Dizziness is one of the symptoms for which most patients come to neurology consultations, whether they are referred by a general practitioner, a specialist in traumatology, an ear, nose and throat specialist or a cardiologist. Dr. Lecanda, an expert in Neurology, talks about the types of dizziness and their diagnosis.
Types of dizziness and symptoms
At first glance it seems an easy symptom to diagnose and treat, but experience says otherwise. Perhaps because of the sum of factors that contribute to this symptom so frequent and misdiagnosed in its multiple etiologies. Let us give some examples: a person gets up at night to go to the bathroom and suddenly feels dizzy, like a dizzy spell that makes him fall down and sometimes lose consciousness after urinating. On other occasions, while lying down, when moving the head in a lateral position, he feels a sudden spinning dizziness, as if the whole environment was spinning around him, associated with nausea and vomiting, and when he gets up, he loses his balance.
Another type of dizziness refers to the patient who feels as if he were sailing on a boat or as if he were in a state of drunkenness. This symptom can last for several days without any clear instability in walking.
Another type of symptom is a clear instability with left or right latero-pulsion in walking, which can also last for days or weeks. It also requires another person to lean on in order not to fall. It can also be a sudden symptom with a fall, without losing consciousness, or with loss of consciousness, which is commonly called lipotimia.
Diagnosis of dizziness
In the first case it can be diagnosed with prior neurological and cardiac tests, of a vaso-vagal syndrome, by stimulation of the vagus nerve. When getting out of bed, orthostatic hypotension is produced, and after urinating, due to contraction of the detrusor bladder muscle, hypotension increases.
In the second case we can speak clinically of a benign paroxysmal positional vertigo of the inner ear due to involvement of the balance organ of one ear. It can be diagnosed by means of specific tests in consultation with the ENT.
In the third case, the diagnosis is reached with previous neurological and cervical tests of a psychosomatic etiology with a background of chronic anxiety and stress, which influences the paracervical muscles by the mechanism of somatization. Almost always a rectification of the cervical lordosis due to contractures and paracervical tension is observed.
In the fourth case it is important to perform a brain MRI or brain CT to assess the existence of small vessel cerebral ischemia or ischemic leukoencephalopathy. This can rule out outbreaks of multiple sclerosis and other neurological pathologies.
There are cases of sudden dizziness that accompany more complex symptomatology, which may consist of severe vascular-brain onset disorders such as vertebrobasilar ischemia or cardiac disorders such as coronary ischemia.
They can be the beginning of serious problems that must be diagnosed as soon as possible by means of complementary explorations, since the prognosis is conditioned by early diagnosis. Caution should be exercised when diagnosing dizziness as a “cervical” problem, without further examination. There is nothing worse than the patient feeling overwhelmed without clear medical information and without adequate treatment. This can lead to a symptomatology that becomes chronic with the anxiety burden that this entails.