Dizziness is a common symptom leading to over 8 million doctor visits a year. Dizziness may just be a little uncomfortable, or it can be severe enough to make it impossible to walk or drive safely.
Most of the time, dizziness is not caused by something life threatening. However, sometimes dizziness means something more sinister. How can patients and doctors tell when dizziness is serious?
What is meant by "dizziness"?
The word "dizziness" can be used to describe several distinct sensations. In order to know whether your dizziness is due to a serious medical condition, it is important that you describe what you are feeling as clearly as possible.
Confusion, tingling, anxiety, and other ways of "feeling funny"
Some people use the word "dizzy" as a substitute for another kind of symptom. For example, "dizzy" has been used to mean feeling slightly disoriented or fatigued. These feelings can be caused by a very large number of things, many of them benign. If these problems persist, it is best to discuss them with a general physician before coming to a neurologist.
This is the sensation you may have had when standing up too quickly. The feeling may be associated with becoming pale or clammy. In extreme cases, this sensation comes just before blacking out. Lightheadedness is caused by a decreased amount of blood flow to the brain. This can be caused by something as common as not drinking enough water or something as serious as heart disease.
While this type of dizziness does not normally require a neurologist, blood flow to the brain can be reduced by narrow blood vessels in the head or neck. Diseases of the autonomic nervous system, which moderates blood pressure, can also lead to lightheadedness. These cases require a neurologist. If you are having episodes of lightheadedness, you should visit a primary care physician. If these episodes are associated with stroke symptoms or chest discomfort, you should go to an emergency room.
This is the sensation of not being able to maintain balance. You may find yourself inexplicably stumbling as you try to walk. You may veer off to the right or left. If this disease is progressing very slowly, it may result from a movement disorder such as Parkinson's disease, or a peripheral nerve disease. More rapidly progressive disequilibrium may represent a disease such as Guillain-Barre syndrome, an autoimmune disorder that attacks peripheral nerves.
If you have been increasingly off balance lately, you should be seen by a medical professional as soon as possible. If disequilibrium occurs suddenly, if could represent a disease such as stroke, and you should go to an emergency room for evaluation. Most people with persistent disequilibrium will benefit from seeing a neurologist.
Vertigo is the sensation of the world spinning around you, as if you had recently been on a fast merry-go-round. Sometimes you may feel nauseous at the same time. Vertigo is so uncomfortable that it usually doesn't take long for people to come to their doctors.
Vertigo is caused either by a problem in the inner ear or the brainstem. Problems with the inner ear are known as peripheral vertigo. While peripheral vertigo can keep a patient from walking or driving safely, most of the causes of peripheral vertigo are not particularly dangerous.
Central vertigo, on the other hand, means that something is affecting the brainstem. In addition to controlling balance, equilibrium, and eye movements, the brainstem holds centers for such important functions as breathing, maintaining consciousness, and controlling heart rate and blood pressure. The brainstem can be affected by toxins, metabolic problems such as kidney failure, or neurological problems like multiple sclerosis or stroke. Any sign of brainstem disease could be very serious.
All kinds of vertigo should be seen by a physician. Red flag symptoms for central vertigo include the following:
• Vertigo that starts suddenly
• Vertigo that is associated with any other signs of brainstem disease, including double vision, tingling, numbness, weakness, facial droop, or difficulty swallowing.
• Vertigo that is not associated with a change in position.
• Vertigo that does not go away on its own.
• Vertigo not caused by something known to provoke dizziness, such as some medications, using alcohol, becoming dehydrated, or not having eaten recently.
When seeing a physician for dizziness, it is best to be as specific as possible about what you are feeling. This is not always easy-while I've described some of the most common feeling, sometimes a person has a combination of those feelings, or something that doesn't quite match any category. However, thinking about those types of dizziness may help prepare you for the questions your doctor is likely to ask.
It can sometimes be difficult even for medical professionals to determine how serious dizziness is. If you have any questions or concerns, don't hesitate to call a physician.
Rubin DI, Cheshire WP "Evaluation of 'Dizziness' in the Neurology Office" Seminars in Neurology 2011; 31(1): 029-041
Ropper AH, Samuels MA. Adams and Victor's Principles of Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009.