly sensitive to these
side effects.

Another concern about these drugs is that they may slow or prevent the
central nervous system from adjusting to a problem in the vestibular
system. While vetibular suppressants often help lessen symptoms,
especially in the short term, surgery is the ultimate answer for the
unlucky few with severe BPPV-related vertigo that does not respond to
the canalith repositioning procedure.?

?Loss of balance control
    ?In a normal healthy individual our senses of touch (feet, ankles,
joints), sight (eyes) and inner ear motion sensors work together in
harmony with the brain. A person with a balance disorder, however, may
have a problem in any one of these systems, or in multiple systems. In
some individuals, one or more of the senses are missing and the person
does not realize they are losing their balance. In other people, the
brain gets confused and creates an inaccurate sense of falling when in
fact the person is in balance. The risk of developing one or more of
these problems increases with age as our senses or brain centers are
exposed to degenerative or infectious diseases, or the effects of
injuries accumulated over a lifetime.

Some individuals experiencing balance problems have an obvious medical
diagnosis such as diabetes, Parkinson's disease, or even a stroke that
are primary sources of the problem. In other individuals with balance
difficulties, the cause can even be subtle undetected forms of these
diseases. However, diseases are not the only reason our senses and
movements may be compromised. A history of injuries, such as
concussions, ear infections, or serious sprains or fractures, may
contribute to a loss of balance control over time.?

Benign paroxysmal positional vertigo

   ?This is one of the most common forms of dizziness caused by the
inner ear. Symptoms are believed to be caused by the fragmentation of
a small calcium deposit (otolith) in the inner ear. These fragments
float freely in the inner ear fluid until a change of gravity causes
them to impinge on nerve endings causing a sensation of dizziness.
This can occur spontaneously, follow a viral illness, or result from
head trauma.

The symptoms associated with this condition are a spinning sensation
or lightheadedness, sometimes associated with nausea, which are
brought on by changes in head and body position. The symptoms are of
short duration, lasting seconds to minutes. The ear toward the floor
when symptoms occur is usually the offending ear. There are no
auditory symptoms (hearing loss, ear pressure or tinnitus) associated
with this condition.
This condition is called benign because it is self-limited, that is,
it will improve on its own. Recovery takes several weeks or months,
occasionally up to one year.

Treatment is only for symptomatic relief by using vestibular
suppressant medications such as Antivert or Valium. Rarely is surgery
?Our sense of balance comes from three sources; the eye, the inner
ear, and kinesthetic senses. When one source disagrees with the others
we sense dizziness. Any disturbance in the inner ear or its central
connections may cause a feeling of dizziness with or without auditory
symptoms (hearing loss or tinnitus). If no other cause can be found,
the inner ear is often thought to be the source of the problem.?

?Benign paroxysmal positional vertigo (BPPV) is the most common form
of vertigo. The condition is characterized by brief episodes of
intense dizziness associated with a change in the position of your
head. It may occur when you move your head in a certain direction, lie
down from an upright position, turn over in bed or sit up in the
morning. Moving your head to look up also can bring about an episode
of BPPV.

Vertigo usually results from a problem with the nerves and the
structures of the balance mechanism in your inner ear (vestibular
labyrinth) that sense movement and changes in the position of your
head. BPPV occurs when tiny particles in your inner ear that help
maintain your balance break loose and fall into the wrong part of the
canals of your inner ear. When these particles shift, they stimulate
sensors in your ear, producing an episode of vertigo.?

?What is Benign Paroxysmal Positional Vertigo (BPPV)? 
Benign Paroxysmal Positional Vertigo (BPPV) is an inner ear problem
that results in short lasting, but severe, room-spinning vertigo. Its
name, BPPV, indicates that it is benign, or not a very serious or
progressive condition; paroxysmal, meaning sudden and unpredictable in
onset; positional, because it comes about with a change in head
position; and vertigo, causing a sense of room-spinning or whirling,
often expressed as "dizziness". Although called benign, those who
suffer from this distressing and incapacitating condition do not
trivialize BPPV.?

?Most now agree that BPPV is caused by an ear-rock (otoconia) that has
broken free, possibly because of aging, disease, or trauma, and is now
loose in one of the semicircular canals. Eppley has devised a maneuver
in which the head is rotated into various positions so as to move the
broken chunk of ear-rock to a less troublesome position; this appears
to work well for many patients.?

?It is possible that you are suffering from a mild inner ear disorder
although the description of your symptom does not provide enough
information to formulate an educated guess regarding diagnosis. If the
symptom is frequent and has been present for some time I would
recommend an evaluation by an otolaryngolgist or a neurologist.
Isolated mild vertigo such as you describe, particularly if
consistently associated with movement such as which occurs in an
automobile, is not highly suggestive of epilepsy.?

?Vertigo has many causes. You may have this type of dizziness because
you have small calcium deposits in your inner ear. You may have
vertigo because of swelling or fluid in your inner ear. Vertigo may
happen if you have migraine headaches or an anxiety disorder. Rarely,
vertigo is caused by poor blood flow or a tumor.?

Rotary vertigo

?A 51-year-old man presented with a chief complaint of rotary vertigo.
His symptoms had begun 1 year earlier, when be first experienced a
brief spell of rotary vertigo with diaphoresis. He had gone to an
emergency room, where his electrocardiogram was normal. Thereafter, he
would experience a similar spell every few months; these spells
occurred with a position change and while walking.?

Ménière's disease
?The symptoms of Ménière's disease occur suddenly and can arise daily
or as infrequently as once a year. Vertigo, often the most
debilitating symptom of Ménière's disease, typically involves a
whirling dizziness that forces the sufferer to lie down. Vertigo
attacks can lead to severe nausea, vomiting, and sweating and often
come with little or no warning.

Some individuals with Ménière's disease have attacks that start with
tinnitus (ear noises), a loss of hearing, or a full feeling or
pressure in the affected ear. It is important to remember that all of
these symptoms are unpredictable. Typically, the attack is
characterized by a combination of vertigo, tinnitus, and hearing loss
lasting several hours.

People experience these discomforts at varying frequencies, durations,
and intensities. Some may feel slight vertigo a few times a year.
Others may be occasionally disturbed by intense, uncontrollable
tinnitus while sleeping. Ménière's disease sufferers may also notice a
hearing loss and feel unsteady all day long for prolonged periods.
Other occasional symptoms of Ménière's disease include headaches,
abdominal discomfort, and diarrhea. A person's hearing tends to
recover between attacks but over time becomes worse.?

 Ménière's disease is usually characterized 4 symptoms.
1) Periodic episodes of rotatory vertigo or dizziness.
2) Fluctuating, progressive, low-frequency hearing loss
3) Tinnitus
4) A sensation of "fullness" or pressure in the ear.

?The exact cause of Ménière's disease is not known, but it is believed
to be related to hydrops or excess fluid in the inner ear. It is
thought that endolymphatic fluid bursts from it's normal channels in
the ear and flows into other areas causing damage. This may be related
to swelling of the endolymphatic sac or other issues in the vestibular
system of the inner ear, which is responsible for the body's sense of
balance. The symptoms may occur in the presence of a middle ear
infection, head trauma or an upper respiratory tract infection, or by
using aspirin, smoking cigarettes or drinking alcohol. They may be
further exacerbated by excessive consumption of caffeine and even salt
in some patients.?'s_disease

Basilar artery insufficiency
?A transient ischemic attack commonly causes vertigo when the blood
supply through arteries to the brain stem, cerebellum, and back of the
brain is reduced. This disorder is called vertebrobasilar
insufficiency. The arteries affected include the vertebral arteries
and basilar artery, which is formed when the two vertebral arteries
join together in the back of the head. Less common disorders that
cause vertigo by affecting the brain stem or cerebellum include
multiple sclerosis, skull fractures, seizures, infections, and tumors
growing in or near the base of the brain.

Occasionally, vertigo is caused by disorders that suddenly increase
pressure within the skull, putting pressure on the brain. These
disorders include benign intracranial hypertension, brain tumors, and
bleeding (hemorrhage) within the skull.?

?Vertebral basilar insufficiency occurs when there is narrowing of the
arteries that supply the posterior brain (subclavian, vertebral, or
basilar arteries). It is usually the result of hardening of the
arteries (atherosclerosis), and occurs among patients older than 50
years of age. The narrowed arteries decrease the blood flow and,
therefore, the oxygen to the vestibular center in the brain. Since the
vestibular system is very sensitive to a lack of oxygen, balance
problems are often one of the first symptoms of vertebral basilar
Other signs of decreased oxygen to the brain are also usually present.
These signs include visual changes, weakness, and fainting. Patients
tend to describe their imbalance as lightheadedness that frequently
occurs when they stand up quickly. In fact, patients rarely get
lightheaded or dizzy when laying flat or resting in a chair.?

?In vertebrobasilar artery (VBA) insufficiency, vertigo is sudden in
onset, lasts only minutes, is associated with nausea and vomiting, and
is usually accompanied by a range of neurologic deficits (eg,
extremity weakness, numbness, incoordination, and dysarthria;
diplopia; field defects; tinnitus; hearing loss; loss of
consciousness; drop attacks). Isolated vertigo without additional
symptoms can be the presenting manifestation of vertebrobasilar

Vestibular Disorders
The vestibular system, located in the inner ear, detects head motion
and position to aid in maintaining balance and visual stability. When
there is a problem with this system, individuals will report symptoms
such as vertigo, dizziness, spinning, wooziness, imbalance, nausea,
and motion sickness.  Some individuals may may suffer from falls or
may report having difficulty completing daily and leisure activities.?

?Vestibular neuritis refers to a disorder of the vestibular system
without an associated auditory deficit or other disease of the central
nervous system. It is a unilateral peripheral disorder, primarily
affecting patients in their third and fourth decades, which is
associated with ipsilateral caloric weakness. Except for persistent
unsteadiness, symptoms usually resolve by 3-6 months. The episode of
vertigo usually consists of a series of attacks within a 10 day

?Viral infections are the cause of dizziness in about 5% of cases and
affect all age groups. They create inflammation of both the inner ear
(labyrinthitis) and the nerve connecting the inner ear to the brain
(neuronitis). Frequently an upper respiratory or gastrointestinal
infection may precede the dizziness by up to two weeks. Initially
there may be severe vertigo aggravated by movement of the head. Nausea
may be present. The symptoms improve over a couple of days though
there may be some dizziness for another few weeks or so. Hearing loss
may accompany labryinthitis though not neuronitis.?

Acoustic Neuroma
Acoustic Neuroma is a benign slow growing tumour. It arises from the
myelin-forming Schwann cells which form a sheath or coating for the
acoustic nerve fibres. An Acoustic Neuroma will grow and expand into
the cerebellopontine angle. A number of lesions of the
cerebellopontine angle will present with unilateral otologic
complaints and it will not always be possible to distinguish these
preoperatively from Acoustic Neuromas.
?Minor disturbances of balance are common, with episodes of rotary
vertigo being less common. These episodes may last several seconds or
minutes to hours, with associated marked visceral autonomic symptoms.?

Spinal Stenosis
?Loss of balance. Pressure on the cervical spinal cord can affect the
nerves that control your balance, resulting in clumsiness or a
tendency to fall.?


?A critical distinction is differentiating vertigo from nonvertigo.
Vertigo is the true rotational movement of self or the surroundings.
Nonvertigo includes light-headedness, unsteadiness, motion
intolerance, imbalance, floating, or a tilting sensation. This
dichotomy is helpful because true vertigo is often due to inner ear
disease, whereas nonvertigo symptoms may be due to CNS,
cardiovascular, or systemic diseases.

Sudden onset and vivid memory of vertigo episodes are often due to
inner ear disease, especially if hearing loss, ear pressure, or
tinnitus is also present. Gradual and ill-defined symptoms are more
common in CNS, cardiac, and systemic diseases. The time course of
vertigo is also important. Episodic true vertigo that lasts for
seconds and is associated with position changes is probably due to
benign positional vertigo. Vertigo that lasts for hours or days is
probably caused by Ménière disease or vestibular neuronitis. Vertigo
of sudden onset that lasts for minutes can be due to vascular disease,
especially if cerebrovascular risk factors are present.?

Additional Information

I suggest you return to your doctor for further treatment. Keep in
mind that most cases of benign vertigo resolve themselves in a fairly
short time. I wish you the best.

If any part of my answer is unclear, please request an Answer
Clarification, before rating. This will allow me to assist you
further, if possible.

Sincerely, Crabcakes

Search Terms
Rotary vertigo
Benign paroxysmal positional vertigo
Calcium deposits + ear
Ménière's disease
chronic vestibulopathy
Acoustic Neuroma
basilar artery insufficiency

Clarification of Answer by crabcakes-ga on 29 Sep 2005 00:43 PDT
Here is another interesting link on the topic, sent to me by my
colleague, umiat-ga.

Sincerely, Crabcakes

Clarification of Answer by crabcakes-ga on 29 Sep 2005 08:45 PDT
Oooops! I forgot to add the link but I see Umiat-ga added it in a comment below!

Request for Answer Clarification by pennylane100-ga on 29 Sep 2005 11:22 PDT
Only when I am driving, however, I have always had poor balance and
find it difficult to walk down the stairs without holding on.

Clarification of Answer by crabcakes-ga on 29 Sep 2005 12:17 PDT
Hello Pennylane,

   I'm sorry you were not pleased with my answer. It would have been
helpful for you to wait for me to respond before rating this question,
as I would have been happy to search further, until you were satisfied
with the answer.

   I wish you luck getting this problem resolved.

   Sincerely, Crabcakes
pennylane100-ga rated this answer:3 out of 5 stars
Thank you for your answer.   I realize that I should have provided
more background for it to have been of more help.  I have had this
condition for many years and while it is life defining for me, the
neurologists (two) that I have seen do not seem to know anything about
it.  Although the first one did do extensive testing, he was unable to
explain anything about it to me.  While he mentioned positional
vertigo, it does not really seem to fit that catagory.   However you
noted the difference between vertigo and non vertigo symptons and that
was very helpful as it led me to believe that my symptons are
nonvertigo.   This is an avenue I can now explore

Subject: Re: Balance problems while driving
From: myoarin-ga on 28 Sep 2005 18:02 PDT
Does this occur on any road (banked and non-banked ones, at corners)
and at any speed?  I assume that you feel that you will fall to the
left (centrifugal force), but ask that too?
Subject: Re: Balance problems while driving
From: umiat-ga on 29 Sep 2005 07:05 PDT
I just wanted to ad this interesting link that might contain some
useful information for you!

"Driving disability and dizziness."
Subject: Re: Balance problems while driving
From: pennylane100-ga on 29 Sep 2005 13:11 PDT
Dear Crabcakes,

It was not that I was not pleased with your answer, as I mentioned,
you were only able to work with the info I gave you and I think you
did a good job.
I did not realize how the system worked and that I should have
contacted you further before rating you.

I think you gave me a lot of information and I have been able to come
up with more answers about my condition because of it.
Subject: Re: Balance problems while driving
From: pennylane100-ga on 29 Sep 2005 13:16 PDT
Dear myoarin-ga 

Thank you for your comment, I had not thought about that and actually
I always  feel that I am going to fall to the right.   Not sure what
that means but at least it is something to tell the doctor when I go
Subject: Re: Balance problems while driving
From: pennylane100-ga on 29 Sep 2005 13:18 PDT
Dear umiat-ga

Thanks for the link, very useful info.
Subject: Re: Balance problems while driving
From: spartan512-ga on 06 Oct 2005 14:16 PDT
Wow,i found someone with my same problem except i only have this
problem veering left at highway speeds.Just had my first appointments
with a neuroligist and a ear specialist.They are suggesting an
mri.Hopefully we can somehow keep abreast of each others progress.

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