Introduction
Dizziness is one of the most common neurological symptoms among the patients who consult the Neurologist. Similar to headache, it is very important 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 the Neurologist.
In general, dizziness (or giddiness) is described by patients as “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 indicate brain and ear disorders.
What are the causes of loss of smell and taste?
Brain Disorders
The most likely possibility is Stroke, which is caused by blockage of the blood vessel in the brain. This usually occurs among the elderly people who have risk factors such as Diabetes, smoking, high blood pressure and high cholesterol level.
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.
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.
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 loss of consciousness and fainting attacks.
Low Blood Pressure
When patients have low blood pressure, there is reduction in blood flow to the brain, leading to inadequate amount of oxygen in the brain. Consequently, patients have dizziness and fainting attacks.
There underlying causes of low blood pressure are as follow:
- Dehydration – insufficient amount of water in the body due to vomiting and diarrhea
- Excessive dose of high blood pressure medications
- Neurological disorders such as Parkinson’s disease, which can cause drop in blood pressure.
- Hormonal deficiency.
Blood Disorders
There is a long list of blood disorders that can cause dizziness such as Anemia (inadequate amount blood in the body), low or high glucose level, kidney disease, reduced salt level and thyroid hormone abnormality.
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?
Ideally, all patients who have headache should consult the Neurologist, as headache can be a neurological emergency.
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 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).
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