Diagnosing Dizziness

The types of dizziness can vary as much as the causes

Dizzy woman portrait
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Dizziness is a very common problem. More often than not, it is caused by a condition or illness that is easily treated or resolves on its own. Sometimes, however, dizziness can be a sign that something serious or even life threatening. By identifying the "type" of dizziness a person is experiencing, doctors can often pinpoint the underlying cause before it becomes a problem.

Types of Dizziness

Dizziness is a term which can be used to describe several distinct sensations, each of which is linked to different organ systems or illnesses.

By describing these sensations, you can provide your doctor the means to offer a diagnosis and begin investigations.

Dizziness can be described in the following ways:

  • Presyncope is "feeling lightheaded." This is the sensation you may experience if standing up too quickly. In some cases, you may turn pale, feel clammy, or even pass out (which we refer to as syncope). Presyncope happens as a result of the restriction of blood to the brain. It may be caused by something as simple as not drinking enough water or as serious as heart disease.
  • Disequilibrium is feeling "off balance." This is the sensation of not being able to maintain balance, often veering to one side of the other. If it appears suddenly, it may be caused by something as uncomplicated as an ear infection or as serious as a neurological disease. If the symptoms progress slowly, it may be the result of a degenerative movement disorder such as Parkinson's disease or a systemic (all-body) infection affecting the nervous system.

  • Vertigo is when everything is "spinning in circles." It is the same sensation you have if you've been spinning around quickly and suddenly stop. Vertigo can be caused by an inner ear problem, resulting in peripheral vertigo. It can also be the result of a problem with the brainstem which regulates balance and equilibrium. We refer to this latter condition as central vertigo. Causes can include everything from toxins and metabolic disorders (such as kidney failure) to multiple sclerosis and stroke. Double vision, tingling, numbness, weakness, facial drooping, or difficulty swallowing may also accompany.

  • Non-specific dizziness is more about "feeling funny." In this case, the term dizziness may be used to describe a symptom you can't put your finger on, such as fatigue or disorientation. It may involve an "out of body" sensation you may be having after starting a new medication. In some cases, the sensation may be psychiatric in nature.

Dizziness as a Symptom of Serious Illness

Around eight million people visit their doctors each year due to unexplained dizziness. It most cases, the cause will be simple and require little or no medical intervention. At other times, dizziness can serve as an early warning sign to a severe or life-threatening situation.

Among the most serious conditions associated with dizziness:

  • Vertebrobasilar insufficiency is a term used to the decreased blood flow to the brainstem. When this happens, a person may experience symptoms of central vertigo which go well beyond lightheadedness. If blood supply is reduced for a brief period of time, it can cause a transient ischemic attack (sometimes referred to as a "mini stroke"). If the restriction is longer, it can lead to a stroke and permanent brain damage.
  • Brainstem infections can also lead to vertigo. One of the more common causes is viral labyrinthitis, a type of infection that leads to inflammation in the inner ear. Other, more serious infections include Cryptococcus (a fungal infection frequently seen in people with advanced HIV) or communicable bacteria such as tuberculosis or listeria. Viruses such as herpes zoster can also cause dizziness by attacking the nerves in your face nearest your ear.
  • Heart disease is frequently associated with dizziness due to an insufficient blood supply to the brain. Advancing cardiovascular diseases reduce the heart's ability to pump blood efficiently against the pull of gravity. This is why standing up quickly can cause presyncope in some. Cardiac arrhythmias (irregular heart beats) can often do the same thing.
  • Endocrine tumors are rare but are known to secrete hormones that can make us feel dizzy. An example is an insulinoma, a tumor which secretes the same hormone used by diabetics to regulate blood sugar. If too much is released, the person's blood sugar can become so low as to cause dizziness, weakness, and disorientation. Another type, called pheochromocytoma, secretes hormones that increase blood pressure and may cause nonspecific dizziness.
  • Guillain-Barré is an autoimmune disorder in which the body's immune system attacks the peripheral nervous system. Guillain-Barré may be triggered by an acute bacterial or viral infection. Symptoms typically start as weakness and tingling in the feet and legs which gradually spread to the upper body. Unsteadiness is common as the disease advances. Paralysis can sometimes occur.
  • Wernicke’s encephalopathy (WE) is caused by a deficiency of thiamine (vitamin B1). People with WE can have problems moving their eyes as well as maintaining steadiness when walking. Moreover, they can develop memory problems which may become irreversible unless they are provided the vitamin as soon as possible. Most symptoms will improve quickly if thiamine deficiencies are treated early.

A Word From Verywell

When seeing a physician about symptoms of dizziness, be as specific as possible when describing what you are experiencing. Be sure to disclose information about any and all medications you may be taking, prescribed or otherwise, or any changes you may have made to your diet, lifestyle, alcohol intake, or work schedule.

The more precise you are about the symptoms you are experiencing, the more readily a diagnosis can be made.

Sources:

Ropper, A.; Samuels, M.; and Klein, J. Adams and Victor's Principles of Neurology (10th Edition). New York: McGraw-Hill, 2014; ISBN-10:007179474.

Rubin, D. and Cheshire, W. "Evaluation of 'Dizziness' in the Neurology Office" Seminars in Neurology. 2011; 31(1): 029-041.

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