Dizziness Explained

Dizziness
Field:	ENT surgery, Otorhinolaryngology; if the dizziness is confirmed to be a symptom of a nervous system disorder, then neurology
Symptoms:	Feeling of things are spinning or moving when they are not, lightheadedness, giddiness, or unsteadiness

Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium^[1] or a non-specific feeling, such as giddiness or foolishness.^[2]

Dizziness is a common medical complaint, affecting 20–30% of persons.^[3] Dizziness is broken down into four main subtypes: vertigo (~25–50%), disequilibrium (less than ~15%), presyncope (less than ~15%), and nonspecific dizziness (~10%).^[4]

• Vertigo is the sensation of spinning or having one's surroundings spin about them. Many people find vertigo very disturbing and often report associated nausea and vomiting.
• Presyncope describes lightheadedness or feeling faint; the name relates to syncope, which is actually fainting.
• Disequilibrium is the sensation of being off balance and is most often characterized by frequent falls in a specific direction. This condition is not often associated with nausea or vomiting.
• Non-specific dizziness may be psychiatric in origin. It is a diagnosis of exclusion and can sometimes be brought about by hyperventilation.^[2]

Mechanism and causes

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.^[5] Thus dizziness can be caused by a variety of problems and may reflect a focal process (such as one affecting balance or coordination) or a diffuse one (such as a toxic exposure or low perfusion state).^[6]

Common causes of dizziness include:

• Inadequate blood supply to the brain due to:
  • A sudden fall in blood pressure
  • Heart problems or artery blockages^[7]
  • Anaemias, such as vitamin B₁₂ deficiency anemia, iron deficiency anemia
• Loss or distortion of vision or visual cues
• Standing too quickly/prolonged standing
• Disorders of the inner ear
• Dehydration
• Distortion of brain/nervous function by medications such as anticonvulsants and sedatives
• Dysfunction of cervical proprioception^{[8] [9]}
• Side effects from other prescription drugs, such as proton-pump inhibitors^[10] or Coumadin (warfarin)^[11]

Diagnosis

Differential diagnosis

Dizziness may occur from an abnormality involving the brain (in particular the brainstem or cerebellum), inner ear, eyes, heart, vascular system, fluid or blood volume, spinal cord, peripheral nerves, or body electrolytes. Dizziness can accompany certain serious events, such as a concussion or brain bleed, epilepsy and seizures (convulsions), stroke, and cases of meningitis and encephalitis. However, the most common subcategories can be broken down as follows: 40% peripheral vestibular dysfunction, 10% central nervous system lesion, 15% psychiatric disorder, 25% presyncope/disequilibrium, and 10% nonspecific dizziness.^[12] Some vestibular pathologies have symptoms that are comorbid with mental disorders.^[13]

While traditional medical teaching has focused on determining the cause of dizziness based on the category (such as vertigo vs. presyncope), research published in 2017 suggests that this analysis is of limited clinical utility.^{[14] [15]}

Medical conditions that often have dizziness as a symptom include:^{[12] [16] [17]}

• Benign paroxysmal positional vertigo
• Ménière's disease
• Labyrinthitis
• Otitis media
• Brain tumor
• Acoustic neuroma
• Motion sickness
• Ramsay Hunt syndrome
• Fatal Familial Insomnia
• Migraine
• Multiple sclerosis
• Pregnancy
• Low blood pressure (hypotension)
• Low blood oxygen content (hypoxemia)
• Heart attack^[18]
• Iron deficiency (anemia)
• Vitamin B₁₂ deficiency
• Low blood sugar (hypoglycemia)
• Hormonal changes (e.g. thyroid disease, menstruation, pregnancy)
• Panic disorder
• Hyperventilation
• Anxiety
• Depression
• Age-diminished visual, balance, and perception of spatial orientation abilities
• Stroke; cause of isolated dizziness in 0.7% of people who present to the emergency department

Epidemiology

About 20–30% of the population report to have experienced dizziness at some point in 2008.^[19]

Disequilibrium

In medicine, disequilibrium refers to impaired equilibrioception that can be characterised as a sensation of impending fall or of the need to obtain external assistance for proper locomotion. It is sometimes described as a feeling of improper tilt of the floor, or as a sense of floating. This sensation can originate in the inner ear or other motion sensors, or in the central nervous system. Neurologic disorders tend to cause constant vertigo or disequilibrium and usually have other symptoms of neurologic dysfunction associated with the vertigo. Many medications used to treat seizures, depression, anxiety, and pain affect the vestibular system and the central nervous system which can cause the symptom of disequilibrium.^[20]

See also

• Balance disorder
• Broken escalator phenomenon
• Chronic subjective dizziness
• Coriolis effect (perception)
• Equilibrioception
• Ideomotor phenomenon
• Illusions of self-motion
• Motion sickness
• Postural orthostatic tachycardia syndrome
• Proprioception
• Seasickness
• Spatial disorientation
• The spins, a state of dizziness and disorientation due to intoxication
• Vertigo

External links

• Dizzytimes.com —Online community for people with vertigo and dizziness
• Dysautonomia Youth Network of America, Inc.

Notes and References

1. Book: http://www.dartmouth.edu/~dons/part_2/chapter_14.html#chpt_14_presyncope . Chapter 14: Evaluation of the Dizzy Patient . Reeves AG, Swenson RS . Disorders of the Nervous System: A Primer . 2008 . Dartmouth Medical School . 2011-05-24 . 2011-08-24 . https://web.archive.org/web/20110824112805/http://www.dartmouth.edu/~dons/part_2/chapter_14.html. dead .
2. Web site: Approach to the patient with dizziness . Branch Jr WT, Barton JJ . UpToDate . February 10, 2011.
3. Karatas M . Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes . The Neurologist . 14 . 6 . 355–64 . November 2008 . 19008741 . 10.1097/NRL.0b013e31817533a3 . 21444226 .
4. Post RE, Dickerson LM . Dizziness: a diagnostic approach . American Family Physician . 82 . 4 . 361–8, 369 . August 2010 . 20704166 .
5. Web site: Dizziness and Vertigo . 2009 . Merck Manual . 2010-08-12 . 2018-07-05 . https://web.archive.org/web/20180705010644/http://www.merck.com/mmpe/sec08/ch084/ch084e.html?qt=dizziness&alt=sh . dead .
6. Web site: What Causes Dizziness? Its Symptoms, Control and Risk Factors . 4 July 2020 . Healthroid . Chris . Norris . vanc .
7. Web site: 10 Surprising Facts About Dizziness and Vertigo. 2021-11-14. EverydayHealth.com. en.
8. Chu EC, Chin WL, Bhaumik A . Cervicogenic dizziness . Oxford Medical Case Reports . 2019 . 11 . 476–478 . November 2019 . 31844531 . 6902624 . 10.1093/omcr/omz115 .
9. Chu . ECP . Cervicogenic Dizziness Associated With Craniocervical Instability: A Case Report . Journal of Medical Cases . 2021 . 12 . 11 . 451–454 . 10.14740/jmc3792 . 34804305 . 8577610 .
10. Web site: Drug Safety and Availability – FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs). Center for Drug Evaluation and Research . www.fda.gov. 17 April 2018.
11. Web site: Common Side Effects of Coumadin (Warfarin Sodium) Drug Center – RxList. rxlist.com. 17 April 2018.
12. Chan Y . Differential diagnosis of dizziness . Current Opinion in Otolaryngology & Head and Neck Surgery . 17 . 3 . 200–3 . June 2009 . 19365263 . 10.1097/MOO.0b013e32832b2594 . 9923013 .
13. Lawson BD, Rupert AH, Kelley AM. 2013. Mental Disorders Comorbid with Vestibular Pathology . Psychiatric Annals. 43. 7. 324 . 10.3928/00485713-20130703-07.
14. Muncie HL, Sirmans SM, James E . Dizziness: Approach to Evaluation and Management . American Family Physician . 95 . 3 . 154–162 . February 2017 . 28145669 .
15. Kerber KA, Newman-Toker DE . Misdiagnosing Dizzy Patients: Common Pitfalls in Clinical Practice . Neurologic Clinics . 33 . 3 . 565–75, viii . August 2015 . 26231272 . 10.1016/j.ncl.2015.04.009 . 9023124 .
16. Tusa RJ . Dizziness . The Medical Clinics of North America . 93 . 2 . 263–71, vii . March 2009 . 19272508 . 10.1016/j.mcna.2008.09.005 .
17. Bronstein AM, Lempert T . Management of the patient with chronic dizziness . Restorative Neurology and Neuroscience . 28 . 1 . 83–90 . 2010 . 20086285 . 10.3233/RNN-2010-0530 .
18. O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, Menon V, O'Neil BJ, Travers AH, Yannopoulos D . 6 . Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care . Circulation . 122 . 18 Suppl 3 . S787-817 . November 2010 . 20956226 . 10.1161/CIRCULATIONAHA.110.971028 . free .
19. Neuhauser HK, Lempert T . Vertigo: epidemiologic aspects . Seminars in Neurology . 29 . 5 . 473–81 . November 2009 . 19834858 . 10.1055/s-0029-1241043 .
20. Book: Konrad HR . Chapter 123: Vertigo and Associated Symptoms . https://www.ncbi.nlm.nih.gov/books/NBK228/ . Walker HK, Hall WD, Hurst JA . Clinical Methods: The History, Physical, and Laboratory Examinations. . 3rd . Boston . Butterworths . 1990 . 21250072 . 0-409-90077-X .