Dizziness

Dizziness is one of the most common neurological symptoms among the patients who consult the Neurologist.  Similar to headaches, it is essential to pay attention to dizziness because it is sometimes caused by life-threatening neurological disorders such as Stroke and heart disorders (especially abnormal heart rhythm).

Compared to other neurological symptoms, I have to emphasize that there is a much longer list of underlying causes of dizziness—it can be something wrong with the brain, ear, heart, blood pressure, blood, etc. As such, the management of dizziness is also one of the most challenging and difficult in Medicine. Therefore, I advise every patient who has dizziness to consult a Neurologist.  

In general, dizziness (or giddiness) is described by patients as a “floating sensation (as if sitting on a boat),” unsteadiness, and vertigo (“spinning sensation—the room is turning round and round”). It is important to be familiar with the medical term “vertigo,” as it strongly indicates brain and ear disorders. 

What are the common causes of dizziness?

a. Brain disorders

The most likely possibility is Stroke, which is caused by blockage of the blood vessels in the brain. This usually occurs among elderly people who have risk factors such as Diabetes, smoking, high blood pressure, and high cholesterol levels.

Among young patients, another possible cause of dizziness is Multiple Sclerosis, an uncommon neurological disorder caused by inflammation of brain cells.

As stated earlier, the presence of vertigo points towards the brain as the underlying cause of dizziness. 

b. Ear disorders

The most common ear disorder is known as Benign Positional Vertigo (BPV), which is a common cause of dizziness. The cause of BPV is generally unknown.

c. Heart disorders

Abnormal heart rhythm results in ineffective pumping of blood to the brain, depriving the brain cells of oxygen, and leading to dizziness. In severe cases, patients have a loss of consciousness and fainting attacks.

d. Low blood pressure

When patients have low blood pressure, there is a reduction in blood flow to the brain, leading to an inadequate amount of oxygen in the brain. Consequently, patients have dizziness and fainting attacks.

The underlying causes of low blood pressure are as follows:

• Dehydration – insufficient amount of water in the body due to vomiting and diarrhea
• Excessive doses of high blood pressure medications
• Neurological disorders such as Parkinson’s disease, can cause drop in blood pressure.
• Hormonal deficiency.

e. Blood disorders

There is a long list of blood disorders that can cause dizziness such as Anemia (inadequate amount of blood in the body), low or high glucose level, kidney disease, reduced salt level, and thyroid hormone abnormality.

f.Emotional disorders

These refer to Anxiety (excessive worrying and thinking), Depression (feeling low or sad), and work-related stress. Emotional disorders are one of the most common causes of dizziness.

Sleep disorders such as difficulty in falling asleep and early awakening, are common symptoms that co-exist with Emotional disorders and further aggravate the dizziness that these patients with Emotional disorders are already suffering from.

When should a patient with dizziness urgently consult the Neurologist?

Patients are advised to urgently consult the Neurologist if:

• There is vertigo
• There is loss of consciousness, falls, or fainting attacks
• There is chest pain or palpitation
• There are other symptoms such as slurring of speech, weakness or numbness of limbs, and blurring of vision.

What will the Neurologist do for patients with dizziness?

The Neurologist will perform a physical examination, blood tests, CT / MRI brain scan, heart scan (Echocardiogram), Holter study (recording of heart rhythm), and other relevant tests.  Some patients may need to be referred to the Cardiologist (heart specialist).

Dr Chew Nee Kong
Consultant Neurologist.

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