Dizziness (Dizzy) (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Dizziness facts
- Introduction to dizziness (feeling dizzy)
- What causes dizziness?
- Low blood pressure as a cause of dizziness
- Postural or orthostatic hypotension as a cause of dizziness
- High blood pressure
- Diabetes as a cause of dizziness
- Endocrine diseases which cause dizziness
- Hyperventilation as a cause of dizziness
- Heart conditions which cause dizziness
- Vasovagal syncope as a cause of dizziness
- Dizziness and vertigo
- What are the symptoms experienced when a person feels dizzy?
- When should I call the doctor for dizziness?
- How is dizziness diagnosed?
- How is vertigo diagnosed?
- How is dizziness treated?
How is vertigo diagnosed?
The diagnosis of vertigo is most often made based upon history and clinical presentation. If the patient is experiencing a spinning sensation that worsens by a change in position, and lessens by lying still, the health care professional can confirm the cause of dizziness as vertigo if there are appropriate findings on physical examination.
Further history may be taken to make certain that the symptom of vertigo is isolated to an inner ear condition and not due to a problem in the brain (for example, a stroke).
Physical examination will focus on the neurologic examination and may involve looking at eye movements. With vertigo, nystagmus may be present. This is an involuntary movement of the eyes, slow and smooth in one direction with fast twitches in the other. It is the eyes' attempt to compensate for the abnormal signals being created in the inner ear. The patient may be asked to lay flat or sit upright to uncover the presence of nystagmus.
The patient's hearing may be tested to assess potential hearing loss. This may be seen in Meniere's disease or with an acoustic neuroma, but not necessarily with labyrinthitis or benign positional vertigo.
The rest of the neurologic examination may be done to look for one-sided weakness, loss of coordination, or loss of balance as potential signs of stroke.
Evaluation for BPPV or labyrinthitis is often complete at this point, although depending upon the health care professional's concerns, further testing may be indicated. Referral may be made to a physical therapist specially trained in vestibular therapy for diagnosis confirmation and symptom relief.
If there is confusion as to the potential cause of vertigo, imaging of the brain may be needed. Magnetic resonance imaging (MRI) may be indicated since this test evaluates the cerebellum more accurately. Computerized tomography (CT scan) may be used in an emergency to look for bleeding in the brain.
How is dizziness treated?
Dizziness is a symptom, not a disease, and treatment will be directed to the underlying cause. For example, dizziness or lightheadedness due to dehydration from gastroenteritis may require intravenous fluids and medications to stop the vomiting and diarrhea, while dizziness or lightheadedness from a heart rhythm condition may require admission to the hospital and specialized testing and treatment.
- Vertigo from inner ear problems may often be treated with maneuvers to reposition the crystals and debris in the semicircular canals. Repositioning techniques that can be helpful include the so-called Epley and Semont maneuvers, and the patient may be taught these to use at home.
- Depending upon the reason for the inner ear inflammation, oral steroid medications to decrease that inflammation might be prescribed.
- Over-the-counter or prescription medication is occasionally recommended or prescribed to help with vertigo. Meclizine (Antivert) or diazepam (Valium) may help with control of mild symptoms.
- In patients with intractable symptoms and vomiting, intravenous diazepam (Valium) may be considered.
- Patients with Meniere's disease or acoustic neuroma are usually referred to an ear, nose, and throat specialist (otolaryngologist, ENT physician) for further evaluation and care.
Learn more about: Valium
Medically reviewed by Avrom Simon, MD; Board Certified Preventative Medicine with Subspecialty in Occupational Medicine
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.
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