Dizziness

last authored:

Introduction

Dizziness is a common complaint which increases with age; it is the most common presenting problem in ambulatory patients over 75.

Dizziness is a broad category of signs and symptoms, include presyncope, dysequilibrium, and vertigo.

presyncope
dysequlibrium
vertigo

Presyncope

Presyncope is the feeling one is about to faint. It can be accompanied by feeling light-headed, tunnel vision, diaphoresis, a sensation of buzzing, or rubbery legs.

Causes can be vasovagal (post-vomiting, urination, defecation, or coughing) vascular (hypotension, vertobasilar insufficiency, subclavian steal) cardiac (arrhythmia, valvular problems) or neurological (seizure, hydrocephalus). Cervical spondylosis is present on X-ray in most people over 70, and this can exascerbate or cause dizziness.

Dysequilbrium

Dysequilibrium is a sensation of imbalance, usually accompanied by a fear of falling. It can be partly due to cerebellar dysfunction, peripheral neuropathy, deconditioning, Parkinson's disease, and certain medications.

Vertigo

Vertigo is the illusion of false motion, usually of the world. Spinning within the head is typically functional or psychogenic.

Nausea, vomiting, nystagmus, ataxia, and diaphoresis may also be present. The body almost always adapts to make vertigo temporary.

Common causes include BPV, vestibular neuronitis, Meniere's disease, and migraines. Stroke and acoustic neuromas are rare causes.

Peripheral vertigo is associated with sensory loss and tinnitus, suggesting problems with cranial nerve VIII. Central vertigo is associated with vestibular nuclei, connections within the brainstem, or cerebellum.

cerebral hemmorhage or infarction
multiple sclerosis
acoustic neuromas

Benign paroxysmal positional vertigo (BPPV)

comes and goes lasts for seconds or minutes and is related to position of head. It is possibly caused by free-floating particles.

Fixed with Epley maneuvers.

Meniere's disease

quite rare
recurrent attacks of vertigo lasting hours
associated tinnitus, hearing loss, aural pressure
possibly caused by endolymphatic hydrops, with mixing of endolymph and perilymph