Persistent Dizziness: Possible Causes and Next Steps

Dizziness and an unsteady sense of balance?

Hello, Doctor.
I have been experiencing dizziness for over a month.
I have seen specialists in neurology, otolaryngology, and cardiology, and all tests have come back normal.
However, my symptoms have not improved with medication.
I would describe my symptoms as a feeling of weightlessness, which primarily includes: 1.
When standing still, I feel like my center of gravity is constantly shifting.
2.
When lying down, I have a sensation of almost falling off the bed.
3.
While sitting or lying down, I occasionally feel my body swaying, with a frequency that matches my heartbeat.
4.
I do not experience a feeling of lightheadedness or pressure in my head; it is mainly a physical sensation.
5.
When walking, I feel a bit unsteady, but I am not at risk of falling.
6.
The above symptoms have been persistent without interruption.
7.
The symptoms slightly improve for a while after I wake up in the morning.

I would like to ask the doctor: 1.
What could be the possible causes of my dizziness? 2.
Is this dizziness more related to lightheadedness or vertigo? Since the otolaryngology examination showed no issues, I feel a sense of vertigo where my body feels like it is swaying, making it hard to distinguish.
3.
Should I continue to consult with neurology and otolaryngology, or should I consider seeing a psychiatrist?

Wang, 20~29 year old female. Ask Date: 2023/06/21

Dr. Jiang Junyi reply Neurology

Hello Mr.
Wang,
You mentioned that "the symptoms improve slightly after getting up in the morning...
and the body feels like it's swaying." This may indicate proprioceptive abnormalities caused by cervical spine issues.
Often, this is related to muscle fascia tightness and degeneration of the cervical spine.
Symptoms may include pain at the affected site, discomfort, muscle stiffness, or a sensation of heaviness in the head and neck.
Additionally, autonomic nervous system dysfunction should also be considered.
Generally, when experiencing dizziness, it is important to first rule out anemia or fluid deficiency that could lead to inadequate cerebral circulation.
Symptoms may improve with hydration and electrolyte replenishment.
Blood tests can assist in evaluating dizziness.
These tests should include screening for potential complications such as anemia, hyperthyroidism/hypothyroidism, diabetes, recurrent vestibular neuritis, autoimmune diseases, neurosyphilis, and central nervous system disorders.
I recommend that you consult a neurologist to discuss further examinations and treatment.
If your symptoms occur during specific events or times, it may be worthwhile to consider psychological factors.
Thank you for your inquiry, and feel free to discuss any related questions!
Wishing you good health and peace,
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital

Reply Date: 2023/06/21

More Info

Persistent dizziness can be a perplexing and distressing symptom, especially when it has lasted for over a month without clear diagnosis or relief from medication. Based on your description, it seems that you are experiencing a sensation that could be classified as a form of dizziness, potentially leaning more towards a feeling of imbalance or unsteadiness rather than true vertigo.

Possible Causes of Your Dizziness
1. Vestibular Disorders: Even though you have seen an ENT specialist, vestibular disorders can sometimes be subtle and may not always present with classic symptoms. Conditions like vestibular neuritis or benign paroxysmal positional vertigo (BPPV) could cause sensations of imbalance or a feeling of being off-balance.

2. Neurological Issues: While you have consulted with a neurologist, some neurological conditions can be challenging to diagnose. Conditions such as migraines (vestibular migraines), multiple sclerosis, or even transient ischemic attacks (TIAs) could present with dizziness as a symptom.

3. Orthostatic Hypotension: This condition occurs when blood pressure drops significantly upon standing, which can lead to dizziness or a feeling of lightheadedness. It might be worth monitoring your blood pressure in different positions (lying down, sitting, and standing) to see if this could be a contributing factor.

4. Anxiety and Stress: Psychological factors can manifest physically, leading to sensations of dizziness or a feeling of unreality. Anxiety can cause hyperventilation, which may contribute to feelings of lightheadedness or dizziness.

5. Medication Side Effects: If you are taking any medications, it’s important to consider that some can cause dizziness as a side effect. Reviewing your medications with your healthcare provider could be beneficial.

6. Cervical Issues: Sometimes, issues related to the cervical spine, such as cervical spondylosis or muscle tension, can lead to dizziness or a sensation of imbalance.

Differentiating Between Dizziness Types
From your description, it seems that your symptoms align more with a sensation of imbalance rather than true vertigo, which is characterized by a false sense of spinning. The fact that you do not experience a feeling of spinning or motion when stationary suggests that your dizziness may not be vestibular in nature. Instead, it could be related to proprioception (the sense of body position) or other non-vestibular causes.

Next Steps
1. Follow-Up with Specialists: Given that you have already seen a neurologist and an ENT specialist, it may be worthwhile to revisit them with your ongoing symptoms. You might also consider asking for a referral to a vestibular rehabilitation specialist who can provide targeted therapy for balance issues.

2. Psychological Evaluation: If your symptoms persist without a clear physical cause, consulting with a mental health professional may be beneficial. They can help assess whether anxiety or stress is contributing to your symptoms.

3. Physical Therapy: Engaging in physical therapy, especially vestibular rehabilitation therapy, can help improve balance and reduce dizziness. A physical therapist can provide exercises tailored to your specific symptoms.

4. Lifestyle Modifications: Keeping a symptom diary may help identify triggers or patterns in your dizziness. Additionally, ensuring adequate hydration, managing stress, and avoiding sudden movements can be helpful.

In conclusion, persistent dizziness can stem from a variety of causes, and it may require a multidisciplinary approach to identify the underlying issue. Continuing to seek medical advice and exploring different specialties may ultimately lead to a clearer diagnosis and effective treatment.

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