What is dizziness?

By: Dr. Daniel Larson, MD
Southwest Ohio ENT Specialists

Dizziness is a symptom that can be described very differently from one person to another. Generally speaking, there are three types of dizziness: lightheadedness, imbalance or disequilibrium, and vertigo.

The most common type of dizziness is lightheadedness. People with lightheadedness often feel the sensation that one might feel before passing out. This type of dizziness is also described as the sensation similar to when one stands up too fast. With the sensation of lightheadedness, it is very important to have a discussion with a primary care provider to rule out medical problems. Lightheadedness could be caused by diabetes, hypertension, hypotension, dehydration, circulation issues, medication side effects, and other medical conditions.

Imbalance or disequilibrium is often described by people who have poor balance, others describe the sensation of being drunk. People who have imbalance or disequilibrium may have weakness of the peripheral vestibular system (inner ear). This is known as peripheral vestibular hypofunction. This is a condition that may develop slowly with age but may also develop after an insult to the inner ear. Conditions such as vestibular migraine, Ménière’s or labyrinthitis may cause peripheral vestibular hypofunction. If a person experiences any of these conditions they are often able to recover with time and vestibular rehabilitation. If the patient does not have a history of vertigo, this condition may be a form of neuropathy and is often seen in patients with diabetes.

Imbalance or disequilibrium may also develop from central nervous system (brain or spinal cord) conditions. Central nervous system imbalance may arise from injury to the brain stem which is essential for postural control, eye movements and spinal reflexes. New onset imbalance with additional neurologic symptoms such as muscular weakness, facial droop, blurred vision, unsteady gait or numbness may suggest stroke or aneurysm. Slowly progressive imbalance may suggest multiple sclerosis, progressive demyelination disease or Parkinson’s. Nutritional deficiencies or metabolic disorders may also cause chronic imbalance. This is most commonly seen in chronic alcoholism that leads to thiamine deficiency, creating a condition known as Wernicke’s encephalopathy. A tumor impacting the eight cranial nerve (balance and hearing nerve) may also cause chronic imbalance. The most common tumor is a vestibular schwannoma. A meningioma is the second most common.

Imbalance or disequilibrium may also develop due to mechanical problems. Patients who have arthritis or other musculoskeletal problems may have balance issues. Patients who have diabetes may develop peripheral neuropathy and lose sensational awareness which leads to imbalance or disequilibrium.

Vertigo is when someone experiences the illusion of motion. Sometimes people feel that they are moving or the room is moving around them. There are many different types of vertigo. Most commonly people will often describe the sensation as being on a merry go round. Vertigo can be rotational but it can also make people feel that they are moving up and down or left to right. Sometimes people have sudden onset with a very short duration in which they feel as if they were shoved. Other times people may experience something known as a drop attack where they suddenly fall to the ground. When people feel these sensations, the body is not actually moving. When a person feels as though they are shoved or fall to the ground, it is not because their body is moving it is because their inner ear is being stimulated and our natural reaction is to move the opposite direction. In short, vertigo is caused by an active process occurring within the vestibular system.

There are many other terms that patients use to describe dizziness. Sometimes people describe this as woozy, wonky, unstable, spacey, disconnected to their body or just not right. These sorts of descriptions are often due to dysfunction of the central vestibular processing center. These symptoms may primarily develop from central dysfunction or secondarily occur as a results of peripheral dysfunction.

Is important to note that vertigo or lightheadedness, when they come along with other neurologic symptoms, may be concerning. If the patient experiences visual changes, muscle weakness (facial droop), headache, changes in thinking ability, difficulty with speech, or any other neurologic problem emergency evaluation is recommended.

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