Causes of Dizziness

Common Causes of dizziness with presenting symptoms

Disorder  Tempo Symptoms Circumstances
Vestibular neuritis Acute dizziness  R Vertigo, disequilibrium, nausea and vomiting, oscillopsia Spontaneous, exacerbated by I head movements
Labyrinthitis , Acute dizziness Vertigo, disequilibrium, nausea and vomiting, oscillopsia, hearing loss and tinnitus Spontaneous, exacerbated by head movements
Wallenberg’s infarct Acute dizziness Vertigo, disequilibrium, nausea and vomiting,
lateroPulsion, ataxia, crossed sensory loss, oscillopsia
Spontaneous, exacerbated by I head movements
Bilateral vestibular deficit or >7 days from a Unilateral vestibular defect  Chronic dizziness Dizzy, disequilibrium, occasionally oscillopsia Induced by head movements, walking. Exacerbated when I walking in the dark or on uneven surfaces
Mal de debarquement I Chronic dizziness J Rocking or swaying as if on a boat Spontaneous while lying or sitting
Rarely occurs while in motion
Oscil1opsia Chronic dizziness S Subjective illusion of visual motion Spontaneous with eyes open
Anxiety/depression ‘ Chronic dizziness Lightheadedness, floating, or rocking Induced by eye movements with head still
Benign paroxysmal positional vertigo Spells: seconds Vertigo, lightheadedness, nausea Positional: lying down, sitting up or turning over in bed, bending forward
Orthostatic hypotension Spells: seconds Lightheadedness Positional: standing up
Transient ischemic attacks Spells: minutes ‘Vertigo, lightheadedness, disequilibrium” Spontaneous
Migraine . Spells: minutes , Vertigo, dizziness, motion sickness Usually movement-induced
Panic attack Spells: minutes Dizziness, nausea, diaphoresis, fear, palpitations, paresthesias Spontaneous or situation
Motion sickness Spells: hours Nausea, diaphoresis, dizziness I Movement induced, usually vlsuovestibular mismatch
Meniere’s disease  Spells: hours Vertigo, disequilibrium, ear “ fullness from hearing loss and tinnitus ‘ Spontaneous, exacerbated by  head movements

Common symptoms of dizziness and Mechanisms or systems involved

Symptoms Mechanism
Disequilibrium: imbalance or unsteadiness while standing or walking Loss of vestibulospinal, proprioception, visual, and/or motor function, joint pain or instability, and psychological factors
Lightheadedness or presyncope · Decreased blood flow to the brain
Sense of rocking or swaying as if on a ship , (mal de debarquement) Vestibular system adapts to continuous, passive motion and must ! readapt once environment is stable
Motion sickness Visuo-vestibular mismatch
Nausea and vomiting Stimulation of medulla .
Oscillopsia: illusion of visual motion Spontaneous: acquired nystagmus
Head-induced: severe, bilateral loss of the vestibulo-ocular reflex
Floating, swimming, rocking, and spinning inside of head (psychologically induced) Anxiety, depression, and somatoform disorders I
Vertical diplopia Skew eye deviation I
Vertigo: rotation, linear movement, or tilt Imbalance of tonic neural activity to vestibular cerebral cortex

Quick Reference to Causes of dizziness.

AG Kerr FRCS (Ann Acad Med Singapore, 2005;34:285-8)

  Pathology of Vertigo
Sensation of rotation
Episodic Seconds Stimulation or depression of the labyrinth
  Hours Metabolic of biochemical failure of the labyrinth
Prolonged Weeks Destructive lesion of the labyrinth
Sensation of unsteadiness
Episodic Seconds Physiological overload of the vestibular system
  Hours to days Temporary impairment of the vestibular system
Prolonged Weeks to months Vestibular inadequacy
  Main Causes of Short-lived Rotatory Vertigo
(duration: less than 1 minute, usually about 20 seconds)
Benign positional vertigo,  Labyrinthine fistula, Caloric effect,
Vertebrobasilar insufficiency
  Main Causes of Longer Episodic Rotatory Vertigo
(duration: ¼-24 hours, usually a few hours)
Meniere’s disease,  Delayed endolymphatichydrops, Syphilitic labyrinthitis
Decomposition of a previously compensated vestibular lesion,
“Vestibular-Meniere’s disease”
  Main Causes of Prolonged Rotatory Vertigo
(duration: up to 3 weeks)
Vestibular neuronitis
Trauma Accidental Head injury
Ear surgery
  Planned Labyrinthectomy
Vestibular nerve section
Labyrinthitis Bacterial or viral
Vascular lesions of the labyrinth
Metastaitic deposits in Cerebello-Pontine angle
  Main Causes of Short-lived Unsteadiness
(duration: less than 1 minute, usually a few seconds)
Rapid head movements – especially post-concussion
Abnormal input Visual (including heights),  Cervical
Minor inadequacies Visual

Main Causes of Longer Episodic Unsteadiness
(duration: from hours to days)
Motion sickness
Perilymph fistula
Active chronic suppurative otitis media
Decompensation of previously compensated lesion
  Main Causes of Prolonged Unsteadiness
(duration: weeks to months, even years)
×Metabolic effect (reversible) e.g., anticonvulsants
×Destructive effect (irreversible) e.g., ototoxic antibiotics
CNS lesions
×Multiple sclerosis
×Vascular disease
Floating patient
Active chronic suppurative otitis media