Dizziness

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