Dizziness is one of the commonest symptoms encountered by physicians in clinical practice, and probably the most difficult one to treat too! Dizziness is the chief presenting symptom in about 3% of primary care visits for patients of 25 yrs and older, and in nearly 3% of all emergency admissions. It is said that most astute clinicians can also feel a bit dizzy trying to solve the problem of dizziness in their patients! The confusion starts from the fact that patients are often not clear by what they mean by “feeling dizzy”. “Feeling dizzy” means different things to different people, or even to the same person in different situations. It is further complicated as the causes of dizziness ranges from benign to life-threatening disorders, and features that distinguish these, may be very subtle.
A detailed history can usually classify dizziness into one of four categories:
- Vertigo (usually described as false sense of motion or spinning sensation)
- Disequilibrium (usually results in off-balance or wobbly feeling)
- Presyncope (generally described as blackouts or feeling of losing consciousness)
- Light-headedness (consists of vague feelings of being disconnected with the environment)
All these types of dizziness can be a sign of several underlying illnesses. That’s why detailed history and examination with appropriate investigations are mandatory, before suggesting that the symptom of dizziness is functional or psychosomatic in origin.
Treatment: Successful treatment of dizziness is totally dependent on the exact diagnosis of the cause of dizziness and there is no ‘one size fits all’ solution available. That’s why recurrent or persistent dizziness should never be ignored.
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Causes of dizziness: Causes of dizziness differ as per the age group of the patient. Dizziness in kids is commonly due to simple reasons like uncorrected Refractive Error or Migraine associated with dizziness. Young patients are more tolerant to dizziness and often present to the physician late. Benign Positional Vertigo and Vestibular Migraine are common in young patients. Elderly don’t tolerate dizziness at all and should be evaluated thoroughly due to high possibility of serious causes like Stroke. Elderly people with Diabetic Neuropathy, Labile Hypertension and gait problems experience dizziness more frequently, and tend to have frequent falls due to dizziness.
When should one seek help? Seeking help in cases of dizziness is essential as there are many serious and even life threatening cases associated with dizziness, and timely diagnosis of the cause of dizziness is essential for proper treatment.For the same reason, trying non-medical channels of treatment without proper evaluation can turn out to be dangerous. Feeling of dizziness can be worsened by frequent travel, repeated jerks, inadequate sleep and irregular schedules; high velocity sports or rides should be completely avoided.
(Disclaimer: Writer is Kavita Barhate, Consultant Neurologist, Fortis Hospital, Kalyan. Views expressed are a personal opinion.)