Dizziness

Dizziness is a term  used to describe a range of sensations like feeling of spinning, swaying, tilting, floating or woozy. You may also feel that you might faint (lightheadedness) or sometimes you may have difficulty walking straight. When dizziness is associated with a feeling of  you or the surrounding  moving or spinning, it is called  vertigo. These feelings come and go and may last for seconds, hours or days and worsen with walking, standing up or moving your head.

Dizziness is a very common reason adults visit their doctors. Frequent dizzy spells or dizziness that occurs constantly can significantly affect your daily life. Dizziness that either resolves itself or resolves quickly with treatment is usually not so serious. However, in rare cases, dizziness indicates a serious life-threatening condition, especially when it is related to the disease of brain. Dizziness affects your sense of balance and increases your risk of falling leading to fall-related injuries, like hip fracture in elderly people.

 

Causes

Your sense of balance is affected by combined sensory input from following:

  • Eyes, that determine where your body lies in space and how it is moving;
  • Inner ear, that has sensors to help detect back-and-forth motion and gravity; and
  • Sensory nerves, that send messages about position and body movements to your brain.

 

Any disturbances in one or more of these paths may be responsible for dizziness. Because of a complex interaction between these inputs, finding an exact cause of dizziness is often difficult.

Dizziness that presents as light-headedness occurs when your brain doesn’t get enough blood supply. This may occur when:

  • There is a sudden drop in your blood pressure. This may happen when you suddenly get up from sitting or lying down position (particularly when you are very old or taking some medicine that drops the blood pressure). This is called orthostatic hypotension.
  • You are dehydrated because of diarrhea, vomiting, high fever, less drink and more activity in a hot weather, etc.
  • Other causes, such as:
    • You have  low hemoglobin or low blood sugar.
    • You have heart problems such as, abnormal heartbeat or heart attack.
    • Stroke (weakness of the part of your body due to bleeding inside the brain or block in the blood supply of the part of the brain).
    • You are taking anti-seizure, antidepressant or sedatives medicine.

 

Dizziness that presents as vertigo occurs when you have problem with the balance due to some abnormalities in the brain or inner ear. Some of them are life threatening while most are not serious.

  • Inner ear problems: The calculi or inflammation or infection in the inner ear that controls balance leads to vertigo. Those conditions are named as:
    • Benign Paroxysmal Positional Vertigo (a harmless disease caused by movement when there are stones in the inner ear),
    • Vestibular neuritis (inflammation of nerve that controls balance, caused by viral infection) and
    • Meniere disease (a serious disease caused by fluid in the inner ear).
  • Head injury: Concussion or mild traumatic brain injury affects the area that controls balance.
  • Brain problems: Bleeding in the brain, stroke or transient ischemic attack, disease like multiple sclerosis, Parkinson disease affect control of balance.
  • Migraine: In some kinds of disease causing headache, known as migraine, there can be dizziness associated with headache.
  • Medications: In rare cases, some medicines affect the function of inner ear or brain causing dizziness.

 

When to see a doctor

If you have dizziness, either with light headedness or vertigo, associated with any of the following symptoms, you should consult the doctor immediately.

  • Headache, especially if it is new or severe.
  • Vomiting, especially if it is projectile or repeated.
  • High fever.
  • Fainting and alteration of senses for more than few minutes.
  • Sudden change in speech or hearing or in vision.
  • Numbness or tingling sensation.
  • Weakness in leg(s) or hand(s).
  • Inability to walk without help.
  • Chest pain, shortness of breath.
  • Racing or skipping heart beat.
  • Head injury.
  • Seizures, Stiff neck.

 

In absence of above symptoms, if you experience recurrent, severe and prolonged episodes of lightheadedness or vertigo, you should consult your doctor.

 

Treatment options

Treatment of dizziness depends on symptoms  and the underlying cause. The treatment is usually effective, but the symptoms may occur again.

Mostly dizziness or vertigo is caused by less serious conditions, even though this symptom itself may feel like serious or bothersome. The treatment is aimed at reducing such symptom and treating the cause, if identified.

Your doctor will ask you details of your symptoms, any history of diseases and a list of currently taking medicine. The doctor will also examine you in detail including blood pressure in sitting and standing positions. You may also be asked to do these tests:

  • ECG.
  • Hearing tests.
  • Balance testing.
  • Blood tests.
  • CT or MRI of brain.

 

Your doctor may prescribe medicine to reduce symptom of dizziness or vertigo that is severe or lasting for long time. Other treatment option is balance rehabilitation. It helps by training your brain to modify its response to vestibular changes. This treatment work better if started soon after you get the vertigo. You should try to reduce the risk of falls at home by eliminating potential hazards such as loose electrical cords, slippery rags or walking in poorly-lit areas. Surgery may be needed in Meniere’s disease.

If you get light-headed when you stand up, following these steps may help you:

  • When standing, make sure you hold on to something.
  • Get up slowly from a lying position and stay seated for sometime before standing.
  • Avoid sudden change in your posture.
  • If you have flu or other febrile illness, drink plenty of fluids to avoid being dehydrated.

 

If you have vertigo, following these steps may prevent the worsening of your symptoms:

  • Keep still and rest at the time of symptoms.
  • Avoid sudden movements or change in position.
  • When you have a loss of balance, use cane to support if you need to walk at all.
  • Avoid bright and flickering lights and reading at the time of vertigo attacks.
  • Avoid driving, climbing, swimming or operating heavy machinery until one week after your symptoms are gone.

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