Dizziness, vertigo and balance disorders

Dizziness, vertigo and balance disorders are commonly reported symptoms during doctor’s visits. In the USA dizziness is the third most common complaint of patients seen in primary care. It was shown that at least 8,3% of patients older than 65 present with dizziness every year. The true figure is expected to be even higher as many patients do not report their dizziness.

Dizziness is a non-specific term for unsteadiness and impaired spatial orientation. It includes vertigo, lightheadedness, disequilibrium, pre-syncope, giddiness and fogginess.

There are numerous conditions that may present with these symptoms. It is very important to establish exactly what a patient means when reporting symptoms. The same word may often have different meanings to different patients and ideally the word dizziness should not be used.

DizzinessVertigo is a symptom and not the name of a specific disease. It originates from the Latin word “vertō” which means “ a whirling or spinning movement”. Vertigo can be divided in subjective vertigo (motion of patient self) and objective vertigo (motion of environment). It can also be divided in peripheral (inner ear and nerve) and central (brainstem and connections). The sensation of motion may be rotational, linear or tilting.

Vertigo is often accompanied by nausea, vomiting and hearing loss. Common conditions that present with vertigo include benign paroxysmal positional vertigo (BPPV), Meniere’s disease (MD), vetibular neuritis, vestibular migraine(MAV), multiple sclerosis (MS) and stroke.

Balance problems, imbalance or disequilibrium refer to the impaired ability of a patient to maintain upright posture. It can be present when seated but is more common when standing and walking. There may be a tendency to veer to a specific side may be present. This unsteadiness can also be accompanied by spatial disorientation.

home-slide-2Is more common in the elderly. In younger patients it can be caused by vestibular disorders of the ear, neurological disorders, musculoskeletal disorders, cardiovascular disorders and side effects of medication. The significance of this is that it may lead to falls and injuries. This can be prevented if managed properly.

Dr Hofmeyr has a special interest in vertigo, dizziness and balance disorders.