Non-Specific Dizziness: Causes and Management Strategies

Nonspecific dizziness

Hello, doctor.
One morning in February of last year, I woke up feeling dizzy (I weighed 116 kg at the time).
Initially, it felt like an earthquake, and I didn't think much of it.
However, by the end of March last year, my doctor prescribed me medication for blood sugar control (which was said to help with weight loss).
After taking it for a week, I felt discomfort near my heart, so I went back to the doctor.
An electrocardiogram was performed, and the doctor said it was muscle pain in my chest, with no heart issues, but my blood pressure was a bit high (155/101), and I was advised to take antihypertensive medication.
After three days of taking it, I experienced numbness in my head, hands, and feet, which led me to the emergency room.
The emergency physician indicated it was a side effect.
The next day, I returned for a follow-up, and the doctor advised me to stop the medication.
I discontinued both the blood pressure and blood sugar medications.
After that, I experienced two days of insomnia, followed by worsening dizziness that turned into a sense of imbalance, which initiated my journey of examinations.

I underwent a series of tests including a CT scan of the head, MRI of the head, intracranial blood flow assessment, eye movement tests, neck CT, 24-hour Holter monitoring, exercise stress test, echocardiogram, tilt table test, autoimmune screening, liver and kidney ultrasound, colonoscopy, blood tests, urine tests, autonomic nervous system evaluation, spinal CT, and sleep apnea assessment (which I had previously tested as severe seven years ago but did not treat).
The results indicated mild stenosis in the right cerebral artery (the neurologist said it wouldn't affect my dizziness), small bone spurs in the neck that did not compress nerves, a normal heart, some spinal degeneration with small bone spurs that also did not compress nerves, and mild fatty liver, which has since resolved upon re-examination this year.
The recent sleep apnea test showed an AHI of 54 and blood oxygen saturation at 48%, with slightly elevated bilirubin (33, which the doctor said is common in Asian individuals).
Other than that, there were no significant issues.

Since those two days of insomnia, I have experienced a warm sensation in the back of my head every night, along with neck discomfort.
I find it easier to sleep when I avoid pressure on the back of my head; if I do press on it, I feel a sensation of falling.
I started using a CPAP machine in September last year, which improved my energy levels, and my blood pressure is currently normal, with my weight reduced to 90 kg.
However, I still experience persistent dizziness daily, along with occasional gastrointestinal discomfort, and numbness in my hands and feet (especially the left side).
Sometimes I also feel chest tightness.
I walk briskly every day, and I notice that sitting alleviates my dizziness, while standing and walking exacerbate it.
By mid-January of this year, the dizziness intensified to a floating sensation.
I feel fine upon waking in the morning, but it worsens after noon, and improves slightly after bathing in the evening.

Doctor, could this be due to autonomic nervous system dysfunction or sleep apnea causing cerebral hypoxia? I feel a heavy sensation in the back of my head, but it’s not a spinning sensation; it feels more like faintness.
What should I do?

Alvin, 40~49 year old female. Ask Date: 2017/09/09

Dr. Ye Qianyu reply Family Medicine

Hello! In clinical practice, the various conditions you mentioned can indeed lead to dizziness.
I recommend keeping a diary to thoroughly assess the events before and after the episodes of dizziness, as this will help identify the key factors contributing to your symptoms and allow for targeted treatment.
Another urgent matter is weight loss.
Although I do not know your height, based on the limited information you provided, it appears that you may be dealing with issues of overweight and metabolic syndrome.
I suggest consulting with a professional nutritionist and physician to assist you in losing weight, which should help prevent the progression of chronic diseases.
Thank you for your inquiry.

Reply Date: 2017/09/09

More Info

Understanding non-specific dizziness can be quite complex, especially when it is accompanied by a variety of symptoms and medical history, as in your case. Dizziness can stem from numerous causes, including vestibular disorders, cardiovascular issues, neurological conditions, and even psychological factors. Given your extensive medical history, let's break down the potential causes and management strategies for your dizziness.

Possible Causes of Dizziness
1. Vestibular Dysfunction: The vestibular system, which helps control balance, can be affected by various conditions. Given your history of dizziness and the fact that you experience symptoms when standing or walking, it’s possible that there could be an issue related to the inner ear or vestibular pathways.

2. Autonomic Nervous System Dysfunction: Your symptoms of dizziness, especially when standing, could indicate a form of dysautonomia. This condition affects the autonomic nervous system, which controls involuntary bodily functions. Symptoms can include dizziness, lightheadedness, and fainting, particularly upon standing (orthostatic hypotension).

3. Cervical Spine Issues: The presence of cervical spine osteophytes (bone spurs) could potentially contribute to dizziness, especially if there is any compression of the vertebral arteries or nerves. However, your doctors have indicated that these do not appear to be pressing on nerves.

4. Sleep Apnea: Your history of severe obstructive sleep apnea (OSA) could be a significant contributor to your dizziness. OSA can lead to intermittent hypoxia (low oxygen levels) during sleep, which may affect brain function and contribute to feelings of dizziness and fatigue during the day.

5. Medication Side Effects: The medications you were prescribed for blood pressure and blood sugar management can also have side effects that include dizziness, lightheadedness, and numbness. It’s essential to communicate any side effects to your healthcare provider.

6. Psychological Factors: Anxiety and stress can manifest physically, leading to symptoms such as dizziness, tingling in the extremities, and a feeling of imbalance.

Management Strategies
1. Medical Evaluation: Continue to work closely with your healthcare providers, including neurologists and cardiologists, to monitor your symptoms and adjust medications as necessary. It may be beneficial to have a comprehensive review of all medications to identify any that could be contributing to your symptoms.

2. Vestibular Rehabilitation Therapy (VRT): If vestibular dysfunction is suspected, VRT can be an effective treatment. This therapy involves exercises designed to improve balance and reduce dizziness.

3. Autonomic Testing: If dysautonomia is suspected, consider undergoing tests to evaluate autonomic function. This might include tilt-table testing or other assessments to determine how your body responds to changes in position.

4. Sleep Study: Given your history of severe sleep apnea, a repeat sleep study may be warranted to assess the current state of your condition and the effectiveness of your CPAP therapy. Proper management of sleep apnea can significantly improve daytime symptoms, including dizziness.

5. Lifestyle Modifications: Maintaining a healthy lifestyle, including regular physical activity, a balanced diet, and proper hydration, can help manage symptoms. Gradually increasing your activity level, especially with exercises that improve balance, can be beneficial.

6. Cognitive Behavioral Therapy (CBT): If anxiety or stress is contributing to your symptoms, CBT can help manage these feelings and reduce the physical manifestations of anxiety.

7. Follow-Up: Regular follow-ups with your healthcare providers are crucial to monitor your symptoms and make necessary adjustments to your treatment plan.

Conclusion
Dizziness can be a multifaceted issue, and it often requires a comprehensive approach to diagnosis and management. Given your complex medical history, it’s essential to continue working closely with your healthcare team to explore all potential causes and tailor a management plan that addresses your specific needs. Always report any new or worsening symptoms to your healthcare provider promptly, as this can help in adjusting your treatment plan effectively.

Similar Q&A

Understanding Non-Specific Dizziness: Causes and Next Steps for Patients

Hello doctor, I have been experiencing dizziness for almost three years now. During this time, I have undergone numerous tests, but the cause of my dizziness remains undetermined. The doctors have suggested that it may be due to anxiety or sleep apnea leading to autonomic nervous...

Dr. Liao Yaopan reply Family Medicine
Hello, dizziness is a non-specific symptom. It is advisable to first have an evaluation and differential diagnosis by a neurologist. Normal sleep and regular exercise are also very important and may help alleviate your discomfort. Please note that online consultations are not equ...

Managing Dizziness: Exploring Medical Options Beyond Neurology and ENT

Hello, Director Wu. For long-term dizziness and occasional vertigo, aside from neurology and otolaryngology, which other specialties can I consult? 1. If dizziness is caused by blood pressure issues, what are the typical symptoms? 2. In a stable mental and physical condition, ...

Dr. Wu Zongying reply Family Medicine
Hello: Dizziness may not always have a detectable cause. Even with medication, improvement is not guaranteed. In terms of diet, it is advisable to avoid consuming high-concentration or strongly flavored soups, as they may affect the inner ear's semicircular canals and lead t...

Unexplained Dizziness: Navigating Neurological Concerns and Next Steps

Hello Doctor, I have been experiencing continuous dizziness for a week (at times, it feels like there is a force pushing my eyeballs outward), slight imbalance while walking, and decreased dexterity in my hands. Occasionally, I have tremors, nausea, and diarrhea. During this peri...

Dr. Lin Zijing reply Neurology
The causes of dizziness can be broadly categorized into the following: 1. Vestibular disorders: Such as motion sickness, viral infections, abnormal displacement of otoliths, and Meniere's disease. 2. Visual disorders: For instance, wearing glasses with an incorrect prescrip...

Managing Persistent Dizziness: Insights from Neurology and Emergency Care

Hello Dr. Hong, I have been experiencing severe dizziness recently, accompanied by vomiting and diarrhea, which led me to visit the emergency department. They assisted with blood tests and a CT scan of my brain (which showed no issues). The dizziness and vomiting require treatmen...

Dr. Hong Weibin reply Neurology
Hello, I apologize for the late response. There are many causes of dizziness. If you have already undergone imaging studies of the head and confirmed that there are no structural issues in the brain, a detailed medical history inquiry is necessary for diagnosis. Generally, the ...