Introduction
Dizziness is an altered sense of balance and place, possibly described as lightheaded, feeling faint or as if head is spinning. It simply means ‘light-headedness’.
It usually due to impaired supply of blood, oxygen and glucose to the brain
It may suggest some form of unsteadiness, or could precede a fainting spell.
Causes:
- Side effects of medications, notably anti hypertensives and sedatives
- Anaemia
- Arrhythmias
- Fever
- Hypoglycaemia
- Brain stem lesions
- Excessive blood loss
- Alcohol overdose
- Prolonged standing
- Autonomic neuropathy (especially in diabetic patients)
- May be accompanied by vertigo (giddiness) in some individuals
- May culminate in loss of consciousness
Clinical features
- Light-headedness
- Feeling faint especially on attempting to stand or after squatting
- Weakness
Differential diagnoses
- Benign positional vertigo
- Labyrinthine disorders
- Hysteria
- Premonitory symptoms of epilepsy
- Migraine aura
- Warning symptom of posterior circulation stroke (posterior inferior cerebellar artery)
- Cervical spondylosis with compression of vertebral artery
- Brain tumour (acoustic neuroma)
Complications
- Falls with injury
- Stroke
- If due to intracranial tumour: raised intracranial pressure with coning
- If due to other intracranial pathology: cranial nerve palsies
Investigations
- Full Blood Count and differentials
- Electrocardiography
- Echocardiography
- X-ray sinuses
- Random blood glucose
- Doppler etc.Neuro-imaging: CT scan, MRI, carotid
Management
Management depends on the aetiological factor identified
Treatment objectives
- Eliminate symptom
- Prevent recurrence
- Drug treatment will depend on underlying cause(s)
Non-drug treatment
- Stop all medicines suspected to be
responsible - Physiotherapy: pressure stockings
Drug treatment:
- Prochlorperazine/Cinnarazine for severe attacks.
- Aspirin tablets as anti-platelet agent
Notable adverse drug reactions, cautions,
contraindications etc.
- Aspirin and other NSAIDs to be used with caution in patients with history of dyspepsia, asthmatics (especially aspirin
Prevention:
- Avoid precipitants
- These must be identified early for effective prevention