Also called: Lightheadedness, Vertigo, Presyncope, Disequilibrium
Dizziness is a disorienting sensation that may be described as feeling faint, unsteady or lightheaded. These feelings may be attributed to minor physiological changes, such as those caused by standing too quickly or consuming too much caffeine. However, dizziness may also be a sign of more serious underlying factors, such as a neurological (nervous system) disease.
Dizziness is related to the body’s sense of balance. Maintaining balance, or equilibrium, depends on the brain and spinal cord (known as the central nervous system) processing information from several sensory systems, including those of the ears, eyes, skin, muscles and joints. A person may feel dizzy when one or more of these systems send contradictory information to the brain or the brain is unable to process the information it receives.
Physicians typically associate four disorders with dizziness: vertigo, disequilibrium, near-fainting (presyncope) and non-specific dizziness. They differ in the patient’s sensations and the associated physiological activities. In addition to these forms of dizziness, the patient may also experience other symptoms including confusion, nausea and fainting.
Dizziness may result from minor imbalances in the body or be a symptom of a more serious condition. In some cases, sitting or lying down may help the sensation pass. Patients should consult the physician if the dizziness does not pass within a few days, becomes severe, or is associated with a loss of coordination. In some cases, dizziness may be a sign of a stroke, brain tumor, multiple sclerosis or epilepsy, and early detection may aid treatment for the underlying condition.
To determine the underlying condition causing dizziness, the physician will likely conduct a physical examination and neurological examination. In addition, imaging tests, blood tests and heart tests are among the many methods that may be necessary to identify the underlying condition.
Dizziness is a sensation of spatial disorientation. Patients may experience a loss of balance or feel that the room is spinning. The term may also be used to describe any number of similar sensations, including feeling lightheaded, unsteady or woozy. In addition to dizziness, patients may also experience other symptoms such as confusion, nausea, fainting, sweating, headache, vision loss or blurred vision and fatigue.
Dizziness is related to the body’s sense of balance, also known as equilibrium. Maintaining balance requires communication and a series of complex processes between the central nervous system (the brain and spinal cord) and the senses. The sensory systems involved in balance include:
- Vestibular system. This system of the inner ear monitors movement and direction. It is comprised of three fluid-filled canals that are connected to sacs called the saccule and the utricle. The vestibular system is able to sense both the direction and the speed of the body’s movement.
- Visual system. The eyes are able to monitor the body’s motion and position in space. They add to the information provided by the vestibular system and the proprioceptive system.
- Proprioceptive system. The nerves in the skin, muscles, ligaments and joints provide continual information on the position and movement of parts of the body. They are able to sense the feeling of walking, for example, or the physical sensation of traveling fast.
Each of these systems is important in maintaining balance, but only two are required to function at one time. The systems send information on the body’s movement and position in space through neurons (nerve cells) to the brain and spinal cord. Inside the brain, the cerebellum, cerebral cortex, brain stem and several other brain regions are involved in processing and producing a response to the signals. Dizziness may result when the brain is unable to process the signals from the sensory systems or the sensory systems send contradictory information to the brain.
In general, there are four disorders that may be characterized as dizziness. These include:
- Vertigo. The patient experiences the sensation of falling, spinning, or abnormal movement of the surrounding environment.
- Disequilibrium. A sense of imbalance that may occur while standing or walking.
- Presyncope. A near-fainting sensation. It may be preceded by ringing in the ears (tinnitus) or diminished vision.
- Nonspecific dizziness. Vague sensations of lightheadedness or wooziness that cannot be identified as vertigo, disequilibrium or presyncope.
Potential causes of dizziness
Dizziness is a result of miscommunication between sensory tissues and the brain. This miscommunication can have a wide variety of potential causes, many of which are temporary and minor. However, in some cases, dizziness may be a sign of a more severe condition that may require medical attention.
One of the most common causes of dizziness relates to problems of the ear. Any disruption of the vestibular system of the inner ear may result in brief or prolonged bouts of dizziness. This may be caused by many factors including inner-ear infections or injuries to the ear. People with hearing loss or tinnitus tend to experience dizziness, which may or may not be related to a more serious underlying condition.
Another common cause of dizziness is conflicting messages from the sensory tissues to the brain. For example, some people may experience dizziness while traveling in a car (known as motion sickness). This is because the eyes sense that the body is moving very fast, whereas the inner ear registers that the body itself is not moving at all. Some older people may also experience this type of dizziness while walking. This may be due to poor vision or a decreased sense of position because of neuropathy. In these cases, the brain does not receive all the sensory signals it is expecting and dizziness may result.
Anything that affects the brain, particularly the parts of the brain involved in movement or balance may also lead to dizziness. For example, one of the first symptoms of a stroke or a transient ischemic attack (TIA) is dizziness as the parts of the brain that are associated with movement and balance are deprived of oxygen and unable to work efficiently. Additionally, dizziness may be caused by factors such as head injuries, seizures and brain tumors or lesions.
There are also several diseases and conditions that may cause dizziness. These may include:
- Ménière disease
- Parkinson’s disease and parkinsonism
- Multiple sclerosis
- Olivopontocerebellar atrophy
- Progressive supranuclear palsy
Brief, isolated dizzy spells may occur without being cause for alarm. They may be due to pregnancy, standing too quickly, consuming stimulants (e.g., caffeine, nicotine), taking certain medications or wearing new prescription eyeglasses. In these cases, sitting or lying down may help the dizziness pass. Repeated or long-lasting spells of dizziness may indicate a more serious condition, in which case, the patient should consult a physician.
Treatment of dizziness
Individuals who experience dizziness are generally advised to sit or lie down immediately and wait for the sensation to pass. They should avoid the use of caffeine, alcohol and tobacco, which can worsen symptoms, and refrain from operating motor vehicles and other heavy machinery. Most spells of dizziness are temporary and normally resolve themselves within a short space of time.
A physician should be contacted immediately if any of the following occur:
- The person loses consciousness.
- Vision, hearing or speech are impaired or lost.
- The patient experiences chest pain or tingling, numbness or weakness in a limb.
- The room appears to spin.
- Dizziness interferes with daily activities.
- Lightheadedness lasts for more than a few days.
- Dizziness occurs after taking a specific medication (e.g., aminoglycoside antibiotics which can damage the hair cells in the inner ear).
Diagnosing dizziness begins with a medical provider taking a medical history and performing a physical examination and a neurological examination. The physician will examine the patient’s eyes, ears and reflexes. Vital statistics, including pulse rate, blood pressure and temperature will also be taken. To pinpoint the exact nature of the dizziness, the physician may request further information about the patient’s symptoms. Questions may include:
- When did the dizziness begin?
- How often does the dizziness occur?
- Is the dizziness accompanied by other symptoms, such as fainting, nausea or vomiting?
- Does the patient feel as though the room is spinning?
- Is the dizziness interfering with activities?
Based on the patient’s responses to these questions and the results of the physical and neurological examinations, the physician may recommend additional tests. These may include:
- Imaging tests. Cranial computed tomography (CAT scans) and magnetic resonance imaging (MRI) create images of the patient’s brain for the physician to examine. They may identify a brain tumor, stroke or other possible neurological cause of dizziness.
- Electronystagmogram and hearing tests. These detect abnormal movements of the eyes or damage to the inner ear, both of which affect balance and may cause dizziness.
- Blood test or urine test. Analysis of body fluids may identify abnormal levels of blood sugar (glucose) or proteins. This may indicate an underlying condition that may cause dizziness.
Once the underlying cause of the dizziness is diagnosed, treatment for the condition may begin as soon as possible. Many treatments may be available and the patient’s physician will recommend the most suitable depending on the cause. Options include taking or discontinuing medications, lifestyle modification (e.g., stopping smoking, exercising), or a medical procedure or surgery. It is important to follow all of the physician’s recommendations for treating dizziness, including proper use of medications and lifestyle changes. Controlling the underlying condition will likely reduce or prevent the occurrence of further dizzy spells.
Questions for your doctor regarding dizziness
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following dizziness-related questions:
- What is the cause of my dizziness?
- Is it related to a neurological or other serious medical condition?
- What tests can help diagnose the cause of my dizziness?
- Can you recommend a specialist to help treat my dizziness?
- Could any of my current medications be contributing to my dizziness?
- What are my treatment options?
- What changes to my daily lifestyle do I need to make?
- Are there activities I should avoid?
- How soon will my dizziness resolve?
- What should I do if my dizziness becomes more severe?