Giddiness or dizziness is one of the most common complaints received in the neurology clinic. Patients use various terminologies to describe it like lightheadedness, blackout, imbalance etc.
But there is more to dizziness than just its symptoms. Let’s take a look at it from a Neurologist’s perspective and delve into the types, causes, and effects of the different forms that dizziness might undertake.
Whenever a patient comes with a complaint of giddiness or dizziness, we try to classify into one of its 5 types which are:
- Syncopal dizziness or Syncope: The patient feels like they are blacking out and depending on the severity of the symptoms, it may be restricted to only to blacking-out and lightheadedness which is called pre-syncope. The patient can use the words lightheaded, woozy and faint to describe this particular episode. If the patient loses consciousness momentarily, it is called syncope. The most common cause of the syncopal dizziness is Neuro-cardiogenic syncope or Vasovagal syncope. It is triggered by the sight of blood, severe pain, sudden fear, prolonged standing or micturition. The other causes of the syncope are abnormal heart rhythm, abnormal heart structure etc. The differential diagnoses which needs to be considered in the case of transient loss of consciousness are seizures (fits) and conversion reaction. A detailed history of the event helps in coming to an appropriate diagnosis. These details include whether the patient’s eyes were open or closed, whether there were jerky movements of the upper or lower limbs, the passage of urine or stool in the clothes. If the event is witnessed, then bystanders can play a crucial role in providing the description of the event since the patient is unconscious during the episode. If the event is unwitnessed, there are some examination findings which help to give the diagnostic clue. Hence it is very important to seek medical attention and rule out the serious causes of the loss of consciousness.
- Vertiginous dizziness or vertigo: The patient feels a reeling sensation as if their head is rotating or the environment is rotating. It can also be described as spinning, whirling, tilting, falling. Vertigo can be caused by the central causes or the more common peripheral causes. The central causes are seen due to the involvement of the stem of the brain (Brainstem) or small brain (Cerebellum). The central causes of vertigo are a stroke, demyelination, tumor etc. The peripheral causes involve the balance control system in our body i.e. semicircular canals and the vestibular nerve. The causes of peripheral vertigo include benign positional vertigo, vestibular neuronitis, Meniere’s disease etc. The differentiation between peripheral and central vertigo and between the causes of each one of them can be done by detailed history and examination. Hence it is important to consult the doctor, to rule out serious causes and receive appropriate treatment.
- Dis-equilibrium dizziness: In this type of dizziness, the patient feels an imbalance of gait while walking or standing. The structure of the nervous system involved in this type of dizziness involves nerves controlling the balance (Large fibers in the nerve), spinal cord (Posterior columns), bilateral vestibular dysfunction; lesions involving various part of the brain like brainstem; cerebellar; extrapyramidal or drug effects etc. Detailed history and examination are important for the diagnosis and appropriate treatment.
- Multiple sensory dizziness: This type of dizziness is common in the elderly. It is experienced as a vague dizziness present all times. It occurs due to multiple concurrent issues like nerve problem (Peripheral neuropathy), cervical spondylosis, poor vision due to Cataract, or Macular degeneration.
- Ill-defined dizziness: This is experienced as a vague dizziness usually associated with multiple non-specific complaints. It can happen at any age and to either sex but it is commonly seen in young females. Usually, the cause of this type of dizziness is stress. Lifestyle modification plays an important role for the relief from this type of dizziness.
Aster Speciality Clinic, International City