Dizziness: Insights from a Neurology Perspective

Dizziness inquiry?

Hello Dr.
Jiang, I previously sought help from a neurologist due to sudden dizziness.
The symptoms began while sitting, with a sensation starting from the back of my head.
The surroundings did not appear distorted or spinning.
Later, the condition worsened, but lying down alleviated the symptoms completely.
However, sitting up on the bed for less than two seconds would trigger severe dizziness again, while lying down would bring relief.
Since I needed to work, I endured the situation until it eased enough for me to get out of bed.
I later noticed that standing or walking would cause dizziness, while sitting was less severe.
Nausea accompanied the dizziness, but there was no headache.
The neurologist did not arrange for any tests, only inquired about my family medical history, and indicated that it was not related to thrombosis or bleeding since there was no accompanying headache.
They prescribed two weeks of Cerebrolysin and Betahistine but did not explain the possible causes.
My condition has improved significantly, but I still experience mild dizziness intermittently for a few hours.
Should I schedule a follow-up appointment? Recently, I have also experienced muscle spasms in my neck and slight pain radiating to the top of my head, but I am unsure if it is related or due to my habits.
I am a bit concerned.
Additionally, I have noticed mild numbness in my left hand and left side of my face.
After self-assessment, my facial expressions and speech are normal, and I can perform fine motor tasks with my fingers and arms without issues.
Thank you, Dr.
Jiang, for your guidance.

Mr. Zhang, 50~59 year old female. Ask Date: 2016/04/04

Dr. Jiang Junyi reply Neurology

Based on your description, the symptoms you mentioned are more likely due to syncope.
Syncope is more likely to occur when a person is standing, as this position results in the least blood flow to the brain.
Often, there is not enough time to react, leading to fainting.
The chances of it happening while sitting are lower, and it is almost nonexistent when lying down.
Prior to losing consciousness, symptoms such as nausea, yawning, dizziness, a feeling of warmth, sweating, and cold extremities may occur.
If you frequently experience these symptoms, do not force yourself to stand; it is advisable to sit down or squat quickly to avoid fainting.
It is recommended that you discuss examination and treatment options with a neurologist or cardiologist.
Wishing you good health and peace.

Reply Date: 2016/04/04

More Info

Dizziness can be a complex symptom with various underlying causes, and your experience highlights several important aspects to consider from a neurology perspective. The symptoms you describe—sudden dizziness when sitting, a sensation starting from the back of your head, and the absence of visual distortion—suggest that this may not be a straightforward case of vertigo, which typically involves a spinning sensation. Instead, your symptoms could be indicative of other conditions that affect balance and spatial orientation.

Possible Causes of Dizziness
1. Vestibular Disorders: The vestibular system, located in the inner ear, plays a crucial role in maintaining balance. Conditions such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis could lead to dizziness, especially when changing positions. However, your description of the dizziness not being accompanied by spinning sensations might suggest a different issue.

2. Orthostatic Hypotension: This condition occurs when blood pressure drops significantly upon standing, leading to dizziness. If you experience dizziness primarily when standing or sitting up, this could be a contributing factor. It’s important to monitor your blood pressure in different positions to rule this out.

3. Cervical Issues: Given that you mentioned neck muscle pain and tenderness, cervical spine issues could also be a factor. Cervical vertigo can occur when there is irritation or injury to the neck structures, affecting balance and spatial orientation.

4. Neurological Conditions: While your neurologist ruled out serious conditions like thrombosis or hemorrhage, other neurological issues could still be at play. Conditions such as migraines (even without headache), multiple sclerosis, or transient ischemic attacks (TIAs) can present with dizziness and other neurological symptoms.

5. Anxiety and Stress: Psychological factors can also manifest physically. Anxiety can lead to dizziness and a feeling of lightheadedness, especially in stressful situations.

Recommendations
Given your symptoms, it would be prudent to follow up with your neurologist, especially since you are still experiencing intermittent dizziness and have developed new symptoms such as neck pain and mild numbness in your left hand and face. Here are some steps you might consider:
1. Return to Your Neurologist: Schedule a follow-up appointment to discuss your ongoing symptoms and any new developments. It’s important to communicate all your symptoms, including the neck pain and numbness, as these could provide valuable clues to your diagnosis.

2. Further Testing: While your initial evaluation did not indicate serious issues, further tests such as MRI or CT scans may be warranted to rule out any structural problems in the brain or cervical spine. Additionally, vestibular function tests could help assess the health of your inner ear and balance system.

3. Physical Therapy: If vestibular issues are suspected, vestibular rehabilitation therapy (VRT) can be beneficial. A physical therapist specialized in vestibular disorders can help you with exercises to improve balance and reduce dizziness.

4. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their duration, and any associated factors (like position changes, stress levels, etc.). This information can be very helpful for your healthcare provider.

5. Lifestyle Modifications: Ensure you stay hydrated, avoid sudden position changes, and consider stress-reduction techniques, as these can sometimes alleviate dizziness.

Conclusion
Dizziness is a multifaceted symptom that can arise from various causes, and your case underscores the importance of thorough evaluation and follow-up. While it’s encouraging that your symptoms have improved, the persistence of mild dizziness and the emergence of new symptoms warrant further investigation. Don’t hesitate to advocate for your health and seek the necessary follow-up care to ensure a comprehensive understanding of your condition.

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