The bike ride would have gone well, if it weren’t for the heavy rains that had turned the stretches of the trail into a quagmire. My clumsiness also contributed to the predictable, but above all, unwelcome mishap. Finally, I took a showy fall, the end of which was my head against a root. I was blinded for a few moments, feeling like I was going to faint, but it didn’t. I vaguely remember the immediate events after the crash, but I recovered well. Out of prudence, I continued the journey until I had completed it.
The next morning, still off duty, I decided to swim safely, opting for zero risk of falling. But caution didn’t prevent another bad moment, after a turn I saw everything around me spin. I could see the bottom of the pool change position with the surface successively, a visual confusion of under and over. There was no logic, but I feared I would slip into the swirling pool. As a defense, I steadied my feet as I braced my hands on the edge. Touch guided me, vision did the opposite. This dissociation made me nauseous.
I imagined that I was suffering from an ischemic stroke, a specific area of ​​my brain, tasked with giving me balance, would die. This fear was influenced by old reminiscences of mine.
I had once helped a young woman who had suffered a stroke while she was swimming. I remembered her frightened expression, from the abrupt worsening to the deep sleepiness as she was taken to the hospital. Fortunately, there was a happy ending, treatment was adequate, and she made an exceptional recovery. The young woman had relied on a neurologist by the pool, who perhaps contributed to her improvement. But the patient at the time would be me, the neurologist, who would be surrounded by clumsy hunchbacks. I envisioned a lot of people around me, pouring alcohol on my wrists and fanning myself, a waste of time.
The anxiety was brief as the vertigo disappeared and the pool settled into its proper place. My reasoning, also accommodated, brought the reason for me to understand what happened. The dizziness was caused by the sudden movement of the turn, I did not suffer a stroke. Hours later I took a test on my bed, for diagnostic purposes. Sitting on the bed, I turned my head to the right side and lay down, and behold the convolutions again. My room rotated, but this time it was fun. I already knew what happened to me. My problem was a common one, with a pompous and very self-explanatory name: benign paroxysmal positional vertigo (BPPV).
Inside each of our ears is a precious organ, the labyrinth. This delicate structure signals to our consciousness the position of our head in relation to the body and space. Yes, my dear and unsuspecting reader, for the brain there is nothing obvious. If you know that your head is hanging over your neck, bent or not, it’s because there are neural systems that tell your consciousness that it is.
The labyrinth is part of one of these systems. Inside there is a liquid, positioned in different compartments. Any rotation of the head displaces the fluid differently in each of the compartments. Special cells sensitive to hydrodynamic changes, transform the movement of the liquid into information, and forward them to various brain centers. Including eye movement control nuclei. Thus, if the skull moves to the left, the eyes move to the right, at the same speed, without the interference of consciousness. This apparatus makes it possible for us to fix our gaze on something of interest, even if we move quickly over very uneven terrain.
My bicycle tumble sheared my labyrinth. As a result, clumps of cell debris were formed in their compartments. These consolidated into calculations, which impeded the labyrinthine flow. Thus, the rotation of my head would trigger a non-harmonic sway of liquids, in response, my eyes would move where they should have been stationary. The eye movement lasted until the liquids returned to rest, but as they shook, I saw the world samba.
The reason for my BPPV was the accident, but stones can form for unknown reasons, by the way, that’s how it is most of the time. But that doesn’t matter for the cure. Almost always a series of head movements is enough to throw the lumps out of the maze, and end the problem. That’s what I did and so, I had the cure.
This text of mine is not that original. Another neurologist had already described BPPV itself, also after an accident. But my redundancies don’t stop there. My experience has shown, once again, how misleading sensory information makes the mind confused and get the impression, and the attachment to the absurd — the swimming pool spinning. Without failing to demonstrate that we often evoke inappropriate memories for coping with unusual circumstances, as I do when thinking about stroke. The brain mechanisms that build what we believe to be reality are very delicate, a rich construction, usually precise, but sometimes very fragile.
Reference:
1. Mumford CJ. Post-traumatic benign paroxysmal positional vertigo. Pract Neurol. 2019 Aug;19(4):354–5.
