| Dizziness is a term that is used to explain different sensations, such as lightheadedness and spinning (vertigo) accompanied by an involuntary, rapid, rhythmic eye movement (nystagmus), giddiness, and a feeling like one is going to faint (syncope). Without other symptoms, this condition is usually not serious.
There are many causes for dizziness and giddiness. Decrease in circulating blood and oxygen to the brain can cause dizziness and fainting. Sudden change in one's position from sitting or lying (postural hypotension) can also cause dizziness. Irregular heart rate or rhythm (dysrhythmia) can result in a sudden reduction in the amount of blood pumped to the brain and can cause dizziness. Temporary deficiency of blood in the brain secondary to narrowing of the arteries in the brain (cerebral transient ischemic attack, or TIA) can result in dizziness. Dizziness can result from medications such as vasodilators, decongestants, antidepressants, antihypertensives, antihistamines, or diuretics; from anemia due to blood loss; and from decreased blood volume or fluid loss from trauma or sweating. When lightheaded dizziness leads to syncope or an actual loss of consciousness, problems with blood circulation (heart, blood vessels, and problems that affect their function) must be checked. Dizziness may also occur with diabetes mellitus and Parkinson's disease.
Disorders involving the balance organs in the ear resulting from infection or inflammation of the inner ear (labyrinthitis), inner ear fluid imbalance (Ménière's disease), viral infection of the vestibular nerve (vestibular neuronitis), and inner ear fluid leaking into the middle ear can cause individuals to feel dizzy or unsteady; ringing in the ears (tinnitus) can also develop. Double vision (diplopia) is a more serious symptom that may indicate a disease affecting the brainstem, a warning of a serious stroke, or other disease processes. Slurred speech (dysarthria) that accompanies dizziness and vertigo points to a process affecting the brain itself.
Other causes of dizziness include anxiety, stress, fatigue, fever, strenuous coughing, straining with defecation or urination, stomach flu, common cold, pressure on the neck (tight collar), spinning rapidly around in a circle (as during carnival rides), low blood pressure (hypotension), severe pain, injury, fright, standing rigidly at attention, alcohol intoxication, certain drugs, hyperventilation, low blood glucose (hypoglycemia), perforated eardrum (tympanic membrane), ear diseases (i.e., mastoiditis, otitis media, cholesteatoma, vestibular neuronitis), and hysterical seizures.Risk: Susceptibility to dizziness and giddiness increases with age. The female to male ratio is 1.5 to 1 (Hamid). |
Source: Medical Disability Advisor
| History: The individual is questioned in detail as to when dizziness occurs, the nature of the dizziness, how long the spells last, other concurrent symptoms, and for a history of any other disease processes. The individual may complain of lightheadedness, spinning (vertigo), fainting (syncope), unsteadiness, and the sense that surrounding noises are growing fainter and fainter. Sometimes other symptoms such as nausea, vomiting, visual blurring, sweating, generalized discomfort, and disorientation may follow dizziness. Physical exam: Upon examination, the physician may detect problems with vision, sensitivity to noise or bright light (photophobia), ability to think (cognitive), or memory. The individual may be disoriented and sweat profusely. Blood pressure may be low (hypotension). Tests: The underlying cause for dizziness may be determined by positional testing using Frenzel lenses. Vigorous head shaking in the horizontal plane for about 10 seconds may reveal the reason for dizziness. Other tests that may be used to rule out a balance disorder include a test of vestibular system (caloric test), a check for abnormal eye movements (electronystagmogram, or ENG), imaging studies of the head and neck (CT scan, MRI), and posturogram (where the individual stands on a platform and body sway is recorded in response to the movement of the platform), an audiogram to identify sensorineural hearing loss resulting from nerve damage, carotid angiogram to identify narrowing or other abnormality in the carotid artery (main artery to the brain), carotid doppler studies, electrocardiogram (ECG), chest x-ray, echocardiogram, wearing a Holter monitor to assess cardiac function, and psychological tests to evaluate stress and identify anxiety and panic disorders and their triggers. |
Source: Medical Disability Advisor
| Treatment for dizziness is based on its underlying cause, and may consist of bed rest and taking medications such as antihistamines, centrally acting anticholinergics, antibiotics, or medications affecting the GABA (gamma-aminobutyric acid) receptors.
If medical management is not effective, surgery may be indicated. A variety of inner ear surgical procedures can be done for dizziness if the condition is due to a balance disorder. These include the removal of the interconnecting cavities/canals (labyrinth) that constitute the inner ear (labyrinthectomy), cutting the balance nerve (selective vestibular neurectomy), or placing a shunt within the labyrinth (endolymphatic shunt).
Postural hypotension is treated by educating individuals to be cautious about rising suddenly from bed, instructing them to exercise their legs, and to sit at the edge of the bed (dangle) to make sure they do not feel lightheaded before standing.
Dietary changes and reducing alcohol, caffeine, and nicotine intake may be helpful in the treatment of dizziness. Regular exercise, moving slowly and deliberately, and taking good care of health are also important in treating this problem. |
Source: Medical Disability Advisor
| In most cases individuals recover fully. If dizziness is due to an underlying disease, prognosis will depend on that disease, its severity, and how well it can be treated. Attacks of dizziness are usually controlled in one-half to two-thirds of individuals who have the endolymphatic shunt. Recovery from this procedure is short compared to other procedures.
Attacks of dizziness are permanently cured for a high percentage of people after selective vestibular neurectomy; labyrinthectomy also results in a high cure rate for dizziness. |
Source: Medical Disability Advisor
| Complications include trauma associated with falls that are due to fainting. An underlying disease process may have associated complications. |
Source: Medical Disability Advisor
| Work restrictions and accommodations may depend on the job the individual performs. Operating machinery, driving a motor vehicle, and handling hazardous objects pose a safety concern. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have postural hypotension? Does individual have an adverse side effect from prescription medications? Is there anemia or fluid loss? Does individual have an irregular heart rate or TIAs? Does individual have any heart problems, diabetes, or Parkinson's disease? Are there any disorders of any part of the ear? Does individual have tinnitus?
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Has individual had a head injury?
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Is there double vision or slurred speech?
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Does individual exhibit anxiety, stress, fatigue, fever, or strenuous coughing?
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Has there been straining with defecation or urination, stomach flu, common cold, pressure on the neck (tight collar), or spinning rapidly around in a circle (as during carnival rides)? Does individual experience severe pain, injury, fright, or standing rigidly at attention?
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Are there signs of alcohol intoxication, hyperventilation, or hypoglycemia? Does individual have hysterical seizures?
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Were a caloric test, ENG, CT, MRI, and posturogram done? Was an audiogram, carotid angiogram, and Doppler studies performed? Has individual has an ECG, chest x-ray, echocardiogram, and Holter monitor?
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Was psychological testing done?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Has individual been on medications? Were they helpful? Is surgery indicated?
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Has individual made any necessary dietary changes such as reducing alcohol, caffeine, and nicotine intake?
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Does individual exercise regularly? Take good care of health?
Regarding prognosis:
- Has individual undergone vestibular rehabilitation with a trained professional?
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Can individual's employer accommodate any necessary restrictions?
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Does individual have any conditions that may affect ability to recover?
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Has individual experienced trauma associated with falls due to fainting?
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Source: Medical Disability Advisor
| Hamid, Mohamed, and Nicholas Loarenzo. "Dizziness, Vertigo, and Imbalance." eMedicine. Eds. Spiros Manolidis, et al. 4 Oct. 2004. Medscape. 23 Oct. 2004 <http://emedicine.com/neuro/topic693.htm#section~medical_treatment>. |
Source: Medical Disability Advisor
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