Dizziness and blackouts

Introduction

Dizziness and blackouts treatment guidelines – Dizziness is a nonspecific term that refers to abnormal sensation of body orientation or position in space.
These include feeling of unsteadiness, light-headedness and vertigo.
Patients often find these sensations difficult to describe.
Dizziness is almost always associated with other symptoms, therefore a careful history and focused physical examination should be performed in all cases to identify the cause.
Like dizziness, “blackouts” is a vague, descriptive term implying either altered consciousness, visual disturbance or a sensation of falling.
A careful history, particularly from an eye-witness, is essential.
Episodes of transient disturbance of consciousness and falls are common clinical problems.
It is usually possible to distinguish between a fit (a seizure), an episode of fainting and other types of attack from the history given by the patient and the account of an eye witness.

Causes of dizziness and blackouts

1. Cardiovascular

  • Vasovagal-(fainting)
  • Postural hypotension
  • Acute haemorrhage
  • Cardiac arrhythmias
  • Severe aortic stenosis
  • Complete heart block with Stokes-Adams attacks
  • Vertebro-basilar insufficiency

2. Cerebral

  • Transient Ischaemic Attacks (TIA)
  • Stroke
  • Epilepsy

3. Others

  • Drug-induced
  • Severe anaemia
  • Hypoglycaemia
  • Middle ear disease
  • Meniere’s disease
  • Conversion disorder (Hysterical fainting/Hyperventilation)

Symptoms of dizziness and blackouts

The following are the symptoms of dizziness and blackouts

  1. Light-headedness
  2. Loss of consciousness
  3. Sense of motion or spinning of body
  4. Unsteadiness
  5. Nausea
  6. Vomiting
  7. Tinnitus

Signs of dizziness and blackouts

The signs of dizziness and blackouts include the following

  1. Sweating (suggests vasovagal episode/hypoglycaemia)
  2. Tachycardia or bradycardia (suggest cardiac arrhythmia)
  3. Hypotension
  4. Postural hypotension
  5. Pallor
  6. Nystagmus, dysdiadochokinesis, ataxia, hypotonia, dysarthria (suggests cerebellar cause)
  7. Focal neurological signs suggests stroke, TIA

Investigations

These vary depending on the cause

  • FBC
  • Random blood sugar
  • X-ray of cervical spine
  • ECG

Treatment for dizziness and blackouts

 Objectives

The treatment objective of dizziness and blackouts is:

  • To identify and appropriately manage the possible underlying cause(s)

Non-pharmacological treatment

  • Postural hypotension – review medications
  • Hyperventilation syndrome – breathing control exercise
  • Counseling
  • Cervical collar
  • Moulded cervical pillows

Pharmacological treatment

  • Treat the underlying cause

Referral Criteria

Refer patients to a physician specialist for evaluation if the cause is difficult to determine.
If the cause is identified, refer to the appropriate specialist for further evaluation and management.