Giddiness or Dizziness ( A Simple Guide to Dizziness) is a common symptom seen by the family doctor more in the elderly than the young.
Giddiness has been described as light-headedness, unsteadiness or simply feeling faint.
Vertigo on the other hand is a feeling that the room is moving or spinning, or that the person is moving when they are not.
Balance difficulty is when a person feels they are about to fall, has difficulty staying balanced, or may actually fall.
There are many causes of giddiness:
1.insufficient blood flow to the brain
2.Stress and Anxiety
3.Lack of sleep
4.Low blood sugar
A Patient on diabetic medication should always carry a sweet with him in case his blood sugar drops too low and suck the sweet if he feels giddy.
I once made a house call to a elderly man's house because he was in a comatose state. When I check his medicine, it appeared that he was given a diabetic medicine. When I check his blood sugar it was way below normal. I gave an intravenous glucose solution and that cause him to wake out immediately. Later he was given a glucose tolerance test and found that he has no diabetes. It was a misdiagnosis by another doctor.
It is dangerous to give diabetes medicine to a person unless he has been confirmed by blood test to be diabetic.
5.Low or very high blood pressure
6.Anemia (A Simple Guide to Anemia)
7.Fever
8.Cochlear imbalance(Motion Sickness)
9. Medicines especially tranquillizers, antidepressant, anti diabetic, anti hypertensives
10.Brain condition such as Parkinson( A Simple Guide to Parkinson's Disease),brain tumours
Most giddy spells are minor and go away after a while.
However, giddiness can also point to more serious disorders.
These include:
1.Vertigo
There is a spinning sensation or feeling that your surrounding is moving around you.
It is often accompanied by nausea and vomiting.
Nystagmus, a jerky movement in the eye, is a common sign.
Vertigo often indicates an inner ear problem.
Viruses, such as those causing the common cold or flu, can also attack the inner ear and the organ of balance resulting in severe vertigo.
In a more serious case, a bacterial infection such as mastoiditis can make a person lose his hearing and sense of balance.
Poor blood flow to the inner ear can also lead to vertigo.
This is often due to the hardening of the arteries (arteriosclerosis) which is commonly seen in patients with diabetes, high blood pressure or high blood cholesterol.
2.Light-headedness
A typical form of light-headedness occurs when you stand up too fast for the blood to reach your brain.
This form of light-headedness is often transient and harmless. More persistent forms of light-headedness can be caused by:
Loss of body fluids, for instance, loss of water in excessive sweating and diarrhea( A Simple Guide to Gastroenteritis).
This is quite common in people who had lost a lot of fluids as in diarrhea or jogging. Just lifting the head upwards can cause giddiness.
Changes to your blood pressure caused by medicines such as anti-hypertensives, diuretics and anti-depressants.
Medical conditions such as diabetes, Parkinson's disease and Anaemia.
3.Motion sickness or sea-sickness
People prone to this condition can experience nausea and even vomiting when traveling in cars, airplanes, boats, or ships.
The mechanism of motion sickness is described in my blog A Simple Guide to Dizziness so I will not elaborate on it.
Often a patient with motion sickness will ask for some medicines for traveling in a coach or aeroplane. I always advise them to take 2 of these medicine half an hour before traveling.
When the family doctor see a case of giddiness, he will ask for
1.duration of dizziness - to determine if acute or chronic.
2.any evidence of vertigo i.e. episodic sudden sensation of circular turning motion of your body or your surroundings - this is a sign of nervous system or ear disease.
3.sensation of lightheadedness, floating, giddiness, unsteadiness, fainting - all known as pseudovertigo and are more likely to be a sign of cardiovascular disease.
4.occasional dizziness episodes - e.g. benign positional vertigo attacks are brief, usually lasting a minute, and then subside rapidly.
There is a manoeuvre called the BPV (Benign Positional Vertigo) manoeuvre which is believe to clear the debris in the tubes of the cochlea or organ of balance in the inner ear. The debris cause blockage in the tubes of the cochlea resulting in vertigo or imbalance.
In a typical manoeuvre, the patient is seated at 90 degree vertical on the bed. He is then turned to lie on the right of the bed for 30 seconds( sometimes you may have to hold his head down because he cannot stand the spinning). He usually feels better after 30 seconds. He is then brought to the vertical position for another 30 seconds. Then he is turned again to lie down on the left side of the bed for another 30 seconds. Although initially uncomfortable, this manoeuvre can get rid of the benign positional vertigo in 90 per cent of the cases.
5. Continous dizziness episodes may indicate Meniere's syndrome which is characterized by paroxysmal attacks lasting 30 minutes to several hours of vertigo, tinnitus, nausea and vomiting, sweating and pallor and progressive deafness.
6. effect of position (of head or body) or a change in posture on the dizziness - e.g. benign positional vertigo is a common type of vertigo that is induced by changing head position, especially tilting the head backwards, changing from lying to sitting position or turning to the affected side.
Physical examination
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1.Observe for pallor of skin or conjunctiva.
Moderate or severe anemia will cause lightheadedness and dizziness, but usually not true vertigo
2.Blood pressure taken when lying down and again after rapidly arising to standing position.
Very High blood pressure may cause true vertigo or lightheadedness.
Low blood pressure or postural drop in blood pressure is more likely to cause lightheadedness not true vertigo
3.Examine the ear for abnormalities.
Abnormalities on ear examination with no other abnormalities found on nervous system examination may suggest ear wax,
otitis media (middle ear infection), cholesteatoma or petrositis
4.Complete nervous system examination should be performed including visual acuity, inspecting for nystagmus, cranial nerve and cerebellar signs.
If abnormalities are found may suggest multiple sclerosis, advanced brain stem tumor, acoustic neuroma( A Simple Guide to Acoustic Neuroma) or basilar artery insufficiency
Treatment of dizziness depends on whether the symptom indicates a more serious condition.
Most cases of dizziness and motion sickness are mild and self-treatable disorders.
1.Medications such as stemetil or sturgeron are given to balance the inner ear nerves or increase blood flow to the inner ear.
Iron and vitamin supplements may be given to treat anemia.
Other than medicines, the following may relieve some of your discomfort:
2.Avoid rapid changes in position, especially standing up quickly from lying down or turning around from one side to the other.
3.Avoid extremes of head motion (especially looking up) or rapid head motion (especially turning or twisting).
4.Remove or reduce using products that impair circulation, e.g. nicotine, caffeine, and salt.
5.Avoid stress or anxiety, or substances that can trigger dizziness.
These include substances that you are allergic to.
6.Avoid hazardous activities such as driving a car, operating dangerous equipment or climbing a ladder.
7.Avoiding motion sickness
Always travel in a manner such that your eyes will see the same motion that your body and inner ears feel.
When in a car, look forward into the distance.
On a ship, watch the horizon
In a plane, choose the window seat if you can, and look out of the window.
Do not read while travelling and do not sit in a seat facing backwards.
8.Treating balance disorders
The main way is to treat the underlying disease or disorder that may be causing the imbalance in the first place.
These diseases include ear infection, stroke, multiple sclerosis and other diseases of the nerve.
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