Dizziness

• Dizziness is a non-specific term used to describe a sensation of altered orientation in space
• Vertigo is the hallucination of rotation or movement of one's self or one's surroundings. Dizziness is of little diagnostic value without trying to elaborate further information. However, when vertigo, postural hypotension or other types of unsteadiness are less severe or chronic, it may be impossible to describe the sensation more accurately than "dizziness". If there is loss of consciousness then this defines the term syncope
• it has been suggested that there are four types of dizziness (1)
  • vertigo (2)
    • commonest type of dizziness is vertigo
      • more than 50 percent of cases of dizziness in primary care (1)
    • may be described as an illusion of movement (i.e., a false sense of motion)
    • it is frequently horizontal and rotatory
    • illusion of rotation may be of one's self or one's surroundings
    • may be associated with nausea, emesis, and diaphoresis (3)
    • cause may be central or peripheral
      • when associated with nausea and vomiting, should look for a peripheral rather than central cause
    • most cases can be diagnosed clinically and managed in the primary care level(4)
  • light-headedness (2)
    • this is non-specific
    • sometimes difficult to diagnose
    • may be associated with panic attacks
  • presyncope (2)
    • is due to cardiovascular conditions that reduce cerebral blood flow
  • dysequilibrium (2)
    • feeling of unsteadiness and instability
    • causes include
      • peripheral neuropathy
      • eye disease
      • peripheral vestibular disorders
• in addition the following conditions too may present with dizziness
  • psychiatric disorders, seizure disorders, motion sickness, otitis media, cerumen impaction (3)

References:

1. Labuguen RH.Initial Evaluation of Vertigo. American Family Physician 2006; 73 (2)
2. Kanagalingam J et al. Vertigo. BMJ 2005; 330:523
3. Swartz R.Treatment of Vertigo. American Family Physician 2005;71(6)