Dizziness/ Vertigo/ Anxiety

I'm seeing a 20-year-old college student brought in by her mom for panic disorder. She was "normal" until 6 months ago when she suddenly stopped going out to social gatherings. She was diagnosed with agoraphobia- and was given psychiatric medication. Her mom wanted a second opinion. In further questioning, I noted that 6 months ago she had a cold and developed an inner ear infection. After that, each time she went out, she felt dizzy and panicked. This is known as Visual Vertigo Syndrome or Supermarket Syndrome- characterized by vertigo, dizziness, unsteadiness or spatial disorientation by certain visual surroundings. It can happen in traffic, or anywhere there are bright colors on both sides of the visual fields and alternating lights. Patients may feel disoriented or lose their sense of balance. Some begin to panic and they think it is a panic attack. There is a mismatch in the way the eyes respond to stimulation because of an inner ear problem. I referred her for balance training, biofeedback to calm her when she feels she is losing control along with exercises to reprogram her neural pathways. She will not need psychiatric medication. Avoiding alcohol is also important. Already she is 80% better and back socializing and I expect a cure soon.

Afshine Ash Emrani, MD, FACC Internal Medicine, Cardiology

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