Balance Issues: When to See a Neurologist for Dizziness

Recently, I have been feeling unsteady on my feet?

In recent days, I have been feeling a lack of balance, similar to the sensation of dizziness after spinning in circles.
However, the dizziness is quite mild and does not severely affect my ability to walk.
It is usually more noticeable when lying down or getting up from bed, but starting yesterday, I have been experiencing this sensation even during daily activities.
There has been no head trauma, so I suspect it may not be related to an injury.
I am concerned it could be an issue with my autonomic nervous system or the semicircular canals, or even a brain tumor.
I searched online for symptoms, but I do not have the nausea, vomiting, or weakness that are often mentioned (though they may not have appeared yet).
The only recurring sensation is this feeling of dizziness.
What kind of symptoms could this be? If I need to see a doctor, should I consult a neurologist, neurosurgeon, or another specialist? Thank you.

Xiao Xu, 30~39 year old female. Ask Date: 2017/04/18

Dr. Jiang Junyi reply Neurology

Hello, based on your description, benign paroxysmal positional vertigo (BPPV) should be considered first.
The characteristic symptoms include episodes of dizziness lasting a few seconds, related to changes in head position, such as bending over, tilting back, lying down, getting up, turning over, or suddenly turning the head.
In severe cases, it may be accompanied by symptoms such as nausea, vomiting, palpitations, cold sweats, and a feeling of weakness.
The causes are mostly unknown, but some may be due to inflammation, degeneration, or head trauma leading to the displacement of otoliths in the utricle of the inner ear into the semicircular canals.
When the head position changes, the movement of the otoliths within the semicircular canals causes changes in the neural electrical potential of the inner ear, resulting in vertigo.
It is recommended that you consult an otolaryngologist or a neurologist to discuss examination and treatment options.
Wishing you good health and peace.

Reply Date: 2017/04/18

More Info

When experiencing balance issues, such as the sensation of dizziness or feeling off-balance, it is essential to understand the potential underlying causes and when to seek medical attention. Your description of feeling dizzy, particularly when lying down or getting up from bed, suggests that you may be experiencing symptoms related to vestibular dysfunction or autonomic nervous system issues.
Dizziness can arise from various sources, including inner ear problems (such as benign paroxysmal positional vertigo or vestibular neuritis), neurological conditions, or even cardiovascular issues. The inner ear contains structures that help maintain balance, and any disturbance in these structures can lead to dizziness or a sensation of spinning (vertigo). Additionally, autonomic nervous system dysfunction can lead to symptoms like lightheadedness, especially when changing positions, which may indicate issues with blood pressure regulation.

Given your symptoms, it is advisable to consult a healthcare professional. The first step is typically to see a neurologist, as they specialize in conditions affecting the nervous system, including the brain and spinal cord. A neurologist can perform a thorough evaluation, including a detailed history and physical examination, to assess your symptoms and determine if further testing is necessary. This may include imaging studies, such as an MRI or CT scan, to rule out any structural abnormalities in the brain, such as tumors or lesions.

If the neurologist suspects that your dizziness is primarily due to inner ear issues, they may refer you to an otolaryngologist (ENT specialist) who specializes in disorders of the ear, nose, and throat. The ENT can conduct specific tests to evaluate your vestibular function and determine if there is an underlying condition affecting your balance.

It is also essential to monitor any additional symptoms that may develop, such as nausea, vomiting, or changes in vision, as these can provide further clues about the underlying cause of your dizziness. If you experience any concerning symptoms, such as severe headaches, weakness, or changes in consciousness, seek immediate medical attention.

In summary, your symptoms warrant a visit to a neurologist to assess potential neurological causes of your dizziness. Depending on their findings, they may refer you to an ENT specialist for further evaluation of your vestibular system. Early intervention can help identify the cause of your symptoms and guide appropriate treatment, which may include vestibular rehabilitation therapy, medication, or lifestyle modifications to improve your balance and overall well-being.

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