dizziness

Dizziness is a broad term used to describe several related sensations, including lightheadedness, wooziness, faintness, vertigo, and presyncope. Vertigo refers to a spinning or turning sensation, while presyncope implies imminent fainting, and disequilibrium denotes imbalance. Dizziness may be chronic or episodic and may be accompanied by nausea, gait disturbance, blurred vision, or anxiety.

Common causes fall into peripheral and central categories. Peripheral causes include benign paroxysmal positional vertigo (brief spinning triggered by head movement), vestibular neuritis, Meniere disease, and ototoxic medication effects. Central causes include stroke or transient ischemic attack, brainstem or cerebellar lesions, migraine-associated dizziness, multiple sclerosis, and systemic conditions such as anemia or metabolic disturbances.

Evaluation begins with a careful history and physical examination. Red flags require urgent assessment: sudden severe symptoms with neurologic signs, new weakness, slurred speech, severe headache, fever, neck stiffness, or sudden gait impairment. Orthostatic vital signs help assess presyncope risk. Bedside tests such as the Dix-Hallpike maneuver for BPPV and the head impulse test aid localization.

Investigations are guided by findings. If the presentation is classic for BPPV or other benign causes, imaging may be unnecessary. Persistent, progressive, or focal symptoms warrant MRI or CT as appropriate, along with audiometry, blood tests for anemia, thyroid or glucose abnormalities.

Treatment targets the underlying cause. BPPV is often treated with canalith repositioning maneuvers; vestibular rehabilitation can help chronic dizziness. Hydration and salt balance are relevant for Meniere disease; migraine management and anxiety treatment may help migraine- and panic-related dizziness. Review medications for balance effects.

Prognosis varies with cause; many episodes resolve, but some individuals experience recurrent or chronic dizziness. Dizziness is common in older adults and is a major contributor to falls. When symptoms disrupt daily life, a multidisciplinary approach including primary care, neurology, and otolaryngology can improve outcomes.