Dizziness; Causes, Symptoms, Diagnosis, Treatment

Dizziness








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Dizziness is a feeling of being unsteady but can refer to different sensations including vertigo, feeling faint and problems with balance. This leaflet gives a brief overview of the causes of dizziness. There are separate, more detailed leaflets for some of the conditions listed.

Mechanism of Dizziness

Many conditions cause dizziness because multiple parts of the body are required for maintaining balance including the inner ear, eyes, muscles, skeleton, and the nervous system.

Common physiological causes of dizziness include

  • inadequate blood supply to the brain due to a sudden fall in blood pressure & heart problems or artery blockages
  • loss or distortion of vision or visual cues
  • disorders of the inner ear
  • distortion of brain/nervous function by medications such as anticonvulsants and sedatives
  • the result of side effect of prescription drugs, including proton-pump inhibitor drugs (PPIs) and Coumadin (warfarin) causing dizziness/fainting

Types of Dizziness

The clinical approach to the dizzy patient depends crucially on distinguishing among these various kinds of dizziness since the differential diagnosis is peculiar to each type.

  • Vertigo refers to the illusion of environmental motion, classically described as “spinning” or “whirling.” The sense of motion is usually rotatory—”like getting off a merry-go-round”—but it may be more linear—”the ground tilts up and down, like being on a boat at sea.” Disorientation in space and some sense of illusory motion are the common denominators here. Vertigo always reflects dysfunction at some level of the vestibular system, and these problems are discussed in.
  • Disequilibrium represents a disturbance in balance or coordination such that confident ambulation is impaired. Symptomatically, some such patients clearly profess that “the problem is in my legs,” but others feel “dizzy in the head, too.” Common to all patients with disequilibrium is the perception that ambulation either causes the problem or clearly makes it worse. Observation of the patient’s gait and a careful neurologic examination are thus essential in evaluating this type of dizziness.
  • (Pre)syncope means that the patient senses the impending loss of consciousness. When the patient has, in fact, experienced true syncope (actual loss of consciousness), considerations in apply. When the patient has not ever actually lost consciousness, the complaint “I feel like I will pass out” should be viewed skeptically, since other types of dizziness may be so described. In such circumstances, the approach to syncope in may or may not be pertinent.
  • Lightheadedness is very difficult to describe without using the word “dizzy,” but this verbal imprecision is, in fact, very helpful to the clinician. Lightheadedness refers to a sensation “in the head” that is clearly not vertiginous or presyncopal, and that is not invariably related to ambulation. This vague “negative definition” emphasizes that the lightheaded patient’s description is always hazily imprecise, and even articulate patients are frustrated by the request to describe the feeling without saying “dizzy.

Dizziness

The presenting manifestations and causes of peripheral vestibular types of vertigo
Type of disorderPresenting manifestationsExamples and causes
Chronic, bilateral peripheral vestibular dysfunctionOscillopsia on head movement (loss of the vestibulo-ocular reflex) Unsteadiness of stance and gait, worsening in darkness and on uneven ground (because of the partial or total removal of visual or somatosensory cues) Impairment of spatial memoryBilateral vestibulopathy due to (e.g.):

  • ototoxic substances (aminoglycosides)
  • bilateral Menière’s disease
  • meningitis
  • bilateral acoustic neuromas
    (= neurofibromatosis type 2)
Acute/subacute unilateral vestibular dysfunction (labyrinth and/or vestibular nerve) with the asymmetrical vestibular toneRotatory vertigo (lasting a few days to weeks) Oscillopsia due to spontaneous nystagmus Tendency to fall to a particular side NauseaVestibular neuritis due to reactivation of a latent herpes simplex virus type 1 infection
Inappropriate unilateral paroxysmal excitation or loss of function of the peripheral vestibular systemAttacks of rotational or swaying vertigo that (depending on their cause) may or may not be externally precipitated, are of varying duration and are accompanied by various other symptomsBenign peripheral paroxysmal positioning vertigo due to canalithiasis Menière’s disease due to rupture of the endolymphatic membrane Vestibular paroxysm due to neurovascular contact

Causes of Dizziness

Inner ear problems that cause dizziness (vertigo)

Your sense of balance depends on the combined input from the various parts of your sensory system. These include your:

  • Eyes, which help you determine where your body is in space and how it’s moving
  • Sensory nerves, which send messages to your brain about body movements and positions
  • Inner ear, which houses sensors that help detect gravity and back-and-forth motion

Vertigo is the false sense that your surroundings are spinning or moving. With inner ear disorders, your brain receives signals from the inner ear that aren’t consistent with what your eyes and sensory nerves are receiving. Vertigo is what results as your brain works to sort out the confusion.

  • Benign paroxysmal positional vertigo (BPPV) This condition causes an intense and brief but false sense that you’re spinning or moving. These episodes are triggered by a rapid change in head movement, such as when you turn over in bed, sit up or experience a blow to the head. BPPV is the most common cause of vertigo.
  • Infection -A viral infection of the vestibular nerve – called vestibular neuritis, can cause intense, constant vertigo. If you also have a sudden hearing loss, you may have labyrinthitis.
  • Meniere’s disease – This disease involves the excessive buildup of fluid in your inner ear. It’s characterized by sudden episodes of vertigo lasting as long as several hours. You may also experience fluctuating hearing loss, ringing in the ear and the feeling of a plugged ear.
  • A migraine – People who experience migraines may have episodes of vertigo or other types of dizziness even when they’re not having a severe headache. Such vertigo episodes can last minutes to hours and may be associated with a headache as well as light and noise sensitivity.

Circulation problems that cause dizziness

You may feel dizzy, faint or off balance if your heart isn’t pumping enough blood to your brain. Causes include

  • Drop in blood pressure – A dramatic drop in your systolic blood pressure — the higher number in your blood pressure reading — may result in brief lightheadedness or a feeling of faintness. It can occur after sitting up or standing too quickly. This condition is also called orthostatic hypotension.
  • Poor blood circulation-Conditions such as cardiomyopathy, heart attack, heart arrhythmia and transient ischemic attack could cause dizziness. And a decrease in blood volume may cause inadequate blood flow to your brain or inner ear.

Other causes of dizziness

  • Neurological conditionsSome neurological disorders — such as Parkinson’s disease and multiple sclerosis — can lead to progressive loss of balance.
  • Medications Dizziness can be a side effect of certain medications — such as anti-seizure drugs, antidepressants, sedatives, and tranquilizers. In particular, blood pressure lowering medications may cause faintness if they lower your blood pressure too much.
  • Anxiety disorders Certain anxiety disorders may cause lightheadedness or a woozy feeling often referred to as dizziness. These include panic attacks and a fear of leaving home or being in large, open spaces (agoraphobia).
  • Low iron levels (anemia)- Other signs and symptoms that may occur along with dizziness if you have anemia include fatigue, weakness, and pale skin.
  • Low blood sugar (hypoglycemia)- This condition generally occurs in people with diabetes who use insulin. Dizziness (lightheadedness) may be accompanied by sweating and anxiety.
  • Overheating and dehydration If you’re active in hot weather, or if you don’t drink enough fluids, you may feel dizzy from overheating (hyperthermia) or from dehydration. This is especially true if you take certain heart medications.

People experiencing dizziness may describe it as any of a number of sensations, such as:

Symptom of Dizziness

Dizziness, in itself, can be a symptom of some illness and is often accompanied by other symptoms.

The medical conditions that often have dizziness as a symptom include

Diagnosis of Dizziness

X-rays, CT scans, and MRI may be indicated depending upon the patient’s needs.

  • Eye movement testing– Your doctor may watch the path of your eyes when you track a moving object. And you may be given an eye motion test in which cold and warm water or air are placed in your ear canal.
  • Head movement testing– If your doctor suspects your vertigo is caused by benign paroxysmal positional vertigo, he or she may do a simple head movement test called the Dix-Hallpike maneuver to verify the diagnosis.
  • Posturography – This test tells your doctor which parts of the balance system you rely on the most and which parts may be giving you problems. You stand in your bare feet on a platform and try to keep your balance under various conditions.
  • Rotary-chair testing- During this test you sit in a computer-controlled chair that moves very slowly in a full circle. At faster speeds, it moves back and forth in a very small arc.
  • ENG (electro-nystagmography) checking eye movements while sitting down
  • Caloric Test – checking balance in each ear alongside eye movements
  • SVV/SVH short for subjective visual vertical or horizontal carried out in a dark room using lasers
  • Posturography -to check balance test while standing on a platform
  • Dix Hallpike Manoeuvre – to check for a build-up of crystals in the inner ear
  • VEMP Test (vestibular evoked myogenic potential) – to check balance while moving the head.

Treatment of Dizziness

Medications

Therapy of Dizziness

  • Head position maneuvers – A technique called canalith repositioning (or Epley maneuver) usually helps resolve benign paroxysmal positional vertigo more quickly than simply waiting for your dizziness to go away. It can be done by your doctor, an audiologist or a physical therapist and involves maneuvering the position of your head. It’s usually effective after one or two treatments. Before undergoing this procedure, tell your care provider if you have a neck or back condition, a detached retina or blood vessel problems.
  • Balance therapy –You may learn specific exercises to help make your balance system less sensitive to motion. This physical therapy technique is called vestibular rehabilitation. It is used for people with dizziness from inner ear conditions such as vestibular neuritis.
  • Psychotherapy – This type of therapy may help people whose dizziness is caused by anxiety disorders.

Certain foods and nutrients may help relieve symptoms of dizziness.

Water

A common cause of dizziness is dehydration. If you feel tired and thirsty and have less frequent urination when you’re dizzy, try drinking water and staying hydrated.

Ginger

Ginger may help relieve symptoms of motion sickness. It may help also treat nausea in pregnant women. You can take ginger in many forms. Incorporate fresh or ground ginger into your diet, drink ginger tea, or take it in supplement form. However, you should always consult your doctor before taking any kind of supplement, even if it’s natural. Supplements can interfere with other medical conditions you have or medications you take.

Vitamin C

According to the Meniere’s Society, consuming vitamin C can reduce vertigo in people with Meniere’s disease. Foods rich in vitamin C include:

  • oranges
  • grapefruits
  • strawberries
  • bell peppers

Vitamin E

Vitamin E can help maintain the elasticity of blood vessels, which can help prevent circulation problems. Vitamin E can be found in:

  • wheat germ
  • seeds
  • nuts
  • kiwis
  • spinach

Vitamin B-6

Foods rich in vitamin B-6 may also help treat dizziness. Some research has found that vitamin B-6 supplements helped reduce drug-induced vertigo symptoms. However, more research is needed.

Vitamin B-6 can also help prevent anemia. This vitamin can be found in foods such as:

  • pistachios
  • tuna
  • turkey
  • lean pork
  • prunes
  • apricots

Iron

If your doctor thinks you have anemia, they may encourage you to get more iron. Iron can be found in foods such as:

  • red meat
  • poultry
  • beans
  • dark leafy greens

References

Dizziness

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