Dizziness / Syncope

Dizziness is a very common subjective complaint that can have different meanings. Dizziness can mean a spinning sensation, lightheadedness, floating sensation, feeling faint, or unsteady. In general, the feeling of dizziness can be grouped into four categories:

• Vertigo - Vertigo is the sensation of a spinning environment. It is the illusion of motion as if you are riding spinning carousel, which is often felt even if you close your eyes.
• Syncope - Syncope is the feeling of lightheadedness, as though you are about to faint imminently. This may also be known as black out spells.
• Disequilibrium - Disequilibrium is the feeling of unsteadiness or giddiness, as if there’s something wrong with your steps or as if the ground that you’re walking on is not even.
• Others - Other forms of dizziness can be felt as a sense of intense fear, anxiety, or worry, which are mostly psychological in nature.

Causes of dizziness

Just as there are many types of dizziness, so are there many causes of dizziness. Dizziness can be from:

• Problems of the inner ear - Our inner ear is responsible for our balance; so, problems in the inner ear can disrupt our sense of balance and lead to dizziness. Vertigo is the most common form of dizziness from inner ear problems. Examples of conditions that cause vertigo are Benign Paroxysmal Positional Vertigo (BPPV) and Meniere’s disease.
• Cardiovascular problems - When the brain is not sufficiently supplied with blood, you can get a feeling of syncope. A common example of this is vasovagal attacks such as when you suddenly stand up  or when you strain excessively and you feel faint due to blood pooling in your legs. Cardiovascular problems like heart failure or arrhythmias can cause insufficient blood to reach the brain and produce a feeling of syncope.
• Eye problems - Eye problems like blurring of vision on one eye can give you a feeling of unsteadiness or giddiness. Your perception of depth can be affected just like when you’re wearing a new set of glasses.
• Nervous and sensory problems - Neurologic conditions can damage the part of our nervous system that controls balance. Neurologic conditions can give you dizziness in the form of vertigo or disequilibrium.
• Psychological problems - Psychological problems like phobia, anxiety, or panic can cause a feeling of impending sense of doom or lightheadedness.
• Metabolic derangements - Metabolic derangements can affect your brain and cause you to feel syncopal dizziness. These derangements can include low blood sugar, low oxygen levels (as in cases of suffocation), low CO2 levels (as in cases of hyperventilation), and others.

When to seek consult

Although most cases of dizziness are benign in nature and most cases would resolve spontaneously, some would require immediate consult to the doctor. Any form of dizziness associated with the following symptoms require immediate visit to the doctor:

• Loss of consciousness
• Seizures
• Severe headache
• Numbness or weakness on any body part
• Slurring of speech
• Disorientation
• Gait instability
• Fever
• Stiff neck
• Palpitations
• Chest pain

Diagnosis

The evaluation of dizziness is done by first identifying the type of dizziness that the patient is experiencing. It is important to identify if the dizziness is in the form of vertigo, syncope, disequilibrium, or others. This can be done a simple interview or history taking. Afterward, the cause of the dizziness should be identified. This is done by performing a thorough physical examination that includes an ear exam and an exam which focuses on the neurologic and cardiac systems. The findings of these examinations can then be confirmed using diagnostic tests that your doctor might feel necessary.

Treatment

The treatment of dizziness depends on the cause. Dizziness due to ear problems that cause vertigo are treated with medications that include antihistamines and antevert. Head positioning maneuvers might also help to correct inner ear problems. Dizziness due to eye problems is treated by addressing the eye problem such as by prescribing corrective lenses. Cardiovascular problems are also treated accordingly for example by giving anti-arrhythmic drugs or inotropic agents. Psychological problems are treated with anti-anxiety medications or psychotherapy.