Dizziness

Dizziness is defined as "an imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness". Dizziness is commonly used to designate a whole variety of sensations, from a vague sense of weakness to a definite feeling of spinning. Like pain, dizziness is a purely subjective experience.

Dizziness should be distinguished from the term vertigo. Vertigo is a specific form of dizziness in which a false sensation of movement is present. In dizziness, unlike vertigo, there is no universally accepted definition of the quality of the sensation. Instead, the term may indicate a feeling of weakness, a near loss of consciousness, or general anxiety.

Dizziness should be distinguished from syncope. In syncope, also called fainting, there is loss of consciousness.

Cause/etiology

According to a systematic review of original research articles, the most common causes of dizziness among patients who seek medical care are:

• Vertigo is the cause in 55% of patients
  • Peripheral vestibulopathy in 44%
  • Central vestibulopathy in 11%
  • Cardiac causes of dizziness can cause vertigo according to a separate study
• psychiatric causes in 16%
• other conditions in 26%
• unknown cause in 13%

In this study, serious causes were infrequent: cerebrovascular disease (6%), cardiac arrhythmia (1.5%), and brain tumor (<1%).

The feeling of dizziness is prompted by certain circumstances, such as extreme fatigue or hunger. Dizziness is also commonly felt in abnormal conditions like poor blood perfusion to the brain because of low blood pressure or arrhythmia, and when blood levels of carbon dioxide are driven down by prolonged hyperventilation. Despite the fact that there are situations in which the presence of dizziness is predictable, it remains a misunderstood condition in the health sciences that is sometimes interpreted as an arbitrary complaint by a patient who has no physical illness.

It is doubtful that hyperventilation is a cause of chronic dizziness.

Cultural aspects of dizziness

A feeling of dizziness may be feared, discounted or even welcomed depending on the identity and cultural background of the person experiencing it. In the 19th Century, western girls and women who easily became "faint" were often admired as showing refinement and gentility. On the other hand, admission of feeling faint or dizzy has long been denigrated as showing weakness and can be particularly alarming to athletes and soldiers. Because of the underlying values ascribed to a person experiencing the sensation of dizziness in different cultures, a person may be more or less likely to admit to feeling this sensation.

Chronic non-specific dizziness

For patients experiencing chronic dizziness, without vertigo or evidence of balance problems, the condition is often outside of the ability of the health sciences to remedy in routine care. Dizziness without any component of vertigo is technically called "nonspecific dizziness". The medical view of nonspecific dizziness as a condition tends to be skeptical. For example the definition of dizziness in the Steadman's Medical Dictionary is as follows: Imprecise term commonly used by patients in an attempt to describe various symptoms such as faintness, vertigo, disequilibrium, or unsteadiness. Etymology: A. S. [dyzig,] foolish.

Causes of dizziness that persists for more than two weeks after initially seeking health care are:

• vestibular disorders (29%)
  • benign positional vertigo (BPV) (16%)
• psychiatric disorders (6%)
• presyncope (3%)
• dysequilibrium (1%)
• hyperventilation (<1%)

Only 52% of the patients in this study had a single cause.

Medical evaluation of the dizzy patient

There are several important findings in the description of dizziness in addition to the quality of the dizziness. Over-reliance on the quality of the dizziness may lead diagnostic errors.

Prognosis

Among adults over aged 65, one study found that dizziness is a risk factor for stroke only if vertigo is present.

See also

• Syncope