vertigo, presyncope, disequilibrium, syncope
Dizziness is an impairment in spatial perception and stability. Under the term dizziness, there are numerous different complaints that go from the symptom of vertigo (characterized by rotational dizziness), all the way to the feeling of unbalance, instability, light headedness or even "near-fainting".
Dizziness is one of the most frequent complaints in a medical office, for both primary and specialized care, and continues to be a challenge to clinical thinking. It may be caused by more than two thousand primary or secondary conditions, grouped in more than three hundreds of syndromes.
Many of the patients who complain of dizziness and do not have an apparent cause, therefore considered to have idiopathic dizziness, may have a psychiatric disorder. Moreover, even dizziness of organic causes may trigger or worsen "latent" psychiatric alterations.
The association between dizziness and psychiatric disorders is already well known, however little studied, mostly because we lack a truly integrated multidisciplinary approach for these patients. As it happens with clinical thinking, the association with psychiatric disorders is treated as a diagnosis of exclusion, that is, cases of dizziness without detectable organic alterations during physical and neurotological exam. These patients end up being considered as carriers of psychiatric-related dizziness, and are referred to the specialist, who takes over the responsibility for treatment, often times without returning to the first physician who saw them.
On the other hand, labyrinthine symptoms in psychiatric patients are often times dealt upon as psychosomatic or neurovegetative manifestations, mostly associated with an anxiety disorder, not requiring specific investigation or treatment.
One of the psychiatric disorders most commonly associated with dizziness is Panic attacks with or without agoraphobia. Somatic symptoms, especially dizziness, are the main traits of these diseases.
Syncope, also known as fainting, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, usually from low blood pressure. There are sometimes symptoms before the loss of consciousness such as lightheadedness, sweating, pale skin, blurred vision, nausea, vomiting, or feeling warm. Syncope may also be associated with a short episode of muscle twitching. When consciousness and muscle strength are not completely lost, it is called presyncope.
Causes range from non-serious to potentially fatal. There are three broad categories of causes: heart or blood vessel related, reflex also known as neurally mediated, and orthostatic hypotension. Issues with the heart and blood vessels are the cause in about 10% and typically the most serious while neurally mediated is the most common.
Heart related causes may include an abnormal heart rhythm, problems with the heart valves or heart muscle and blockages of blood vessels from a pulmonary embolism or aortic dissection among others. Neurally mediated syncope occurs when blood vessels expand and heart rate decreases inappropriately. This may occur from either a triggering event such as exposure to blood, pain, strong feelings or a specific activity such as urination, vomiting, or coughing. This type of syncope may also occur when an area in the neck known as the carotid sinus is pressed. The final type of syncope is due to a drop in blood pressure from standing up. This is often due to medications that a person is taking but may also be related to dehydration, significant bleeding or infection.
A medical history, physical examination, and electrocardiogram (ECG) are the most effective ways to figure out the underlying cause. Treatment depends on the underlying cause. Those who are considered at high risk following investigation may be admitted to hospital for further monitoring of the heart.
Syncope affects about three to six out of every thousand people each year. It is more common in older people and females.
Dizziness and fainting may be associated with several diseases including:
An ectopic pregnancy is a complication of pregnancy in which the embryo implants outside the uterine cavity. Dizziness may be a result of internal bleeding.