Dizziness

What Dizziness Is and Why It Occurs

Dizziness is a sensation of imaginary movement of the body or surrounding space that does not correspond to reality. In most cases, people describe it as unsteadiness, spinning of objects, imbalance or loss of stability. This symptom is not a separate disease but a signal of possible disorders in the vestibular system, cardiovascular system or nervous system. Dizziness is very common and ranks just after headache as one of the most frequent neurological symptoms.

It is important to distinguish between systemic (vestibular) and non-systemic dizziness. The former is usually accompanied by a feeling of spinning of the body or objects and may indicate damage to the inner ear or neural structures. The latter is often associated with impaired blood supply to the brain, a sudden drop in blood pressure or emotional stress. Dizziness may be short-term or prolonged, occur occasionally or almost daily, so proper diagnosis is crucial.

Main Clinical Manifestations and Types of Dizziness

Dizziness can present in different ways — from a mild feeling of instability to a sharp loss of balance. The symptoms depend on the cause and the organs involved in the pathological process. Doctors distinguish several conditions that patients often describe as dizziness:

• Vestibular dizziness (vertigo). An intense sensation of spinning or movement, balance disturbance, nausea, vomiting, sweating and blurred vision. It occurs when the inner ear or vestibular nerve is affected.
• Presyncope. Sudden darkening before the eyes, a feeling of falling, weakness in the legs, ringing in the ears. It is often caused by arterial hypotension or insufficient oxygen supply to the brain.
• Coordination disorders. Unsteady gait, insecure movements and difficulty maintaining balance. These can indicate damage to the cerebellum or other structures of the central nervous system.
• A feeling of «intoxication» without alcohol. Clouded consciousness, slowed perception, fear of falling, nausea. This often accompanies neuroses, panic disorders or emotional overload.

In each case, it is essential to assess the intensity, recurrence and accompanying symptoms in order to detect the underlying cause in time.

The Most Common Causes of Dizziness

Dizziness has many causes — from benign positional disturbances to complex neurological or cardiac conditions. They can be roughly divided into several groups:

Disorders of the Vestibular System

• Benign paroxysmal positional vertigo (BPPV). Occurs when the position of the head changes, lasts briefly but may recur. Caused by displacement of crystals in the inner ear.
• Labyrinthitis and otitis. Inflammation of the structures of the inner ear leading to balance and hearing impairment.
• Meniere’s disease. Prolonged attacks of dizziness combined with hearing loss, tinnitus and nausea.

Circulatory and Cardiac Disorders

• Arrhythmias, aortic stenosis or hypertrophic cardiomyopathy.
• Atherosclerotic vascular lesions that reduce blood flow to the brain.
• Subclavian steal syndrome and other vascular pathologies.

Neurological and Traumatic Causes

• Head injuries and post-concussion syndrome.
• Multiple sclerosis, stroke, tumours of the cerebellopontine angle.
• Emotional and mental disorders: panic attacks, neuroses, depression.

Special attention should be paid to dizziness after head trauma, as it may indicate damage to the inner ear or brain structures.

Diagnostic Methods and Patient Assessment

To clarify the nature of dizziness, comprehensive assessment is required. In most cases, the patient goes through several diagnostic steps to detect both functional and structural disorders. The examination may include:

• Neurological evaluation, coordination tests and positional maneuvers.
• Audiometry and inner ear function tests to rule out vestibular disorders.
• Electrocardiogram and assessment of the vessels of the head and neck.
• Brain magnetic resonance imaging if serious pathology is suspected.

The earlier the cause is identified, the more effective treatment can be and the easier it is to prevent recurrent episodes.

First Aid and Treatment Options for Dizziness

During an acute episode it is important to stabilise the patient as quickly as possible. First of all, the person should be placed in a horizontal position with the head and neck supported comfortably. Fresh air must be provided, and blood pressure, heart rate and body temperature should be monitored. If nausea leads to repeated vomiting, urgent medical assistance is required.

Further treatment depends on the established cause and may include medication, physiotherapy, psychotherapy, therapeutic exercise and lifestyle modification. The following groups of medicines are most commonly used:

• tranquillisers and antidepressants;
• vestibular suppressants;
• hormonal medicines and diuretics;
• anticonvulsants and glucocorticoids;
• non-steroidal anti-inflammatory drugs;
• beta-blockers.

Treatment must always be individual, as dizziness is a symptom rather than a separate diagnosis. Properly selected therapy helps to reduce the frequency of attacks and improve quality of life.

FAQ

• When is dizziness a dangerous symptom?

  If it is accompanied by weakness in the limbs, loss of consciousness, sudden severe headache or speech disturbances, urgent medical attention is required.

• Is dizziness always related to vestibular disorders?

  No. It may be caused by cardiac, neurological, emotional or metabolic conditions.

• Can dizziness be treated at home without a doctor?

  Self-treatment is unsafe. Only a doctor can determine the exact cause and choose effective therapy.

• Do physical exercises help?

  Therapeutic exercise and vestibular training can significantly improve the condition, but should be used only after consultation with a specialist.