Extreme vertigo post diving

[lragsac]

I recently suffered extreme vertigo accompanied by severe nausea after surfacing from an uneventful dive well within NDL profile (slow ascent, stops at 30/20/10'). I was fine swimming on the surface back to the boat. I boarded the swim platform, made it up the ladder and was then immediately struck by severe vertigo and nausea. Since the incident happened in conjuction with diving, I was initially treated as a possible DCS/AGE case (although I had no other signs/symptoms) and was given a Table 6 treatment. The treatment did not mitigate my signs/symptoms to any degree and it was the opinion of the dive medicine team that I never had DCS. I received a cranial CT scan, and an MRI to rule out stroke or aneurism. Both diagnostic tests were negative. The neurology team at the facility where I was treated theorized that my continuing vertigo is due to either benign paroxysmal positional vertigo (BPPV) or vestibular dysfunction disorder. Either one of these conditions can result from dislodgement of small calcium carbonate crystals known as otoconia that float through the inner ear fluid and strike against nerve endings in the cupula. The neurologists administered the Dix-Hallpike test looking for a characteristic movement of my eyes referred to nystagmus. I was tested for both positions (right and left) with negative results. So, my question specifically to the diving medicine moderators here is can this BPPV or vestibular dysfunction be suddenly brought on by the activity of diving. BTW, I had no trouble clearing on descent and no problems during ascent. Had absolutely no pain in my ears. Some 48+ hours later my vertigo persists, although the nausea has abated completely and I have seen some improvement in the vertigo. I can at least walk unassisted, although with some difficulty and staggering.

 

[beche de mer]

So, my question specifically to the diving medicine moderators here is can this BPPV or vestibular dysfunction be suddenly brought on by the activity of diving. BTW, I had no trouble clearing on descent and no problems during ascent. Had absolutely no pain in my ears. Some 48+ hours later my vertigo persists, although the nausea has abated completely and I have seen some improvement in the vertigo. I can at least walk unassisted, although with some difficulty and staggering.

I was not aware of an association, though if you put yourself through an aquabatic workout, you could have dislodged a resting otolith.

I expect you've Googled the topic but if not, here's a good link.

http://www-surgery.ucsd.edu/ent/PatientInfo/info_bppv.html

Note in particular the Epley manoeuvre, which may treat the condition and if effective, would confirm the diagnosis.

 

[lragsac]

I was not aware of an association, though if you put yourself through an aquabatic workout, you could have dislodged a resting otolith.

I expect you've Googled the topic but if not, here's a good link.

http://www-surgery.ucsd.edu/ent/PatientInfo/info_bppv.html

Note in particular the Epley manoeuvre, which may treat the condition and if effective, would confirm the diagnosis.

Yes, I've Googled the topic and luckily the facility you reference in the link is readily accessible to me. Thanks again. I'm feeling pretty desperate. I've not experienced any improvement in my condition since getting discharged from the hospital.

 

[alfstuff]

Yes, I've Googled the topic and luckily the facility you reference in the link is readily accessible to me. Thanks again. I'm feeling pretty desperate. I've not experienced any improvement in my condition since getting discharged from the hospital.

Your symptoms mirror mine (twice 4 years apart). Both instances were dives of 110 to 115 feet. Vertigo followed between 30 and 90 minutes later. DAN said no to DCS, ENT said ????, possible inner ear barotrauma. Vertigo cleared in several days. I am still looking for a diagnosis, and a connection to diving. You have any luck yet???

 

[lragsac]

Your symptoms mirror mine (twice 4 years apart). Both instances were dives of 110 to 115 feet. Vertigo followed between 30 and 90 minutes later. DAN said no to DCS, ENT said ????, possible inner ear barotrauma. Vertigo cleared in several days. I am still looking for a diagnosis, and a connection to diving. You have any luck yet???

Alas, someone who actually suffered what I still see as a rather bizarre incident. My incident took place 13 days ago and, although I am much improved, I still have symptoms--primarily problems with my balance (during any kind of fast movement or rapid change in position which involves turning).
Also, I can feel that my eyes still don't "track" properly when I try to focus on something while moving. One GP I saw diagnosed labyrinthitis and his opinion was it was not directly caused by diving. It was only triggered by the pressure change. I'm not sure I buy this theory. My perception of this medical condition so far is that it is a very "slippery" diagnosis to make and most docs don't really know why it happens or even what it is. BTW, I was prescribed a diuretic for my condition. No clear prognosis has been given; I've only been told that it will get better and may take a while.

 

[DocVikingo]

Sadly, idiopathic vertigo such as you seem to be reporting often does not receive a very satisfying diagnosis, at least not initially. Various treatments are tried in the hope that one will prove effective.

A diuretic, often in combination with a low salt diet, is an accepted therapeutic first attempt at control in that it can reduce inner ear pressure, a frequent cause of vertigo. There are other treatments that can be tried for symptomatic relief.

The fact that you report feeling much improved over the 2 weeks since onset is quite promising.

Be patient.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

DocVikingo

 

[lragsac]

Sadly, idiopathic vertigo such as you seem to be reporting often does not receive a very satisfying diagnosis, at least not initially. Various treatments are tried in the hope that one will prove effective.

A diuretic, often in combination with a low salt diet, is an accepted therapeutic first attempt at control in that it can reduce inner ear pressure, a frequent cause of vertigo. There are other treatments that can be tried for symptomatic relief.

The fact that you report feeling much improved over the 2 weeks since onset is quite promising.

Be patient.

DocVikingo

Thanks, Doc. I'm trying to be patient, but I'm sure you are aware that, from a patient's point of view, the seemingly nebulous path this diagnosis and treatment takes is most unsettling. Even when/if I do recover completely, that first time back in the water is going to create a lot of anxiety.

 

[kelpmermaid]

but hang in there, L.

 

[ArcticDiver]

That it persists certainly seems to rule out DCS and place it in the idiopathic category. I'm sure you know that idiopathic is a term that essentially means: We haven't the slightest idea why but maybe either we'll figure out the problem or it will go away.

One question that occured to me: Could the fact you were diving be coincidental? Have you been exposed to some gas or chemical in the course of your work or daily life that could have caused a problem? How about some other change in your daily habits?

Again, not medical advise, but a couple more questions to answer. If and when you get a good diagnosis and treatment please post so all can benefit.

 

[lragsac]

That it persists certainly seems to rule out DCS and place it in the idiopathic category. I'm sure you know that idiopathic is a term that essentially means: We haven't the slightest idea why but maybe either we'll figure out the problem or it will go away.

One question that occured to me: Could the fact you were diving be coincidental? Have you been exposed to some gas or chemical in the course of your work or daily life that could have caused a problem? How about some other change in your daily habits?

Again, not medical advise, but a couple more questions to answer. If and when you get a good diagnosis and treatment please post so all can benefit.

You know, the diving could have been coincidental, but it's just so hard to know. I wasn't exposed to anything else unusual in my environment or had any change in my daily habits. It was literally like I was perfectly fine one minute and beset by total vertigo and nausea the next. After I surfaced from the dive, I swam on the surface for several minutes and was fine even then.
The good news: it's 17 days since it happened and I'm about 90% back to normal. I even rode my mountain bike yesterday. It's still very strange riding over bumps; everything jumps around, but I'm finding ways to compensate. I believe the more I do the better my brain gets at learning to compensate.