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Symptoms of dizziness

Medical expert of the article

Neurologist, epileptologist
, medical expert
Last reviewed: 04.07.2025

Symptoms of dizziness are largely determined by the level of damage (peripheral or central parts of the vestibular analyzer, other parts of the nervous system) and associated concomitant neurological symptoms. To establish the localization of the damage and its nature, a thorough analysis of the clinical picture, features of dizziness, and consideration of concomitant symptoms are necessary. Thus, systemic dizziness resulting from damage to the vestibular analyzer can be accompanied by a sensation of tinnitus and autonomic disorders in 2/3 of cases.

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Systemic dizziness

Systemic dizziness is observed in 30-50% of all patients complaining of dizziness, and its frequency increases with age. Its causes are varied, the most common of them are Meniere's disease, neuroma of the VIII pair of cranial nerves, benign paroxysmal positional vertigo, vestibular neuronitis. Correct assessment of anamnestic data and clinical examination results allow in 90% of cases to make a correct assumption about the nature of the disease after the first examination of the patient.

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of systemic dizziness. In Western Europe, the prevalence of BPPV in the general population reaches 8% and increases with age. This disease is based on cupulolithiasis - the formation of calcium carbonate aggregates in the cavity of the semicircular canals, which have an irritating effect on the receptors of the vestibular analyzer. It is characterized by short-term (up to 1 min) episodes of intense dizziness that occur when changing the position of the head (moving to a horizontal position, turning in bed). At the same time, the patient often experiences nausea and other vegetative disorders (hyperhidrosis, bradycardia). During examination, horizontal or horizontal-rotatory nystagmus is detected, the duration of which corresponds to the duration of dizziness. Distinctive features of BPPV are the stereotypical nature of the attacks, their clear connection with the position of the head, greater severity in the morning and a decrease in the second half of the day. An important distinguishing feature is the absence of focal neurological deficit, tinnitus and hearing impairment.

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Vestibular neuronitis

Vestibular neuronitis is characterized by episodes of acute dizziness lasting from several hours to a day (sometimes longer). The disease occurs acutely, much less often - subacutely, usually after a viral or bacterial infection, less often - intoxication. People aged 30-35 years are most often affected. Dizziness is intense, with pronounced vegetative disorders. Characteristic features are preserved hearing, absence of meningeal and focal neurological symptoms.

Post-traumatic dizziness

Post-traumatic dizziness occurs immediately after a head injury, while meningeal syndrome, as well as focal symptoms of damage to the brain and cranial nerves may be absent. Such a clinical picture suggests acute traumatic damage to the labyrinth itself. Much less often, dizziness occurs several days after the injury, which may presumably be associated with the formation of serous labyrinthitis. In some patients, a head injury with damage to the vestibular apparatus can lead to the development of cupulolithiasis, manifested by BPPV syndrome. In many patients, the psychogenic component of dizziness is important.

Toxic damage to the vestibular system

Toxic damage to the vestibular apparatus may develop when using aminoglycosides, which are distinguished by their ability to accumulate in the endo- and perilymph. It should be noted that while gentamicin more often leads to damage to the vestibular apparatus, aminoglycosides such as tobramycin and kanamycin more often cause hearing impairment due to damage to the cochlea. The toxic effect of aminoglycosides leads to the development of progressive systemic dizziness combined with impaired coordination of movements. When prescribing drugs of this group, it should be taken into account that they are excreted mainly by the kidneys. The ototoxic effect of aminoglycosides is usually irreversible.

Meniere's disease

Meniere's disease is characterized by repeated attacks of intense systemic dizziness, noise, ringing in the ears, pronounced vegetative disorders and fluctuating hearing loss. The basis of these manifestations is hydrops - an increase in the volume of endolymph, causing stretching of the walls of the labyrinth canals. The process is often idiopathic, less often develops as a result of an infectious disease, intoxication. The onset occurs at the age of 30-40 years, women are slightly more often affected. Attacks of dizziness last from several minutes to 24 hours with a frequency of 1 time per year to several times per day. They are often preceded by a feeling of congestion in the ear, heaviness, noise in the head, impaired coordination, etc. During an attack, pronounced imbalance and vegetative disorders are observed. After the end of an attack of systemic dizziness, the patient may experience instability when walking and coordination disorders for several hours to several days. Early hearing loss is typical, usually unilateral, progressing over time, but complete hearing loss is not observed. Spontaneous remissions are possible, the duration of which decreases as the disease progresses.

Vertebrobasilar insufficiency

In transient ischemic attacks in the vertebrobasilar system, there is a reversible disruption of the functions of the formations of the brainstem, cerebellum and other structures supplied with blood by the branches of the vertebral and basilar arteries. Transient ischemic attacks occur against the background of impaired patency of the vertebral or basilar arteries, caused primarily by atherosclerotic stenosis, less often by inflammatory diseases (arteritis), vascular aplasia, extravasal compression (for example, in case of trauma to the cervical spine). An important cause is damage to small-caliber arteries due to arterial hypertension, diabetes mellitus or a combination of both. Transient ischemic attacks in the vertebrobasilar system can be harbingers of a stroke with persistent residual effects.

In the structure of dizziness causes, cerebrovascular disorders account for 6%. The immediate cause of dizziness may be damage to the labyrinth itself due to circulatory disorders in the vascularization zone of a. auditiva, as well as damage to the brain stem, cerebellum, and conduction systems of the cerebral hemispheres. The vast majority of patients with vertebrobasilar insufficiency also have other neurological symptoms (damage to cranial nerves, conduction motor, sensory disorders, visual, static-coordination disorders). Dizziness as the only manifestation of vascular pathology of the brain is extremely rare, although it is possible with acute occlusion of the auditory artery, anterior inferior cerebellar artery. In such cases, further diagnostic search is necessary to exclude other causes of dizziness. Episodes of dizziness that occur when changing head position should not be associated with compression of the vertebral arteries by altered cervical vertebrae: the vast majority of these cases are BPPV.

Volumetric processes

Systemic dizziness may be caused by a tumor of the cerebellopontine angle, brainstem, cerebellum, usually a neuroma of the VIII cranial nerve, less often in this area a cholesteatoma, meningioma or metastases are detected. Over a certain period of time, vestibular disorders may be the only clinical manifestation of the disease, preceding hearing disorders, and the systemic nature of dizziness is observed in only half of the cases. In some cases, dizziness may be caused by tumors of the cerebellum or cerebral hemispheres, causing compression of the fronto-pontine and temporo-pontine tracts.

Temporal lobe epilepsy

Repeated stereotypical unprovoked episodes of systemic dizziness, accompanied by pronounced vegetative symptoms (feeling of heat, pain in the epigastrium, nausea, hyperhidrosis and hypersalivation, bradycardia), may be a manifestation of temporal epilepsy. The clinical picture of the seizure may include visual hallucinations and other perception disorders.

Migraine

It is possible for dizziness to develop as an aura preceding a migraine attack. Diagnostic difficulties arise if the headache attack itself is absent or develops in a reduced form.

Data have been obtained indicating a higher incidence of migraine in families with BPPV.

Demyelinating diseases

Dizziness is often observed in patients with demyelinating lesions of the central nervous system, primarily with multiple sclerosis. The characteristic remitting course of the disease, multifocal lesions, and examination results allow us to recognize the nature of the pathological process. Diagnostic difficulties may arise if dizziness occurs at the onset of the disease, in the absence or moderate severity of other symptoms of damage to the brain stem and cerebellum. Dizziness in patients with demyelinating lesions of the nervous system may have a mixed nature and is characterized by a persistent course.

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Encephalitis

Damage to the vestibular analyzer at the level of the brain stem and cerebellum is possible with inflammatory lesions of the brain - encephalitis. A distinctive feature is the single-phase nature of the disease with an acute or subacute onset and stabilization of the condition or gradual regression of symptoms. Along with vestibular disorders, other signs of damage to the nervous system are also detected in the patient.

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Developmental anomalies of the cervical spine and base of the skull

Vertigo, often of a mixed nature, may occur in patients with developmental anomalies of the cervical spine and skull base (platybasia, basilar impression, Arnold-Chiari syndrome), as well as with syringomyelia (syringobulbia). The mechanisms of vertigo in this situation are complex and varied, often their connection with developmental defects is not obvious and may be mediated by vertebrobasilar insufficiency, vestibular dysfunction.

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Non-systemic dizziness

Disturbances of balance

Balance disorders may be caused by a combination of reasons, including dysfunction of the vestibular analyzer of various origins. An important distinguishing feature is the deterioration of the patient's condition with closed eyes, when vision control is lost. In case of cerebellar damage, on the contrary, vision control is not accompanied by a decrease in the severity of ataxia. Balance disorders are observed in patients with damage to the subcortical nuclei, brain stem (neurodegeneration, intoxication, consequences of traumatic, inflammatory, vascular disease, hydrocephalus). The cause of disorders can also be a multisensory deficit - a violation of the receipt and processing of impulses from the vestibular, visual, proprioceptive receptors. Balance disorders are possible with a deficit of information, in particular, from proprioceptors (polyneuropathy), with damage to the posterior columns of the spinal cord (tabes dorsalis, myelopathy). The ataxia that occurs in this case cannot be corrected by vision control. Disturbances of balance, combined with non-systemic dizziness, often occur against the background of the use of certain medications (benzodiazepines, phenothiazine derivatives, anticonvulsants). Dizziness is usually accompanied by increased drowsiness, impaired concentration, the severity of which decreases with a decrease in the dose of drugs.

Pre-syncope conditions

Non-systemic dizziness within the framework of pre-fainting (lipothymic) states is manifested by a feeling of nausea, instability, loss of balance, "darkening in the eyes", ringing in the ears. The above-mentioned states may precede the development of fainting, but complete loss of consciousness may not occur. Characteristic are pronounced emotional disorders - a feeling of anxiety, worry, fear or, conversely, depression, helplessness, a sharp decline in strength.

Most often, such conditions occur with a decrease in systemic arterial pressure (hypersensitivity of the sinus node, vasovagal syncope, orthostatic syncope, paroxysmal disturbances of cardiac rhythm and conduction). Many antihypertensive drugs, anticonvulsants (carbamazepine), sedatives (benzodiazepines), diuretics, levodopa preparations can cause lipothymic conditions. The likelihood of dizziness increases with a combination of drugs, their use in high doses, in elderly patients, as well as against the background of concomitant somatic pathology. Presyncope and fainting conditions can also be caused by disturbances in the biochemical and cytological composition of the blood (hypoglycemia, anemia, hypoproteinemia, dehydration).

Psychogenic dizziness

Psychogenic dizziness is often associated with agoraphobia, neurogenic hyperventilation. Dizziness is one of the most common complaints presented by patients with psychogenic disorders (depressive states, hypochondriacal syndrome, hysteria). Dizziness is one of the most common symptoms of panic attacks. A common form of psychogenic disorders of the vestibular apparatus is phobic positional dizziness, which is characterized by a feeling of instability, unsteadiness of the floor under the feet, subjective disturbances in walking and coordination of movements in the limbs in the absence of objective signs of ataxia and satisfactory performance of coordination tests. Psychogenic dizziness is characterized by persistence, pronounced emotional coloring. Anxiety disorders can develop over time in patients with true vestibular dizziness, which can lead to the formation of restrictive behavior in the patient.


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