Dizziness

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Dizziness
Dizziness.jpg
Vertigo, the sensation of one's surroundings spinning around them, is a common symptom of dizziness.
Specialty 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. [1] It can also refer to disequilibrium [2] or a non-specific feeling, such as giddiness or foolishness. [3]

Contents

Dizziness is a common medical complaint, affecting 20–30% of persons. [4] Dizziness is broken down into four main subtypes: vertigo (~25–50%), disequilibrium (less than ~15%), presyncope (less than ~15%), and nonspecific dizziness (~10%). [5]

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. [7] 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). [8]

Common causes of dizziness include:

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. [14] Some vestibular pathologies have symptoms that are comorbid with mental disorders. [15]

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. [16] [17]

Medical conditions that often have dizziness as a symptom include: [14] [18] [7] [19]

Epidemiology

About 20–30% of the population report to have experienced dizziness at some point in 2008. [6]

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. [21]

See also

Related Research Articles

Ataxia is a neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in eye movements, that indicates dysfunction of parts of the nervous system that coordinate movement, such as the cerebellum.

This is a glossary of medical terms related to communication disorders which are psychological or medical conditions that could have the potential to affect the ways in which individuals can hear, listen, understand, speak and respond to others.

<span class="mw-page-title-main">Ménière's disease</span> Disorder of the inner ear

Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Typically, only one ear is affected initially, but over time, both ears may become involved. Episodes generally last from 20 minutes to a few hours. The time between episodes varies. The hearing loss and ringing in the ears can become constant over time.

A balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness, or wooziness, or having a sensation of movement, spinning, or floating. Balance is the result of several body systems working together: the visual system (eyes), vestibular system (ears) and proprioception. Degeneration or loss of function in any of these systems can lead to balance deficits.

Mal de debarquementsyndrome is a neurological condition usually occurring after a cruise, aircraft flight, or other sustained motion event. The phrase "mal de débarquement" is French and translates to "illness of disembarkment". MdDS is typically diagnosed by a neurologist or an ear nose and throat specialist when a person reports a persistent rocking, swaying, or bobbing feeling. This usually follows a cruise or other motion experience. Because most vestibular testing proves to be negative, doctors may be baffled as they attempt to diagnose the syndrome. A major diagnostic indicator is that most patients feel better while driving or riding in a car, i.e, while in passive motion. MdDS is unexplained by structural brain or inner ear pathology and most often corresponds with a motion trigger, although it can occur spontaneously. This differs from the very common condition of "land sickness" that most people feel for a short time after a motion event such as a boat cruise, aircraft ride, or even a treadmill routine which may only last minutes to a few hours. Since 2020, the syndrome has recently received increased attention due to the number of people presenting with the condition, and more scientific research has commenced in determining what triggers MdDS and how to cure it. This is also due to the fact that MdDs is now officially recognized (2020).

<span class="mw-page-title-main">Vestibular system</span> Sensory system that facilitates body balance

The vestibular system, in vertebrates, is a sensory system that creates the sense of balance and spatial orientation for the purpose of coordinating movement with balance. Together with the cochlea, a part of the auditory system, it constitutes the labyrinth of the inner ear in most mammals.

<span class="mw-page-title-main">Labyrinthitis</span> Medical condition

Labyrinthitis is inflammation of the labyrinth, a maze of fluid-filled channels in the inner ear. Vestibular neuritis is inflammation of the vestibular nerve. Both conditions involve inflammation of the inner ear. Labyrinths that house the vestibular system sense changes in the head's position or the head's motion. Inflammation of these inner ear parts results in a sensation of the world spinning and also possible hearing loss or ringing in the ears. It can occur as a single attack, a series of attacks, or a persistent condition that diminishes over three to six weeks. It may be associated with nausea, vomiting, and eye nystagmus.

<span class="mw-page-title-main">Benign paroxysmal positional vertigo</span> Medical condition

Benign paroxysmal positional vertigo (BPPV) is a disorder arising from a problem in the inner ear. Symptoms are repeated, brief periods of vertigo with movement, characterized by a spinning sensation upon changes in the position of the head. This can occur with turning in bed or changing position. Each episode of vertigo typically lasts less than one minute. Nausea is commonly associated. BPPV is one of the most common causes of vertigo.

<span class="mw-page-title-main">Pagophagia</span> Medical condition

Pagophagia is the compulsive consumption of ice or iced drinks. It is a form of the disorder known as pica, which in Latin refers to a magpie that eats everything indiscriminately. Its medical definition refers to the persistent consumption of nonnutritive substances for over a period of at least one month. However, different studies have included alternative definitions including "daily consumption of 2-11 full glasses of ice (480-2640g)" or "the purposeful ingestion of at least one ordinary tray of ice daily for a period in excess of two months." Pagophagia has been shown to be associated with iron-deficiency anemia and responsive to iron supplementation, leading some investigators to postulate that some forms of pica may be the result of nutritional deficiency.

<span class="mw-page-title-main">Betahistine</span> Chemical compound

Betahistine, sold under the brand name Serc among others, is an anti-vertigo medication. It is commonly prescribed for balance disorders or to alleviate vertigo symptoms. It was first registered in Europe in 1970 for the treatment of Ménière's disease but current evidence does not support its efficacy in treating it.

Lightheadedness is a common and typically unpleasant sensation of dizziness or a feeling that one may faint. The sensation of lightheadedness can be short-lived, prolonged, or, rarely, recurring. In addition to dizziness, the individual may feel as though their head is weightless. The individual may also feel as though the room is "spinning" or moving (vertigo). Most causes of lightheadedness are not serious and either cure themselves quickly, or are easily treated.

<span class="mw-page-title-main">Vertigo</span> Type of dizziness where a person has the sensation of moving or surrounding objects moving

Vertigo is a condition in which a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties walking. It is typically worse when the head is moved. Vertigo is the most common type of dizziness.

<span class="mw-page-title-main">Vestibular nerve</span> Branch of the vestibulocochlear nerve

The vestibular nerve is one of the two branches of the vestibulocochlear nerve. In humans the vestibular nerve transmits sensory information transmitted by vestibular hair cells located in the two otolith organs and the three semicircular canals via the vestibular ganglion of Scarpa. Information from the otolith organs reflects gravity and linear accelerations of the head. Information from the semicircular canals reflects rotational movement of the head. Both are necessary for the sensation of body position and gaze stability in relation to a moving environment.

The semicircular canal dehiscence (SCD) is a category of rare neurotological diseases/disorders affecting the inner ears, which gathers the superior SCD, lateral SCD and posterior SCD. These SCDs induce SCD syndromes (SCDSs), which define specific sets of hearing and balance symptoms. This entry mainly deals with the superior SCDS.

The spins is an adverse reaction of intoxication that causes a state of vertigo and nausea, causing one to feel as if "spinning out of control", especially when lying down. It is most commonly associated with drunkenness or mixing alcohol with other psychoactive drugs such as cannabis. This state is likely to cause vomiting, but having "the spins" is not life-threatening unless pulmonary aspiration occurs.

Vertiginous epilepsy is infrequently the first symptom of a seizure, characterized by a feeling of vertigo. When it occurs, there is a sensation of rotation or movement that lasts for a few seconds before full seizure activity. While the specific causes of this disease are speculative there are several methods for diagnosis, the most important being the patient's recall of episodes. Most times, those diagnosed with vertiginous seizures are left to self-manage their symptoms or are able to use anti-epileptic medication to dampen the severity of their symptoms.

The righting reflex, also known as the labyrinthine righting reflex, is a reflex that corrects the orientation of the body when it is taken out of its normal upright position. It is initiated by the vestibular system, which detects that the body is not erect and causes the head to move back into position as the rest of the body follows. The perception of head movement involves the body sensing linear acceleration or the force of gravity through the otoliths, and angular acceleration through the semicircular canals. The reflex uses a combination of visual system inputs, vestibular inputs, and somatosensory inputs to make postural adjustments when the body becomes displaced from its normal vertical position. These inputs are used to create what is called an efference copy. This means that the brain makes comparisons in the cerebellum between expected posture and perceived posture, and corrects for the difference. The reflex takes 6 or 7 weeks to perfect, but can be affected by various types of balance disorders.

The term chronic subjective dizziness (CSD) is used to describe a commonly encountered type of dizziness that is not easily categorized into one of several other types, and for which the physical examination is typically normal. Patients with CSD frequently initially suffer a sudden injury of some sort to their vestibular system, the neurologic network that preserves sense of balance. Even after this initial injury has healed, people with CSD usually describe a vague sense of unsteadiness worsened by triggers in their environment such as high places, standing on moving objects, or standing in motion-rich environments like busy streets or crowds. There is a clear indication that anxiety and other mental illnesses play a role in the dizziness symptoms that occur with CSD. However, the condition is categorized as chronic functional vestibular disorder, not as a structural or psychiatric condition.

<span class="mw-page-title-main">Vestibular rehabilitation</span> Form of physical therapy for vestibular disorders

Vestibular rehabilitation (VR), also known as vestibular rehabilitation therapy (VRT), is a specialized form of physical therapy used to treat vestibular disorders or symptoms, characterized by dizziness, vertigo, and trouble with balance, posture, and vision. These primary symptoms can result in secondary symptoms such as nausea, fatigue, and lack of concentration. All symptoms of vestibular dysfunction can significantly decrease quality of life, introducing mental-emotional issues such as anxiety and depression, and greatly impair an individual, causing them to become more sedentary. Decreased mobility results in weaker muscles, less flexible joints, and worsened stamina, as well as decreased social and occupational activity. Vestibular rehabilitation therapy can be used in conjunction with cognitive behavioral therapy in order to reduce anxiety and depression resulting from an individual's change in lifestyle.

Inner ear decompression sickness, (IEDCS) or audiovestibular decompression sickness is a medical condition of the inner ear caused by the formation of gas bubbles in the tissues or blood vessels of the inner ear. Generally referred to as a form of decompression sickness, it can also occur at constant pressure due to inert gas counterdiffusion effects.

References

  1. Dizziness at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
  2. Reeves AG, Swenson RS (2008). "Chapter 14: Evaluation of the Dizzy Patient". Disorders of the Nervous System: A Primer. Dartmouth Medical School. Archived from the original on 2011-08-24. Retrieved 2011-05-24.
  3. 1 2 Branch Jr WT, Barton JJ (February 10, 2011). "Approach to the patient with dizziness". UpToDate.
  4. Karatas M (November 2008). "Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes". The Neurologist. 14 (6): 355–64. doi:10.1097/NRL.0b013e31817533a3. PMID   19008741. S2CID   21444226.
  5. Post RE, Dickerson LM (August 2010). "Dizziness: a diagnostic approach". American Family Physician. 82 (4): 361–8, 369. PMID   20704166.
  6. 1 2 3 Neuhauser HK, Lempert T (November 2009). "Vertigo: epidemiologic aspects" (PDF). Seminars in Neurology. 29 (5): 473–81. doi:10.1055/s-0029-1241043. PMID   19834858.
  7. 1 2 3 4 5 6 7 "Dizziness and Vertigo". Merck Manual. 2009.
  8. 1 2 Norris C (4 July 2020). "What Causes Dizziness? Its Symptoms, Control and Risk Factors". Healthroid.
  9. 1 2 "10 Surprising Facts About Dizziness and Vertigo". EverydayHealth.com. Retrieved 2021-11-14.
  10. Chu EC, Chin WL, Bhaumik A (November 2019). "Cervicogenic dizziness". Oxford Medical Case Reports. 2019 (11): 476–478. doi:10.1093/omcr/omz115. PMC   6902624 . PMID   31844531.
  11. Chu, ECP (2021). "Cervicogenic Dizziness Associated With Craniocervical Instability: A Case Report". Journal of Medical Cases. 12 (11): 451–454. doi:10.14740/jmc3792. PMC   8577610 . PMID   34804305.
  12. Center for Drug Evaluation and Research. "Drug Safety and Availability – FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs)". www.fda.gov. Retrieved 17 April 2018.
  13. "Common Side Effects of Coumadin (Warfarin Sodium) Drug Center – RxList". rxlist.com. Retrieved 17 April 2018.
  14. 1 2 Chan Y (June 2009). "Differential diagnosis of dizziness". Current Opinion in Otolaryngology & Head and Neck Surgery. 17 (3): 200–3. doi:10.1097/MOO.0b013e32832b2594. PMID   19365263. S2CID   9923013.
  15. Lawson BD, Rupert AH, Kelley AM (2013). "Mental Disorders Comorbid with Vestibular Pathology". Psychiatric Annals . 43 (7): 324.
  16. Muncie HL, Sirmans SM, James E (February 2017). "Dizziness: Approach to Evaluation and Management". American Family Physician. 95 (3): 154–162. PMID   28145669.
  17. Kerber KA, Newman-Toker DE (August 2015). "Misdiagnosing Dizzy Patients: Common Pitfalls in Clinical Practice". Neurologic Clinics. 33 (3): 565–75, viii. doi:10.1016/j.ncl.2015.04.009. PMC   9023124 . PMID   26231272.
  18. Tusa RJ (March 2009). "Dizziness". The Medical Clinics of North America. 93 (2): 263–71, vii. doi:10.1016/j.mcna.2008.09.005. PMID   19272508.
  19. Bronstein AM, Lempert T (2010). "Management of the patient with chronic dizziness". Restorative Neurology and Neuroscience. 28 (1): 83–90. doi:10.3233/RNN-2010-0530. PMID   20086285.
  20. O'Connor RE, Brady W, Brooks SC, Diercks D, Egan J, Ghaemmaghami C, et al. (November 2010). "Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S787-817. doi: 10.1161/CIRCULATIONAHA.110.971028 . PMID   20956226.
  21. Konrad HR (1990). "Chapter 123: Vertigo and Associated Symptoms". In Walker HK, Hall WD, Hurst JA (eds.). Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.). Boston: Butterworths. ISBN   0-409-90077-X. PMID   21250072.