The Three Types of “Dizziness”

threeDizziness is a vague term that is used to describe a variety of sensations, including vertigo (a sensation of spinning), lightheadedness (a pre-faint feeling), disequilibrium (instability standing or walking), Oscillopsia (visual blurring with head movement) or disorientation (something just ain’t right). I did a whole series on this a couple of years ago.

I have found that there are three main patient groups that present with complaints of of dizziness. The most common is the group of patients who are basically saying, “I’m not dizzy now, but I get dizzy at times.” Those patients with episodic symptoms require questioning about associated symptoms, timing and triggers. For example, “How long does it last? Is it provoked by movement or position change? Are there any changes in hearing noticed?”

Then there is the group that says, “I’m dizzy right now.” Many of these patient show up in the emergency room if they are acutely dizzy, ataxic (inability to walk) or vertiginous. These patients require a physical examination, including inspection for nystagmus (involuntary eye movements that often pinpoint the source of the symptoms) and cerebellar screening exams to rule out the small chance that the symptoms are the result of a stroke. If stroke is suspected, an MRI of the brain should be ordered. Many patients can be accurately diagnosed without MRI scanning.

The third group says, “I am not dizzy. I am unsteady, off balance, afraid of falling.” These patients require a different line of questioning regarding risk factors for falling. For example, “Do you have any burning or tingling in your feet? Do you get lightheaded if you stand up quickly? Do you see equally out of both eyes? Is your balance worse in the dark?” and so on.

From my perspective as a practitioner, the more specific the patient can be when describing their symptoms, the better job I can do for them. Figuring out which of these three groups applies best to you is a good start.

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.