Internal Medicine

Dizziness

introduction

Dizziness (Vertigo) is a subjectively felt Disorientation of the bodyin which the position of the body in space can no longer be clearly perceived and assigned. It is often accompanied by the feeling that the body or environment is moving. One distinguishes the unsystematic dizziness, who has general insecurity, a drowsy feeling and blackening in front of eyes as classic symptoms, from systematic dizziness. This group includes, for example Vertigo, the Vertigo with or without a tendency to fall and the lift feeling. Both can be responsible for acute dizziness.

causes

The Causes of dizziness are as diverse and varied as the symptoms of the vertigo themselves and the patient groups who may be affected. The following are the most common causes. If symptoms are unclear or in doubt, those affected should consult a doctor.

A dizzy spell is always caused by a Disturbed interplay of visual, vestibular and somatosensory perception. This means that the visual stimulus that the eyes perceive, the sense of balance that arises in the inner ear and the intuitive feeling about the location and position of one's own body in space no longer completely match. The cause for this can be a Disruption of the cardiovascular system be. Also a few Medication and / or alcohol shift one's own body perception and can thus become the cause of dizziness. When there are errors in the organ of equilibrium, what is known as vestibular dizziness often occurs (benign paroxysmal positional vertigo).

The physical causes also include sensory dizziness in visual disturbances or polyneuropathy (for example in patients with diabetes mellitus). Here, the body feeling and the perceived image of the environment do not match. In addition, severe anemia (anemia) after blood loss or with chronic undersupply and also hypoglycaemia (HypoglycemiaCause dizziness. Exercise is also a possible cause of dizziness. Why this happens and how can it be prevented, read the next article - Dizziness after exercise.

Not to be neglected causes of dizziness can also always be psychological in nature. Phobic vertigo attacks are known that are caused solely by the fear of falling or experiencing dizziness. Some patients develop panic attacks that can worsen any symptoms. Especially with older patients, one speaks in this context of the post-fall syndrome, which occurs after a first fall and is based on the fear of being able to fall again. All of these causes can be summarized under the term “psychogenic dizziness”.

Read more on the subject below Dizziness causes

Symptoms

Of course, signs of dizziness include the dizziness itself, but also one Poor performance, Strength fatigue and maybe a headache. Some patients shiver and complain of cold hands and feet. Sometimes heart palpitations or palpitations may occur. Also a Turning black before the eyes up to brief moments of the Faint (syncope) is conceivable. Sometimes it can be long before the onset of dizziness Coordination difficulties and "clumsiness" to be watched.

In some cases there is a so-called vertigo patient pathological nystagmus. Nystagmus is a jerky movement of both eyes in one direction followed by a slow backward movement in the opposite direction. In many cases this phenomenon is perfectly normal (physiological nystagmus). For example, a nystagmus helps to fix a certain point of view when you turn your head and of course change the position of the eyes. However, if such nystagmus occurs with no known cause (Turning his head, driving a train, ...), he is often a Indication of a neurological diseasewhich could be related to the dizziness or a disturbance of the balance organ in the ear. Depending on the type of dizziness that triggers the dizzy spell, different symptoms can occur, some of which are easier to influence and some of which are more difficult to influence.

diagnosis

If a doctor searches for the appropriate cause and a diagnosis in a patient with dizziness, he first bases his assumptions on a targeted questioning of the person concerned (anamnese). Important pre-existing conditions such as cardiovascular diseases, lung problems, but also diabetes (diabetes mellitus) and neurological peculiarities are asked about. It is also important to take certain medications and common luxury foods (nicotine, alcohol). Last but not least, the attending physician will ask about previous accidents and injuries as well as moments of fainting.

Some forms of dizziness can then be narrowed down or excluded by asking specific questions. If the dizziness improves with your eyes closed, for example, it is most likely what is known as ocular dizziness, which requires treatment by an ophthalmologist. Was the dizzy spell preceded by a sudden straightening or standing up due to orthostatic dysregulation.

In this case, a simple test provides quick information about the patient's ability to orthostatic: In the Schellong test, the patient initially lies quietly on a couch. The pulse and blood pressure are measured and noted every 2 minutes. The whole thing happens for 10 minutes. The patient is then asked to get up quickly. Now you measure both the pulse and the blood pressure every minute. Normally, the systolic blood pressure should stay about the same and the diastolic blood pressure, like the pulse, should only increase slightly and then settle at its new level. A deviation from this standard pattern usually has a cause. This then has to be found in the further diagnostic procedure.

In a vertigo clinic, which is offered by some clinics and practices, many different examinations and tests to find the cause of the vertigo can be carried out.

Also read the article: Vertigo without findings.

Patients who merely feel dizzy in certain places or in special situations (Bridges, large crowds ...) probably suffer from some kind of phobic postural vertigo. Regardless of the suspicion that the attending physician will already have after all these questions, one will follow physical examination. Either Blood pressure as well as the Pulse are measured once lying down and standing up. This should be done on both sides in comparison. Then be Examined heart and lungs to rule out serious illnesses. When listening to the heart, one looks for signs that may suggest a narrowing of the aorta or heart failure. In addition, the carotid arteries are examined.

During the investigation is additionally on Varicose veins or swollen legs (Edema), which may be signs of heart disease. Is also a short one neurological examination inconspicuous and there is a suspicion of a disturbance of the balance organ, the Romberg experiment be performed. To do this, the patient stands in the middle of the room with his feet closed. He is asked to close his eyes. If the patient does not succeed in stopping because he becomes insecure or even threatens to fall, one speaks of a positive Romberg sign Disturbance of the organ of equilibrium suggests.

If the Romberg attempt is inconspicuous, however, the Trespassing Unterberg connect. The patient should walk in place with his eyes closed. It is important that your feet are clearly off the ground. A healthy subject remains facing straight ahead. Illnesses that are related to the sense of balance, the patient turns around his own axis.
Further investigations will then depending on the existing suspicion carried out.

therapy

The Therapy for vertigo is of course initially dependent on the underlying cause. In some cases it already helps drink a large amount of water, themselves to sit down briefly and make it a little slower. If these measures do not help, you should lie down flat and the Legs up to take. In this position, more blood can flow back towards the heart and any dizzy spells caused by an insufficient supply of oxygen to the brain will improve quickly. Important exceptione of this recommendation Pregnant women! With them the Lie on your back makes dizziness even worse.

In patients with extremely low blood pressurewho experience dizziness more frequently, it is recommended to use the circulatory system Adequate daily hydration (drink a lot!), moderate Endurance sports and regular alternating showers a little to strengthen. Specialized clinics can also carry out special tilt table or standing training. The patient is fixed lying on a table and left to rest for some time. The table is then tilted by almost 90 degrees so that the patient is passively upright. These loads train the body's ability to carry out its adaptive reactions more quickly.

Is the cause of the dizzy spell that will disappear in the foreseeable future? Extreme situation (E.g. travel sickness) become therapy Medication such as dimenhydrinate (Vomex®) also used prophylactically. Drugs containing this active ingredient, reduce nausea and nausea. In patients diagnosed with a benign paroxysmal positional vertigo a so-called helps Positioning maneuvers. This fixed sequence of movements is a liberation maneuver that is usually carried out under the guidance of a doctor. Affected patients can, however, also learn the corresponding movements themselves, which is particularly recommended if postural vertigo occurs frequently.

For many other forms of dizziness with rather rare causes, causal therapies are also known and tested. In case of doubt, a doctor will be happy to advise and inform you.

forecast

Especially with young women and very slim patientswho often suffer from forms of dizziness caused by short-term reduced blood supply to important organs Seizures of dizziness generally recurrent on. Since a real causal therapy (apart from certain prophylactic measures) is not possible, the Cure rate rather low.

Seizures of dizziness occur in very much rapid succession on or last for a long time, it is always advisable to also consider unusual causes and sto exclude more serious diseases at least once. If a doctor clarifies the most likely cause and gives tips and advice on how best to deal with dizzy spells, those affected are usually affected little impaired in their everyday life. In most cases, an acute attack of dizziness will pass as quickly as it starts and, at most, be a little uncomfortable, but not dangerous.

About 40% of the population will experience an attack of dizziness at least once in their life with no further complications. Consists Risk of falling However, the risk potential changes significantly - especially in older patients, a fall can be problematic when suddenly dizzy. Here prophylactic measures to avoid dizziness are all the more important.

prophylaxis

Since therapies do not always help against sudden attacks of dizziness, preventive prophylaxis of an attack is of particular importance. An attack of dizziness is generally promoted by very long bed rest and infections. Anything that weakens the body and the circulation makes dizziness more likely. Help against it copious drinking and moderate endurance sport the To stabilize circulation. It is particularly recommended here Walking or leisurely jogging as well as cycling. Exercise in the fresh air also strengthens the immune system, which in turn prevents infection-related dizziness.

Regular ones also have a positive effect Alternating showers with cold and warm water and that Wearing compression stockings out. Patients who are aware of their low blood pressure should be careful not to get up too quickly (especially in the morning) and take the body's warning signs seriously. Who also like frequent dizziness triggers Avoid alcohol, excessive stress and overheated rooms, can significantly reduce the risk of dizziness.

Sudden attack of dizziness

The beginning of a dizzy spell can be very different. Any symptoms can very acute, this means suddenly and without warning, occur. It can become repeating episodes (recurrent dizziness) or permanent, long-lasting dizziness.

Sudden dizziness can also occur first under physical strain or in certain places, in certain situations become conspicuous. A sudden attack of vertigo is usually more of a good sign. These seizures often go away as quickly as they came. However, especially if such a situation has never been experienced, they can be unfamiliar and sometimes also frightening. Many patients experience sudden attacks of dizziness from time to time and after a while can even identify the cause and the exact trigger themselves.

Sweating as a warning sign

A warning sign of an approaching dizzy spell, a so-called prodrome, refers to all symptoms that lead to dizziness or a Announce fainting can. S.sweating belong to these prodromes as well as slight dizziness at the beginning, Palpitations, paleness and nausea. All of these signs should be taken seriously, but not over-interpreted. fear before an upcoming attack of dizziness reinforced This is even more and in some cases it can make the patient seem dizzy all the more.

A Vicious circle arises from fear of the symptoms, the symptoms themselves, and increased fear. If you feel "strange" or even "queasy", you should notice these feelings and sit or lie down. It is best to also take the legs up and puts it down slightly raised. If that is not possible, it can help to actively contract as many muscles as possible. The resulting pressure activates various body systems at least a little and makes the blood pressure rise a little.

Dizziness with vomiting

With some types of vertigo, in addition to the actual problem of orientation, symptoms such as Nausea and vomiting. A Dizziness with nausea or vomiting suggests a peripheral or central vestibular dizziness as the cause.
But also so-called Kinetoses, as "travel sickness“Known, for example, during a boat trip, can cause vertigo as well as nausea. If this nausea becomes too strong or if it lasts for a long time, the body reacts with vomiting. However, it should not be forgotten that some people are more prone to nausea and vomiting than others. So it also applies individual tolerance limit and condition to be observed.

Spell of dizziness while lying down

At a Spell of dizziness while lying down the cause is often one sudden change of position of the head. Especially in the early morning hours, some patients complain of very brief but severe attacks of vertigo. Often this is the so-called benign paroxysmal positional vertigo.
The triggers for this special form of dizziness are small bits, those of the so-called Otoliths canceled. Otoliths are small crystals in the inner ear that are essential for the perception of gravity and changes in speed. Those bits can move freely in the ear, especially when the head is turned, and depending on size and position, lead to classic symptoms - the body registers stimuli that do not actually match the actual movement and reacts with dizziness.

Dizziness and pregnancy

The cause of an attack of dizziness can also - especially if this is accompanied by nausea - in one existing pregnancy lie. All sorts of perfectly normal things happen during pregnancy Changes in the female body. Unfortunately, some of them also promote unpleasant symptoms such as dizziness. Many women suffer from during pregnancy Anemia (anemia), which in some cases may have already existed in advance and can be reinforced by changes in the mother-to-be's body. Most common reason for such anemia is a Iron deficiencywhich is not an uncommon deficiency symptom, especially in women.

Water retention then increases the blood volume further during pregnancy without the number of red blood cells also increasing. The blood is, so to speak, “thinned”. As mentioned above, such anemia can cause dizziness. That's because under certain circumstances no longer enough oxygen can be transported and too little blood briefly arrives in the brain of those affected. Through the resulting Oxygen deficiency there is temporary dizziness.

Via a similar mechanism with a different cause, a very low blood pressure cause dizziness during pregnancy - during the first half of pregnancy, blood pressure drops noticeably in almost all women. This phenomenon is one of the completely normal adjustment processesthat the body of an expectant mother has to provide. As a rule, blood pressure then rises again in the period after the 22nd week of pregnancy. Women who already had very low blood pressure before the start of their pregnancy suffer a lot from the initial drop in blood pressure at the beginning, since an already low blood pressure now falls even further.

In extreme cases, this can lead to a brief lack of oxygen in the brain. The reason for this is the fact that a certain blood pressure has to be present in order to pump enough blood to the head against gravity. Most of them are the resulting Attacks of dizziness, however, only last a short time and are not of concern to either the mother or the child.

In combination with the problems already explained, symptoms of the often occur, especially at the beginning of a pregnancy pregnancy-related nausea. The Emesis gravidarum, i.e. pregnancy sickness, can be observed in almost 90% of all pregnant women. On the other hand, it rarely develops into a severe form that even requires treatment. Often expectant mothers complain of morning sickness in the first twenty weeks of pregnancy, which can also be accompanied by vomiting. It is not uncommon for women to feel dizzy.

Another - also not uncommon - cause of dizziness and nausea during pregnancy is the so-called Vena-Cava Compression Syndromethat by a Clamping the main drainage vein comes about. Is a woman with an advanced pregnancy in Supine position Can be pregnancy-related severely venlarged uterus, press the adjacent vena cava and thus reduce further blood flow. It comes to Nausea, sweating and one very rapid breathing. The patients are usually pale and restless. If you turn a pregnant woman suffering from vena cava compression syndrome on her side (preferably the left side) all symptoms disappear almost immediately and the woman feels much better. Most women, however, intuitively know this themselves and automatically turn into the correct position.

Spell of dizziness when stooping

Last but not least, a sudden change in position can also cause dizziness. Usually this is a short-term "orthostatic dysregulation". This means that for some time the blood will not be distributed in the body as it should be. As a rule, dizziness occurs when the person concerned wants to lift his head up again after bending down. The blood now needs some time to suddenly be pumped back into the brain against gravity. Before that, it flowed with gravity in a much easier way.

In addition, the blood sometimes "sinks" into the legs. At times there is a condition in the brain that is associated with less blood and thus with the above-mentioned insufficient supply of oxygen and thus triggers dizziness.