Dizziness
Dizziness is a very common problem, and can be divided into four groups: lightheadedness (vague symptoms, can be feeling disconnected from environment), vertigo (false sense of motion, spinning sensation), disequilibrium (off-balance or wobbly), and presyncope (feeling of losing consciousness or blacking out). Below I will discuss the common reasons and treatments for each of the four types of dizziness, but studies show that a final reason is not found in 20% of cases.
Lightheadedness
anxiety and depression are the most common causes, and treatment needs to be directed to help this
medicine side effects and medicine overuse or substance abuse (alcohol or illicit drugs) can give this sensation, and treatment is stopping or adjusting medicines and treatment for substance abuse
hyperventilation is a cause (breathing in excess of need, and people often sigh, and can have associated chest pain, numbness, and bloating), and can be treated by breathing control exercises (and occasionally rebreathing into a paper bag) and anxiety control/medicines
sometimes fever and sinus and ear infections can cause this symptom
Vertigo – problems with the inner ear are the most common causes of this and the most common causes of dizziness, about 30-40% of adults have some problem with this
benign positional vertigo (usually no hearing loss, episodic, and can have spells of recurrent eye movements)-treated during episode with anti-dizziness drug Antivert (or can Valium) and if recurrent needs referral to otolaryngologist for physical therapy exercises and/or canalith repositioning (can view these head and neck exercises at http://www.youtube.com/watch?v=ZqokxZRbJfw&NR=1)
vestibular neuritis (usually no hearing loss, persistent)-viral infection of the vestibular nerve and treated with oral prednisone over 3 weeks
labrynthitis (usually hearing loss, persistent)-infection of the labyrinthine inner ear organs and treated with oral prednisone
Meniere disease (usually hearing loss, episodic)- increased endolymphatic fluid in the inner ear and treated with salt restriction and/or diuretic water pills, and can be treated by injection or surgery by an otolaryngologist
migrainous vertigo (usually episodic vertigo with a migraine and often more pain/discomfort with full light)-treated by migraine prevention and medicines
Disequilibrium – there are many causes of this
medicine side effects are the most common cause of this, especially in the elderly (especially cardiac/blood pressure medicines, anti-depressants, muscle relaxants, anxiety and pain medicines, urinary and erectile medicines)
stroke or TIA are the most life-threatening causes and are almost always associated with other neurological problems such as weakness/paralysis of one side of the body, problems speaking, and others
sometimes ear infections can cause this symptom
poor vision can give this feeling and can lead to falls
Parkinson disease (along with rigidity and slow movements and tremor)
lower extremity numbness (especially in diabetics)
any musculoskeletal disease that can affect walking
Presyncope – usually a cardiovascular cause
arrhythmias (heart rate abnormalities)
heart attacks
carotid artery extreme narrowing
low blood pressure with change of position – if not caused by medicine or significant dehydration or anemia, may be treated first with non drug therapy (increasing water and salt intake, regular exercise, rising slowly from lying or sitting positions, sleeping with the head of bed elevated) and then if needed with medicines midodrine, fludrocortisone, pseudoephedrine, paxil, or desmopressin
medicine side effects as above – especially cardiovascular medicines in elderly
