Dizziness
| Dizziness | |
|---|---|
| Classification and external resources | |
| ICD-10 | R42 |
| ICD-9-CM | 780.4 |
| DiseasesDB | 17771 |
| MedlinePlus | 003093 |
| eMedicine | neuro/693 |
| MeSH | D004244 |
Dizziness is an impairment in spatial perception and stability.[1] Because the term dizziness is imprecise,[2] it can refer to vertigo, presyncope, disequilibrium,[3] or a non-specific feeling such as giddiness or foolishness.[4]
One can induce dizziness by engaging in disorientating activities such as spinning.
- 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. It represents about 25% of cases of occurrences of dizziness.[5]
- 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.
- Presyncope is lightheadedness, muscular weakness and feeling faint as opposed to a syncope, which is actually fainting.
- Non-specific dizziness is often psychiatric in origin. It is a diagnosis of exclusion and can sometimes be brought about by hyperventilation.[4]
A stroke is the cause of isolated dizziness in 0.7% of people who present to the emergency room.[5]
Classification
Dizziness is broken down into 4 main subtypes: vertigo (~50%), disequilibrium (less than ~15%), presyncope (less than ~15%) and lightheadedness (~10%).[6]
Differential diagnosis
Many conditions are associated with dizziness. 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/dysequilibrium, and 10% nonspecific dizziness.[7] Some vestibular pathologies have symptoms that are comorbid with mental disorders.[8] The medical conditions that often have dizziness as a symptom include:[7][9][10][11]
- Benign paroxysmal positional vertigo
- Meniere's disease
- Vestibular neuronitis
- Labyrinthitis
- Otitis media
- Brain tumor
- Acoustic neuroma
- Motion sickness
- Ramsay Hunt syndrome
- Migraine
- Multiple sclerosis
- Pregnancy
- low blood pressure (hypotension)
- low blood oxygen content (hypoxemia)
- heart attack[12]
- iron deficiency (anemia)
- low blood sugar (hypoglycemia)
- hormonal changes (e.g. thyroid disease, menstruation, pregnancy)
- panic disorder
- hyperventilation
- anxiety
- depression
- age-diminished visual, balance, and perception of spatial orientation abilities
Mechanism
Many conditions cause dizziness because multiple parts of the body are required for maintaining balance including the inner ear, eyes, muscles, skeleton, and the nervous system.[10]
Common physiological causes of dizziness include:
- inadequate blood supply to the brain due to:
- loss or distortion of vision or visual cues[10]
- disorders of the inner ear[10]
- distortion of brain/nervous function by medications such as anticonvulsants and sedatives[10]
- result of side effect from prescription drugs, including proton-pump inhibitor drugs (PPIs)[13] and Coumadin (warfarin) causing dizziness/fainting [14]
Epidemiology
About 20–30% of the population report to have experienced dizziness at some point in the previous year.[5]
See also
- Balance disorder
- Broken escalator phenomenon
- Coriolis effect (perception)
- Equilibrioception
- Ideomotor phenomenon
- Illusions of self-motion
- Motion sickness
- Postural orthostatic tachycardia syndrome
- Proprioception
- Seasickness
- Spatial disorientation
- The spins, a state of dizziness and disorientation due to intoxication
- Vertigo
References
- ↑ "dizziness" at Dorland's Medical Dictionary
- ↑ Dizziness at the US National Library of Medicine Medical Subject Headings (MeSH)
- ↑ Reeves, Alexander G., Swenson, Rand S. (2008). "Chapter 14: Evaluation of the Dizzy Patient". Disorders of the Nervous System: A Primer. Dartmouth Medical School.
- 1 2 Branch, Jr, William T., Barton, Jason (February 10, 2011). "Approach to the patient with dizziness". UpToDate.
- 1 2 3 Neuhauser HK, Lempert T (November 2009). "Vertigo: epidemiologic aspects". Semin Neurol 29 (5): 473–81. doi:10.1055/s-0029-1241043. PMID 19834858.
- ↑ Post RE, Dickerson LM (August 2010). "Dizziness: a diagnostic approach". Am Fam Physician 82 (4): 361–8, 369. PMID 20704166.
- 1 2 Chan Y (June 2009). "Differential diagnosis of dizziness". Curr Opin Otolaryngol Head Neck Surg 17 (3): 200–3. doi:10.1097/MOO.0b013e32832b2594. PMID 19365263.
- ↑ Lawson, B. D., Rupert, A. H., & Kelley, A. M. (2013). Mental Disorders Comorbid with Vestibular Pathology. Psychiatric Annals, 43(7), 324.
- ↑ Tusa RJ (March 2009). "Dizziness". Med. Clin. North Am. 93 (2): 263–71, vii. doi:10.1016/j.mcna.2008.09.005. PMID 19272508.
- 1 2 3 4 5 6 7 "Dizziness and Vertigo". Merck Manual. 2009.
- ↑ Bronstein AM, Lempert T (2010). "Management of the patient with chronic dizziness". Restor. Neurol. Neurosci. 28 (1): 83–90. doi:10.3233/RNN-2010-0530. PMID 20086285.
- ↑ O'Connor RE, Brady W, Brooks SC, et al. (November 2010). "Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation 122 (18 Suppl 3): S787–817. doi:10.1161/CIRCULATIONAHA.110.971028. PMID 20956226.
- ↑ http://www.fda.gov/Drugs/DrugSafety/ucm245011.htm
- ↑ http://www.rxlist.com/coumadin-side-effects-drug-center.htm
External links
- Dizzytimes.com Online Community for Sufferers of Vertigo and Dizziness
- Dysautonomia Youth Network of America, Inc.
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