Dizziness

What does the term dizziness mean?

The term dizziness is used to describe an unpleasant sensation of altered orientation of the body in space or, more generally, any unpleasant or strange sensation in the head other than pain.

What is the frequency of dizziness?

Dizziness is one of the most frequent reasons for consultation in Neurology. In a study conducted in 2014 in the Community of Madrid, dizziness accounted for 9.1% of all outpatient neurological consultations. It is also a frequent reason for consultation in other settings, such as ENT consultations and emergency and primary care services.

What are the main causes of dizziness?

The causes of dizziness are very varied, but we can classify them into four main groups depending on the characteristics of the dizziness:

• Vertigo consists of a sensation of displacement of oneself or one’s surroundings. Most often it is a rotational sensation, but sometimes it is a sensation of impulsion.
• Presyncope is a sensation of fainting or imminent loss of consciousness resulting from a decrease in blood pressure and the consequent reduction in cerebral blood perfusion. In many cases it depends on a momentary alteration of postural reflexes (vasovagal or neuromediated syncope), but cardiac disorders and loss of blood volume (anemia, dehydration) must be ruled out. Sometimes presyncope progresses to transient loss of consciousness or syncope.
• Instability caused by neurological diseases or musculoskeletal problems may also be described by patients as dizziness.
• Finally, a significant percentage of patients present with nonspecific dizziness, without the characteristics of previous symptoms. In these cases the causes are very varied, ranging from metabolic disturbances (e.g. hyponatremia, hypothyroidism) to affective disorders (e.g. anxiety, depression) or subtle neurological or vestibular problems.

How are patients with dizziness studied?

As in most patients with neurological symptoms, the most important procedures to establish a diagnosis are the clinical interview (anamnesis) and the physical examination. In this case, the physical examination focuses on detecting cardiovascular or vestibular problems. For this purpose, blood pressure should be measured in the supine (lying down) and standing positions, auscultation of the cervical vessels and the heart, and an examination of the vestibular system, including observation of eye movements at rest and after provocation maneuvers (e.g. head shaking, postural maneuvers), assessment of sitting, standing and walking stability, and examination of limb coordination.

Clinical assessment may be sufficient. However, in some cases it is advisable to perform some complementary studies, including blood tests, cardiological studies (ECG, Holter ECG, echocardiogram), ENT studies (vestibular studies, audiometry) or imaging studies of the brain and cerebral vessels (MRI, CT, Doppler ultrasound).

What is the treatment for motion sickness?

The treatment of dizziness depends on the underlying cause, so for further information we refer readers to the relevant sections.

In some cases no clear cause of dizziness can be found. In this situation, it is advisable to monitor the evolution and start an exercise program aimed at improving balance.

Where can I find additional information on motion sickness?

Additional information on this topic can be found by accessing the Medline Plus portal(https://medlineplus.gov/spanish/) and entering the term dizziness in the search window.

AUTHOR AND DATE OF ISSUE

Dr. Adolfo Jiménez Huete

18/05/2020