Dizziness: Causes, Symptoms, Diagnosis, and Treatment

Dizziness, commonly known as vertigo, is one of the symptoms of balance problems. It manifests as emotion, imbalance, vertigo, and lightheadedness. Additionally, there may be a sensation that the environment is spinning, similar to feeling faint, and loss of balance can occur. Various health issues can cause this condition. These include benign paroxysmal positional vertigo, vestibular migraines, and Meniere’s disease. More serious conditions can also lead to dizziness. Treatment methods vary depending on the identified cause. Doctors typically recommend vestibular rehabilitation, various medications, or special maneuvers. This way, solutions are found for patients’ balance problems.

What is Dizziness?

Dizziness is a condition frequently encountered both in outpatient settings and emergency departments. Most often requiring treatment while lying down, this condition is categorized into vertigo, pre-syncope feelings, lightheadedness, and balance disorders. Patients often struggle to distinguish these symptoms from one another, increasing the complexity of diagnosis. The symptoms individuals experience are usually vague and mixed, making accurate diagnosis difficult. The treatment process is shaped by the correct identification and classification of symptoms. Therefore, healthcare professionals often conduct comprehensive evaluations. Each symptom is thoroughly examined to accurately understand the patient’s overall health status.

What are the Causes of Dizziness?

The causes of dizziness are divided into three main categories. First, there are central or neurological causes. Within this group, strokes in the brainstem and cerebellum, as well as posterior circulation TIAs (transient ischemic attacks), play significant roles. The second category includes peripheral or vestibular causes. These causes include:

• Vestibular schwannomas
• Vestibular migraines
• Meniere’s disease
• Benign paroxysmal positional vertigo (BPPV)
• Bilateral vestibulopathy
• Superior canal dehiscence syndrome

Finally, cardiovascular causes can also lead to dizziness. These conditions include:

• Middle static hypotension
• Presyncope
• Vertebral artery dissection
• Arrhythmias

How Common is it?

Dizziness is a common health issue and can be seen in various age groups. It is particularly more frequent in older individuals. This symptom accounts for approximately 3% of visits to emergency departments and primary healthcare services. Each year, 15 to 20% of adults visit a doctor with complaints of dizziness. In total, this condition leads to approximately 7.5 million people utilizing healthcare services.

The distribution of dizziness by gender is also noteworthy:

• Women are affected three times more often than men.

This condition can be associated with various health problems:

• Serious conditions such as cerebellar stroke or brainstem stroke can be the sole symptom of dizziness.
• More than half of the patients with vertebral artery dissection experience dizziness or vertigo.

What are the Symptoms of Dizziness?

The symptoms of dizziness consist of balance and orientation disturbances that a person experiences. This condition is generally caused by inner ear disorders or nervous system dysfunctions. Symptoms vary from person to person, and some cases may be mild while others are more severe.

The primary symptoms associated with dizziness include loss of balance, a feeling of lightheadedness, and the sensation that the environment is spinning. These symptoms can have a sudden or gradual onset. Their duration can range from seconds to days or weeks. Symptoms may appear spontaneously without a triggering factor or may start after specific triggers. Medications used and changes in medications, alcohol or caffeine intake, and a recent history of head trauma can affect the severity and frequency of dizziness. Additionally, neurological symptoms such as dysarthria, dysphagia, diplopia, body ataxia, and cerebellar signs may suggest central causes of dizziness.

Symptoms indicating a cardiovascular etiology include chest pain, arrhythmias, dyspnea, and changes in orthostatic blood pressure. Such symptoms suggest that the underlying cause of dizziness may be related to the heart or vascular system. During a physical examination, some specific tests related to dizziness include:

Nystagmus:

• Bilateral nystagmus or spontaneous vertical or rotary nystagmus indicates a central cause.
• In BPPV, the rapid component towards the affected side can be fatiguing.
• Vestibular neuritis shows a rapid component away from the affected side and can be suppressed by visual fixation.

Additionally, walking and balance tests are also used in the diagnosis of dizziness:

• A positive Romberg test, where balance is lost with eyes closed, indicates bilateral vestibulopathy or somatosensory dysfunction.
• A wide-based gait suggests cerebellar dysfunction.

Checking vital signs, especially identifying open and orthostatic hypotension, is important in the evaluation of dizziness. Delayed orthostatic hypotension is usually detected with the tilt table test. These tests, which are conducted to differentiate the cause of dizziness, are crucial in determining the treatment plan.

How is Dizziness Diagnosed?

The diagnostic process for dizziness requires a detailed evaluation of the symptoms that patients experience. Healthcare providers typically determine the potential causes of dizziness based on the patient’s history and physical examination. This initial assessment is critically important for understanding the underlying cause of the symptoms.

These tests help in the early diagnosis of life-threatening conditions such as hypoglycemia or cardiac rhythm disorders. However, there may be more complex causes underlying dizziness. In such cases, additional tests may be necessary to confirm the source of the symptoms. Especially if central neurological problems are suspected, imaging methods are utilized.

How is Dizziness Treated?

The treatment of dizziness includes various methods aimed at addressing the underlying cause of the condition. The treatment process varies depending on the severity of the symptoms and the seriousness of the underlying disease. For the treatment of this condition, an accurate diagnosis is first essential. After the diagnosis is made, personalized treatment plans are implemented based on the type of disease.

The recommended treatment methods for Benign Paroxysmal Positional Vertigo are:

• Medications such as meclizine
• Epley maneuver
• Vestibular rehabilitation

In Meniere’s disease, treatment generally includes the following steps:

• Diuretics
• Salt restriction
• Intratympanic dexamethasone or gentamicin in severe cases

The treatment methods used in vestibular neuritis include:

• Antiemetics and antihistamines
• Benzodiazepines or dopamine antagonists
• Vestibular rehabilitation
• Steroids

Vestibular migraines are managed through lifestyle changes, while medications can be used prophylactically.

The recommended treatments for orthostatic hypotension include:

• Increasing water intake
• Reviewing the medication list
• Lifestyle modifications

What are the Complications?

The most critical complications of dizziness include secondary injuries. These health problems especially increase the risk of falls in older individuals. Falls can lead to serious and even disabling injuries. Since dizziness is more frequently observed in older individuals, the likelihood of encountering these complications also increases. The ability of individuals experiencing dizziness to perform daily activities can also be impaired. This condition negatively affects a person’s capacity to move independently. Below are some important complications that dizziness can cause:

• Increased risk of falls
• Disabling injuries
• Deterioration of daily activities

Murat Topdağ