Table 1: Classification of Dizziness
Type | Features | Etiology |
1. Vertigo | Rotary or tilting sensation Episodic Possible associations: nystagmus oscillopsia Vegetative symptoms: nausea Vomiting Pallor diaphoresis |
Labyrinthiasis (often viral) BPPVa (canalithiasis, cupulolithiasis) Labyrinthine ischemia (posterior circulation stroke) Endolymphatic hydrops (e.g. Meniere disease) Ototoxicity (if damage asymmetric) Trauma Central vestibular connections (about 10% of cases) |
2. Presyncope | Sensation of impending loss of consciousness Gradual onset (except if cardiac) Resolution with recumbency (except if cardiac) Associations: generalized weakness visual dimming Vegetative symptoms (as with vertigo) |
Dehydration Orthostasis Vasovagal phenomena Sympatholytic drug therapy (alpha blockade) Primary autonomic insufficiency |
3. Dysequilibrium | Unsteadiness while standing or walking Exacerbated by poor lighting if sensory |
Proprioceptive deficit (e.g. peripheral neuropathy) Visuo-vestibular mismatch (e.g. use of optical devices) Compensated unilateral or balanced bilateral vestibulopathy Dementia Central motor disorders (stroke, Parkinson disease) Musculoskeletal disorders (e.g. DJDb, myopathies) Neuromuscular junction disorders (MGc, L-ESd) |
4. Psychogenic | Vague sensation of giddiness or dissociation Protracted or continuous with periodic flaresTrigger often identifiable (crowds, confined spaces) May be induced by hyperventilation Associations: anxiety (acute or chronic) "light-headedness" "heavy-headedness" "wooziness" |
Anxiety disorder Mood disorder |
a: Benign paroxysmal positional vertigo; b: Degenerative joint disease; c: myasthenia gravis; d: Lambert-Eaton syndrome