Dizziness
Dizziness: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
A common symptom, dizziness is a sensation of imbalance or faintness, sometimes associated with giddiness, weakness, confusion, and blurred or double vision. Episodes of dizziness are usually brief; they may be mild or severe with an abrupt or gradual onset. Dizziness may be aggravated by standing up quickly and alleviated by lying down and by rest.
Dizziness typically results from inadequate blood flow and oxygen supply to the cerebrum and spinal cord. It’s a key symptom in certain serious disorders, such as hypertension and vertebrobasilar artery insufficiency, and it may also occur in anxiety, respiratory and cardiovascular disorders, and postconcussion syndrome.
Dizziness is commonly confused with vertigo—a sensation of revolving in space or of surroundings revolving around oneself. However, unlike dizziness, vertigo is commonly accompanied by nausea, vomiting, nystagmus, staggering gait, and tinnitus or hearing loss. Dizziness and vertigo may occur together, as in postconcussion syndrome.
Emergency interventions
If the patient complains of dizziness, first ensure his safety by preventing falls, and then determine the severity and onset of the dizziness. Ask the patient to describe it. Is it associated with headache or blurred vision? Next, take the patient’s blood pressure while he’s lying, sitting, and standing to check for orthostatic hypotension. Ask about a history of high blood pressure. Determine if the patient is at risk for hypoglycemia. Tell the patient to lie down, and recheck his vital signs every 15 minutes. Start an I.V. line, and prepare to administer medications as ordered.
History and physical examination
Ask about a history of diabetes and cardiovascular disease. Is the patient taking drugs prescribed for high blood pressure? If so, when did he take his last dose?
If the patient’s blood pressure is normal, obtain a more complete history. Ask if he’s had a myocardial infarction, heart failure, kidney disease, or atherosclerosis, which may predispose him to cardiac arrhythmias, hypertension, and a transient ischemic attack. Does he have a history of anemia, chronic obstructive pulmonary disease, anxiety disorders, or head injury? Obtain a complete drug history.
Next, explore the patient’s dizziness. How often does it occur? How long does each episode last? Does the dizziness abate spontaneously? Does it lead to loss of consciousness? Find out if dizziness is triggered by sitting or standing up suddenly or by stooping over. Does being in a crowd make the patient feel dizzy? Ask about emotional stress. Has the patient been irritable or anxious lately? Does he have insomnia or difficulty concentrating? Look for fidgeting and eyelid twitching. Does the patient startle easily? Also, ask about palpitations, chest pain, diaphoresis, shortness of breath, and chronic cough.
Next, perform a physical examination. Begin with a quick neurocheck, assessing the patient’s level of consciousness (LOC), motor and sensory function, and reflexes. Then inspect for poor skin turgor and dry mucous membranes, signs of dehydration. Auscultate heart rate and rhythm. Inspect for barrel chest, clubbing, cyanosis, and use of accessory muscles. Also auscultate breath sounds. Take the patient’s blood pressure while he’s lying, sitting, and standing to check for orthostatic hypotension. Test capillary refill time in the extremities, and palpate for edema.
Medical causes
Anemia
Anemia typically causes dizziness that’s aggravated by postural changes or exertion. Other signs and symptoms include pallor, dyspnea, fatigue, tachycardia, bounding pulse, and increased capillary refill time.
Cardiac arrhythmias
Dizziness lasts for several seconds or longer and may precede fainting in arrhythmias. The patient may experience palpitations; irregular, rapid, or thready pulse and, possibly, hypotension. He may also experience weakness, blurred vision, paresthesia, and confusion.
Carotid sinus hypersensitivity
This disorder is characterized by brief episodes of dizziness that usually terminate in fainting. These episodes are precipitated by stimulation of one or both carotid arteries by seemingly minor sensations or actions, such as wearing a tight collar or moving the head. Associated signs and symptoms include sweating, nausea, and pallor.
Emphysema
Dizziness may follow exertion or the chronic productive cough that’s characteristic of this disorder. Associated signs and symptoms include dyspnea, anorexia, weight loss, malaise, use of accessory muscles, pursed-lip breathing, tachypnea, peripheral cyanosis, and diminished breath sounds. Barrel chest and clubbing may occur.
Generalized anxiety disorder
This disorder produces persistent anxiety (for at least 1 month), insomnia, difficulty concentrating, irritability and, possibly, continuous dizziness that may intensify as the anxiety worsens. The patient may show signs of motor tension—for example, twitching or fidgeting, muscle aches, a furrowed brow, and a tendency to be startled. He may also display signs of autonomic hyperactivity, such as diaphoresis, palpitations, cold and clammy hands, dry mouth, paresthesia, indigestion, hot or cold flashes, frequent urination, diarrhea, a lump in the throat, pallor, and increased pulse and respiratory rates.
Hypertension
In patients with hypertension, dizziness may precede fainting, but it may also be relieved by rest. Other common signs and symptoms include headache and blurred vision. Retinal changes include hemorrhage, sclerosis of retinal blood vessels, exudate, and papilledema.
Hyperventilation syndrome
Episodes of hyperventilation cause dizziness that usually lasts a few minutes; however, if these episodes occur frequently, dizziness may persist between them. Other effects include apprehension, diaphoresis, pallor, dyspnea, chest tightness, palpitations, trembling, fatigue, and peripheral and circumoral paresthesia.
Hypoglycemia
Dizziness is a central nervous system (CNS) disturbance that can result from fasting hypoglycemia. It’s generally accompanied by headache, clouding of vision, restlessness, and mental status changes.
Hypovolemia
Dizziness may be accompanied by other signs of fluid volume deficit, such as dry mucous membranes, decreased blood pressure, and increased heart rate.
Orthostatic hypotension
This condition produces dizziness that may terminate in fainting or disappear with rest. Related findings include dim vision, spots before the eyes, pallor, diaphoresis, hypotension, tachycardia and, possibly, signs of dehydration.
Panic disorder
Dizziness may accompany acute attacks of panic in patients with this disorder. Other findings include anxiety, dyspnea, palpitations, chest pain, a choking or smothering sensation, vertigo, paresthesia, hot and cold flashes, diaphoresis, and trembling or shaking. The patient may feel like he’s dying or losing his mind.
Postconcussion syndrome
Occurring 1 to 3 weeks after a head injury, this syndrome is marked by dizziness, headache (throbbing, aching, bandlike, or stabbing), emotional lability, alcohol intolerance, fatigue, anxiety and, possibly, vertigo. Dizziness and other symptoms are intensified by mental or physical stress. The syndrome may persist for years, but symptoms eventually abate.
Rift Valley fever
Typical signs and symptoms of this disorder include dizziness, fever, myalgia, weakness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever, which can lead to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss.
Transient ischemic attack (TIA)
Lasting from a few seconds to 24 hours, a TIA commonly signals an impending stroke and may be triggered by turning the head to the side. Besides dizziness of varying severity, TIAs are marked by unilateral or bilateral diplopia, blindness or visual field deficits, ptosis, tinnitus, hearing loss, paresis, and numbness. Other findings may include dysarthria, dysphagia, vomiting, hiccups, confusion, decreased LOC, and pallor.
Other causes
Drugs
Anxiolytics, CNS depressants, opioids, decongestants, antihistamines, antihypertensives, and vasodilators commonly cause dizziness.
Herb Alert
Herbal remedies, such as St. John’s wort, can produce dizziness.
Special considerations
Prepare the patient for diagnostic tests, such as blood studies, arteriography, computed tomography scan, EEG, magnetic resonance imaging, and tilt-table studies.
Pediatric pointers
Dizziness is less common in children than in adults. Many children have difficulty describing this symptom and instead complain of tiredness, stomachache, or feeling sick. If you suspect dizziness, also assess the patient for vertigo, a more common symptom in children that may result from a vision disorder, an ear infection, or antibiotic therapy.
Patient counseling
Teach the patient ways to control dizziness. If he’s hyperventilating, have him breathe and rebreathe into his cupped hands or a paper bag. If he experiences dizziness in an upright position, tell him to lie down and rest and then to rise slowly. Advise the patient with carotid sinus hypersensitivity to avoid wearing garments that constrict the neck. Instruct the patient who risks a TIA from vertebrobasilar insufficiency to turn his body instead of sharply turning his head to one side.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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