Dizziness: Causes, Symptoms, and When to Seek Help

Q: Dizziness: Causes, Symptoms, and When to Seek Help

Hello, sir： 1. I would like to ask what my symptoms might indicate. Should we consider Meniere's disease if I have auditory abnormalities? 2. If I need to see a doctor, would you recommend a neurologist or an otolaryngologist? If it is not a case of benign parox

I would like to inquire about issues related to dizziness (vertigo)?

Hello Doctor,
I experienced dizziness for the first time about two years ago after dining at an all-you-can-eat restaurant.
The next day, when I opened my eyes, everything around me was spinning wildly, accompanied by nausea and vomiting.
The second episode of dizziness occurred on June 8: Recently, due to the pandemic, I have been studying and eating at home, and after meals, I would sit down and feel uncomfortable digestion.
Two days prior, I felt something was off with my body (but it didn’t feel like a typical cold).
On that day, after breakfast, I felt like my food hadn’t digested, and my stomach was bloated, which persisted until dinner.
When I was about to sleep, I suddenly lay back on the bed and immediately started feeling dizzy, which lasted for a while and included vomiting.
The next day, I felt better by the afternoon.

The third episode of dizziness was on June 27: Since June 8, I have been experiencing digestive issues, occasional mild dizziness, and sometimes a feeling of increased eye pressure, which makes me uncomfortable.
This morning, when I opened my eyes, I felt a very slight spinning sensation again.
The dizziness lasts longer than what is described online; even with my eyes closed, I still feel some rotation (usually, I can only sleep and cannot do anything else).
Changing positions also triggers dizziness, and sometimes I experience orthostatic hypotension, such as when I squat and suddenly stand up, I see black for a few seconds before it resolves.
Currently, I do not have symptoms like double vision, facial nerve paralysis, slurred speech, weakness in limbs, or loss of balance.
However, I do feel that my neck muscles are stiff, which may be affecting blood circulation, and I have been reading with my head down frequently, leading to poor digestion.
I would like to ask the doctor:
1.
What do my symptoms resemble?
2.
If I need to see a doctor, should I go to a neurologist or an otolaryngologist?
3.
Would you recommend any further examinations? I am concerned that it may be related to brain issues (such as vascular problems or tumors).

4.
If it is a vestibular issue, are there any immediate relief methods? For example, would maneuvers like the Epley maneuver be helpful for me?
5.
If it is caused by a cold virus, am I at risk of experiencing these symptoms again with future colds?
6.
If there is anything else you would like to add, I appreciate your response.
Thank you, Doctor.

ian, 20~29 year old female. Ask Date: 2021/06/27

Dr. Jiang Junyi reply Neurology

Hello, sir:
1.
I would like to ask what my symptoms might indicate.
Should we consider Meniere's disease if I have auditory abnormalities?
2.
If I need to see a doctor, would you recommend a neurologist or an otolaryngologist? If it is not a case of benign paroxysmal positional vertigo (BPPV), treatment is generally medication-based, and both neurologists and otolaryngologists are familiar with these types of medications.
3.
Would you recommend further examinations? I am concerned that it might be related to issues in the brain (such as vascular problems or tumors).
The following conditions would highly suggest central vertigo, thus requiring further imaging studies like a CT scan or MRI of the brain, or a carotid ultrasound:
a.
Older patients experiencing spontaneous persistent vertigo.
b.
Patients with cardiac and cerebrovascular issues experiencing spontaneous persistent vertigo, with a normal head impulse test.
c.
Spontaneous persistent vertigo accompanied by multidirectional nystagmus, severe gait instability, or inability to maintain trunk stability while sitting or standing.
d.
Spontaneous persistent vertigo accompanied by headaches (especially in the occipital region).
e.
No previous history of Meniere's disease.
f.
Patients with cardiac and cerebrovascular issues experiencing spontaneous persistent vertigo along with hearing loss.
4.
If it is a vestibular issue, are there any immediate relief methods? For example, would maneuvers like the Epley maneuver be helpful for me?
5.
If it is caused by a cold virus, I am worried that subsequent colds might trigger these symptoms again.
Daily treatment recommendations:
1.
Reduce intake of sodium (salt), caffeine, nicotine, and alcohol.
2.
During acute symptoms, benzodiazepines, antihistamines, and antiemetics can help alleviate symptoms.
I suggest you visit a neurologist or an otolaryngologist for examination and follow-up.
Please ensure self-protection, cleanliness, and adherence to preventive measures before and after your medical visit.
Thank you for your questions, and feel free to discuss any related issues further! Wishing you good health and peace.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2021/06/27

More Info

Hello! Thank you for sharing your concerns regarding your dizziness and related symptoms. Dizziness can be a complex issue with various potential causes, and it's important to approach it systematically. Let's break down your questions and provide some insights based on your symptoms and medical knowledge.

1. Symptoms and Possible Issues: Your symptoms of dizziness, nausea, and the sensation of spinning (vertigo) could be indicative of several conditions. Given your description, it sounds like you may be experiencing vestibular dysfunction, which can arise from issues in the inner ear (such as benign paroxysmal positional vertigo, or BPPV), vestibular neuritis, or even migraine-associated vertigo. The fact that you also experience symptoms related to digestion and neck stiffness suggests that there may be a multifactorial component to your condition, including muscular tension or gastrointestinal issues that could be contributing to your dizziness.

2. Which Specialist to See: For your symptoms, it would be advisable to consult with an Ear, Nose, and Throat (ENT) specialist or an Otolaryngologist. They can evaluate your vestibular system and determine if there are any inner ear issues contributing to your dizziness. If they rule out vestibular causes, they may refer you to a Neurologist for further evaluation, especially if there are concerns about neurological conditions.

3. Further Testing: Depending on the findings from your initial consultation, further testing may be warranted. This could include balance tests, hearing tests, or imaging studies like an MRI or CT scan if there are concerns about structural issues in the brain or inner ear. It's understandable to worry about serious conditions like tumors or vascular issues, but these are less common causes of dizziness, especially in younger individuals without other alarming symptoms.

4. Immediate Relief for Vestibular Issues: If your dizziness is indeed related to vestibular dysfunction, certain maneuvers like the Epley maneuver can be beneficial, particularly if you have BPPV. This maneuver helps reposition the tiny crystals in the inner ear that may be causing the spinning sensation. However, it's crucial to have a proper diagnosis before attempting any specific treatment.

5. Concerns About Viral Infections: If your dizziness is related to a viral infection (like a cold or flu), it’s possible that it could recur with future infections. However, not everyone who experiences dizziness with a viral illness will have ongoing issues. Maintaining good overall health, managing stress, and addressing any underlying conditions can help mitigate the risk of recurrent symptoms.

6. Additional Considerations: Given your history of anxiety and the physical symptoms you experience, it’s also worth considering the role of anxiety in your dizziness. Anxiety can manifest physically and may exacerbate feelings of dizziness or lightheadedness. Engaging in relaxation techniques, cognitive-behavioral therapy, or mindfulness practices may help manage anxiety and its physical manifestations.

In summary, I recommend seeking an evaluation from an ENT specialist to assess your vestibular function and rule out any inner ear issues. Depending on their findings, they may refer you for further neurological evaluation if necessary. Remember to keep track of your symptoms, including any triggers or patterns, as this information can be invaluable for your healthcare provider in making an accurate diagnosis. Take care, and I hope you find relief soon!

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