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Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a common medical complaint, affecting 20-30% of persons. Dizziness is broken down into 4 main subtypes: vertigo (~25-50%), disequilibrium (less than ~15%), presyncope (less than ~15%), and nonspecific dizziness (~10%). * Vertigo is the sensation of spinning or having one's surroundings spin about them. Many people find vertigo very disturbing and often report associated nausea and vomiting. * Presyncope describes lightheadedness or feeling faint; the name relates to syncope, which is actually fainting. * Disequilibrium is the sensation of being off balance and is most often characterized by frequent falls in a specific direction. This condition is not often associated with nausea or vomiting. * Non-specific dizziness may be psychiatric in origin. It is a diagnosis of exclusion and can sometimes be brought about by
hyperventilation Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blood. ...
.


Mechanism and causes

Many conditions cause dizziness because multiple parts of the body are required for maintaining balance including the
inner ear The inner ear (internal ear, auris interna) is the innermost part of the vertebrate ear. In vertebrates, the inner ear is mainly responsible for sound detection and balance. In mammals, it consists of the bony labyrinth, a hollow cavity in the ...
, eyes,
muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...
s,
skeleton A skeleton is the structural frame that supports the body of an animal. There are several types of skeletons, including the exoskeleton, which is the stable outer shell of an organism, the endoskeleton, which forms the support structure inside ...
, and the nervous system. Thus dizziness can be caused by a variety of problems and may reflect a focal process (such as one affecting balance or
coordination Coordination may refer to: * Coordination (linguistics), a compound grammatical construction * Coordination complex, consisting of a central atom or ion and a surrounding array of bound molecules or ions * Coordination number or ligancy of a centr ...
) or a diffuse one (such as a toxic exposure or low
perfusion Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion is measured as the rate at which blood is deliver ...
state). Common causes of dizziness include: * Inadequate blood supply to the brain due to: ** A sudden fall in
blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
**
Heart problems Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, ...
or artery blockages ** Anaemias, such as
Vitamin B12 deficiency anemia Pernicious anemia is a type of vitamin B12 deficiency anemia, a disease in which not enough red blood cells are produced due to the malabsorption of vitamin B12. Malabsorption in pernicious anemia results from the lack or loss of intrinsic fa ...
, Iron deficiency anemia * Loss or distortion of vision or
visual cues The visual system comprises the sensory organ (the eye) and parts of the central nervous system (the retina containing photoreceptor cells, the optic nerve, the optic tract and the visual cortex) which gives organisms the sense of sight (th ...
* Standing too quickly/prolonged standing * Disorders of the inner ear * Dehydration * Distortion of brain/nervous function by medications such as
anticonvulsant Anticonvulsants (also known as antiepileptic drugs or recently as antiseizure drugs) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of b ...
s and
sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are CNS depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but t ...
s * Dysfunction of cervical proprioception * Side effects from other prescription drugs, such as proton-pump inhibitors or Coumadin ( warfarin)


Diagnosis


Differential diagnosis

Dizziness may occur from an abnormality involving the brain (in particular the brainstem or cerebellum), inner ear, eyes, heart, vascular system, fluid or blood volume, spinal cord, peripheral nerves, or body electrolytes. Dizziness can accompany certain serious events, such as a concussion or brain bleed, epilepsy and seizures (convulsions), strokes, and cases of meningitis and encephalitis. However, the most common subcategories can be broken down as follows: 40% peripheral vestibular dysfunction, 10% central nervous system lesion, 15% psychiatric disorder, 25% presyncope/disequilibrium, and 10% nonspecific dizziness. Some vestibular pathologies have symptoms that are comorbid with mental disorders. While traditional medical teaching has focused on determining the cause of dizziness based on the category (e.g. vertigo vs presyncope), recent research suggests that this analysis is of limited clinical utility. Medical conditions that often have dizziness as a symptom include: * Benign paroxysmal positional vertigo * Ménière's disease *
Labyrinthitis Labyrinthitis is inflammation of the labyrinth – a maze of fluid-filled channels in the inner ear. Vestibular neuritis is inflammation of the vestibular nerve – the nerve in the inner ear that sends messages related to motion and position t ...
*
Otitis media Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, ...
* Brain tumor * Acoustic neuroma * Motion sickness * Ramsay Hunt syndrome *
Migraine Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...
*
Multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...
* Pregnancy * Low blood pressure ( hypotension) * Low blood oxygen content ( hypoxemia) * Heart attack * Iron deficiency ( anemia) * Vitamin B12 deficiency * Low blood sugar ( hypoglycemia) * Hormonal changes (e.g. thyroid disease, menstruation, pregnancy) * Panic disorder *
Hyperventilation Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blood. ...
* Anxiety * Depression * Age-diminished visual, balance, and perception of spatial orientation abilities * a
stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
is the cause of isolated dizziness in 0.7% of people who present to the
emergency department An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...
.


Epidemiology

About 20–30% of the population report to have experienced dizziness at some point in 2008.


Disequilibrium

In medicine, disequilibrium refers to impaired equilibrioception that can be characterised as a sensation of impending fall or of the need to obtain external assistance for proper locomotion. It is sometimes described as a feeling of improper tilt of the floor, or as a sense of floating. This sensation can originate in the inner ear or other motion sensors, or in the central nervous system. Neurologic disorders tend to cause constant vertigo or disequilibrium and usually have other symptoms of neurologic dysfunction associated with the vertigo. Many medications used to treat seizures, depression, anxiety, and pain affect the vestibular system and the central nervous system which can cause the symptom of disequilibrium.


See also

* Balance disorder *
Broken escalator phenomenon The broken escalator phenomenon, also known as the escalator effect and the Walker effect, is the sensation of losing balance, confusion or dizziness reported by some people when stepping onto an escalator which is not working. It is said that ther ...
*
Chronic subjective dizziness The term chronic subjective dizziness (CSD) is used to describe a commonly encountered type of dizziness that is not easily categorized into one of several other types, and for which the physical examination is typically normal. Patients with CSD ...
* Coriolis effect (perception) * Equilibrioception *
Ideomotor phenomenon The ideomotor phenomenon is a psychological phenomenon wherein a subject makes motions unconsciously. Also called ideomotor response (or ideomotor reflex) and abbreviated to IMR, it is a concept in hypnosis and psychological research. It is deri ...
*
Illusions of self-motion Illusions of self-motion (or "vection") occur when one perceives bodily motion despite no movement taking place. One can experience illusory movements of the whole body or of individual body parts, such as arms or legs. Vestibular illusions The v ...
* Motion sickness * Postural orthostatic tachycardia syndrome * Proprioception *
Seasickness Motion sickness occurs due to a difference between actual and expected motion. Symptoms commonly include nausea, vomiting, cold sweat, headache, dizziness, tiredness, loss of appetite, and increased salivation. Complications may rarely include de ...
*
Spatial disorientation Spatial disorientation results in a person being unable to determine their position or relative motion, commonly occurring during periods of challenging visibility, since vision is the dominant sense for orientation. The auditory system, vestibular ...
*
The spins The spins (as in having "the spins")Diane Marie Leiva. ''The Florida State University College of Education''Women's Voices on College Drinking: The First-Year College Experience"/ref> is an adverse reaction of intoxication that causes a state of ve ...
, a state of dizziness and disorientation due to intoxication * Vertigo


References


External links


Dizzytimes.com
Online Community for People with Vertigo and Dizziness
Dysautonomia Youth Network of America, Inc.
{{Authority control Neurological disorders