Dizziness

Not to be confused with Dizziness (film)."Dizzy" redirects here. For other uses, see Dizzy (disambiguation).

Dizziness
Depiction of a person feeling dizzy
Specialty	Otorhinolaryngology, neurology
Symptoms	vertigo, 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]

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]

• 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. ^[6]
• 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 such as persistent postural-perceptual dizziness may be psychiatric in origin. It is a diagnosis of exclusion and can sometimes be brought about by hyperventilation. ^[3]

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:

• Inadequate blood supply to the brain due to:
  • A sudden fall in blood pressure ^[7]
  • Heart problems or artery blockages ^{[7] [9]}
  • Anaemias, such as vitamin B₁₂ deficiency anemia, iron deficiency anemia ^[9]
• Loss or distortion of vision or visual cues ^[7]
• Standing too quickly/prolonged standing ^[8]
• Disorders of the inner ear ^[7]
• Dehydration
• Distortion of brain/nervous function by medications such as anticonvulsants and sedatives ^[7]
• Dysfunction of cervical proprioception ^{[10] [11]}
• Side effects from other prescription drugs, such as proton-pump inhibitors ^[12] or Coumadin (warfarin) ^[13]

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]}

• 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 ^[20]
• 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 ^[6]

Disequilibrium

This section is about the loss of sense of balance. For other uses, see 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

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

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. 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. 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. "Dizziness and Vertigo". Merck Manual. 2009. Archived from the original on 2018-07-05. Retrieved 2010-08-12.
8. Norris C (4 July 2020). "What Causes Dizziness? Its Symptoms, Control and Risk Factors". Healthroid.
9. "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. Archived from the original on March 5, 2011. Retrieved 17 April 2018.
13. "Common Side Effects of Coumadin (Warfarin Sodium) Drug Center – RxList". rxlist.com. Retrieved 17 April 2018.
14. 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. doi:10.3928/00485713-20130703-07.
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.

External links

• Dizzytimes.com (Archived 2020-05-27 at the Wayback Machine )—Online community for people with vertigo and dizziness
• Dysautonomia Youth Network of America, Inc.