Dizzy? | by
Pay Attention to Symptoms for Diagnosis
She closes her eyes, takes a deep breath and steadies herself against the wall or on a nearby chair. That’s what Ruth Gallardo does when she feels a dizzy episode coming on. Gallardo has Meniere’s disease, a type of vertigo. She’s learned through trial and a lot of error over the years that certain things set it off.
“Bending over, some medications and ear infections make it worse,” she says.
Gallardo is just one of the 40 percent of aging adults who report dizzy and balance problems, according to health experts.
“Dizziness is an exceptionally common problem,” says Dr. Michael Mignoli, founder of Vanguard Primary Care. “It’s a frequent concern from people as they age.”
What is dizziness?
People experience “dizziness” in an array of sensations such as spinning, unsteadiness, and lightheadedness. Information about each of these sensations, alone or with other factors, as well as what triggers it, can help your doctor make a diagnosis.
“Dizziness is really an imprecise term,” says Bruce Morgenstern, a neurologist with Blue Sky Neurology at Sky Ridge Medical Center. “The word is not well defined. It is subjective – the patient experiences it but we don’t see it.”
That’s why diagnosing dizziness is a “collaborative effort” between the patient and doctor. The doctor becomes a detective sleuthing out clues from the patient’s medical history and specific descriptions about dizzy episodes.
Generally a patient should see a primary care doctor first and she/he will refer the patient to specialists like an ear nose and throat doctor (ENT) or a neurologist for additional diagnosis.
Dizziness can have many causes – some are benign but others can be life-threatening. Causes are generally grouped into four categories:
Vertigo is an inner ear disorder. “Patients with vertigo generally feel like they are spinning or things around them are moving while they are stationary,” says Dr. Anya Miller, an ENT with Rose Medical Center.
Specialists like Miller can pinpoint the type of vertigo a patient has as: (1) Meniere’s disease, an episodic vertigo that lasts from 30 minutes to a few hours and is usually accompanied by ringing in the ears (tinnitus), hearing loss, and aural fullness; (2) Vestibular neuritis that affects the balance nerve of the inner ear where symptoms can last 24 to 72 hours; or (3) benign paroxysmal positional vertigo or BPPV, the most common type of vertigo where people experience a spinning sensation after movements, especially with the head specifically when rolling over in bed. Miller also says some conditions like migraines can produce symptoms that mimic vertigo.
Presyncope patients feel like passing out or faint. Sometimes it is also accompanied by a rapid heartbeat and can be induced by standing up or changing positions. Most commonly it is due to a failure of the blood pressure to keep up with the brain’s demand. A host of problems could be the cause including dehydration, anemia, hypotension, autoimmune nervous system conditions and even cardiac causes, Morgenstern says.
Ataxia/Disequilibrium can cause people to feel off-balance or wobbly. There are many conditions that can describe the sense of imbalance, many are neurologically based, including the symptoms of stroke. Some other neurological causes can include Parkinson’s disease, acute TIA (transient ischemic attack) or stroke, or Guillain-Barré syndrome. Therapeutic and recreational drugs can cause the sensations of imbalance.
There’s also a miscellaneous category for a host of conditions such as anxiety or even inattentiveness, says Morgenstern.
“As people get older, their dizziness may come from multiple causes,” says Mignoli.
Some people like Gallardo, may have an underlying disorder that’s exacerbated with other things like medications. Since so many aging adults are taking medications, he says patients should make sure to bring up dizziness symptoms to doctors who prescribe medicine, “Sometimes the interactions aren’t quite clear.”
What to do?
“Go to a physician if dizziness persists. But, go to an emergency room if the dizziness is accompanied by signs of a stroke such as double vison, slurred speech or weakness or numbness on one side,” Morgenstern says.
Help Your Diagnosis
Patients can help doctors by writing down information about dizzy episode(s), such as:
- What were you doing just before it happened?
- How you felt during and after the episode? Be specific. Don’t use the word “dizzy” to describe sensations.
- How long did it last?
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