Dizziness is a symptom that is defined differently by different patients. The word “dizzy” encompasses multiple descriptions – lightheadedness, swimming sensation, wooziness, unsteadiness, floating, imbalance, tipping, spinning or vertigo. Dizziness is the third most common cause of outpatient visits. In 80% of these cases, the dizziness is severe enough to require medical intervention. Dizziness affects 50% of the elderly population, making it the most common reason to visit a physician after age 75. Although dizziness can be a disabling condition, it is treatable in the majority of the patients.
Symptoms of Dizziness
Patients describe dizziness as wooziness, a floating or swimming sensation, lightheadedness, vertigo, where the room spins or the head spins in a stationary room, or imbalance and tipping. Symptoms may worsen with certain head movements. Associated symptoms, such as headache, nausea, vomiting, double vision, numbness or weakness, hearing loss, fullness or ringing in the ears and loss of urine control, may also exist.
Causes of Dizziness
The causes of dizziness are as varied as their clinical descriptions and can include different structures, from the inner ear to the brain. The most common causes of dizziness symptoms are outlined below:
Faint sensation or lightheadedness:
- Drop in blood pressure (orthostatic hypotension)
- Vasovagal syncope
- Cardiac arrythmias
- Fatigue and low blood sugar
- Benign paroxysmal positional vertigo
- Labyrinthitis or vestibular neuritis (inner ear infection)
- Meniere’s disease
- Closed head injury
Wooziness or Floating sensation:
- Hyperventilation syndrome
- Cerebellar disorders
- Vestibular weakness
Dizziness Examination and Tests
To reach a diagnosis, your neurologist will obtain a detailed history and accurate description of your symptoms. A detailed neurological examination helps to localize the involved area in the ear or brain. Your doctor may order an electronystagmogram (ENG), a test of eye movements and inner ear function, an MRI and/or blood work to determine the cause of your dizziness.
Treatment of Dizziness
Treatment for dizziness can vary from a simple adjustment of your medications or vestibular rehabilitation to different medical or surgical approaches. A neurologist will determine the cause of your symptoms and develop an appropriate treatment plan. The most common drug used for the symptoms of dizziness is meclizine. The most common form of intermittent and short-lasting vertigo is BPPV, which is typically treated in a vestibular rehabilitation program with certain habituation exercises and a guided movement of the head to help correct the cause called a modified Epley’s maneuver.
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