It is very common to encounter patients presenting with dizziness or ‘chakkar’ in Neurology OPD but what patients perceive or mean by dizziness varies from patient to patient. It can be a manifestation of innocuous condition such as transient low sugars or may signal something as sinister as a brain stroke or a cardiac problem.
Common underlying conditions that can result in dizziness:
- For some patients’ dizziness can be a feeling of lightheadedness or transient blackening in front of the eyes. This can occur in the setting of low blood sugar levels (hypoglycemia) or can occur as a result of a drop in blood pressure in an erect posture which reduces the perfusion to the brain (known as ‘pre-syncope’ in medical terms); sometimes when the symptoms are full-blown, can result in fall and transient loss of consciousness (‘syncope’)
- Pre-syncope/Syncope can sometimes occur without any underlying disease triggered by the site of something unpleasant (such as blood). It can also be situational such as while passing urine or while having a bout of cough
- In some cases, repeated episodes of syncope may be a manifestation of underlying cardiac rhythm disorder or may signal less effective pumping of the heart. It can also be a result of poor circulation to the brain as a result of diseased blood vessels
- For some patients’ dizziness means a false sense of spinning objects in the surroundings without any movement of the head or body. This is known as ‘Vertigo’. One of the most common causes of ‘vertigo’ is BPPV- benign paroxysmal position vertigo; BPPV is a positional vertigo precipitated by a change in the position of the head. It occurs because of the movement of debris particles in the ‘vestibular’ part of the ear which is concerned with balance. Movements of these particles triggered by head movements result in an erroneous sensation of spinning
- Vertigo can also occur in association with Migraine wherein it is often associated with headache, nausea/vomiting, and/or intolerance to light and sound
- In some cases, a viral infection can trigger severe, disabling vertigo as a result of inflammation of ‘vestibular nerve’
- Not uncommonly, dizziness or sense of imbalance, particularly when sudden in onset can be a manifestation of brain-stroke involving the back portion of the brain which is responsible for eye movements and balance control. A tumor involving the same areas of the brain can also result in similar manifestations, though the symptoms in such cases usually develop insidiously
Considering the varied perceptions of dizziness in different patients and the underlying causes varying from relatively benign to grave, it is important that patients having the above symptoms should seek consultation from Neurologist at the earliest. Timely evaluation and treatment can not only relieve the patient of disabling symptoms but can also result in improved prognosis in patients with severe underlying causes.
Dr. Prashant Makhija
MBBS, MD (Medicine)
DM (Neurology), PDF Epilepsy & Sleep Medicine
Consultant Neurologist, Wockhardt Hospitals, Mumbai Central
