The word “dizzy” means so many different things to different people – makes me dizzy 🙄 ! Though most commonly used to describe vertigo, you will make diagnostic errors and delays if you don’t figure out what type of dizzy-magic your patient is really experiencing. So always ask them to describe in more detail what their dizziness is like. You can then ask the right leading questions by knowing the different types of dizzy !
VERTIGO : This is the “room spinning” 😵 dizzy, or the “floor is moving” dizzy. The brain takes a roller-coaster ride without telling the rest of your body ! In other words, patients feel a false sense of motion even when are still. Conditions include BPPV, Meniers, Vertiginous Migraine, Vestibural neurotinits, Posterior circulation stroke, etc
PRE-SYNCOPE: This is the “I feel like I am about to pass out” 🥴 dizzy, might also be described as lightheadedness by some. They feel a lack of energy, legs might “feel like noodles” since they feel too weak to stand up straight and often feel better laying down . Often postural but not always. Conditions include cardiac & orthostatic from low blood volume,anemia, meds, hypoglycemia, etc
DISEQUILIBRIUM: This is “Wobbly” 🚶🏽♂️ type of dizzy – loss of balance ! Walking or standing feels unsteady, they feel always like they are about to fall. The visual input from eyes helps them keep correcting posture continously to avoid falling, but they might feel like they are stumbling around like a new-born calf. If they close those eyes, they loose their visual correction input get a lot more wobbly – Romberg’s sign ! (We all feel a little wobby standing with arms stretched and eyes closed – try it !!! ) Conditions include causes of ataxia and loss of balance (Stroke/TIA, Parkison’s, Peripheral Neuropathy, Normal pressure Hydrocephalous, cord damage, visual loss etc.)
DISSOCIATIVE LIGHTHEADENESS: “I feel drunk” 🙃 dizzy. Hyperventilate for a few minutes and see how you feel ! Or if you remember how that initial buzz while drinking alcohol feels … this will also result in wobbly walking, but patients feel it both in their head and their balance. Conditions including Anxiety causing Hyperventilation, psychiatry meds side-effects, hypoglycemia, etc.
So next time you hear the word “dizzy” hopefully your ears perk up like dog-ears and you remember this post ;). Things may not always be apparent right away, and patients descriptions may sometimes overlap or they simply don’t know how to express how they feel. Leading with these questions and giving your words to their symptoms can help unlock their true symptom.
