Persistent Dizziness for Two Weeks: Possible Causes and Next Steps

Persistent dizziness throughout the day for half a month without improvement?

On August 25, I suddenly started experiencing dizziness, headaches, pain around my right eye, vomiting, and difficulty focusing on the computer screen, especially with text, which made me feel nauseous.
My vision has been somewhat blurry.
I visited an ophthalmologist, who found my intraocular pressure to be 23, but my retina appeared normal.
The ophthalmologist recommended that I see an internist.
I also consulted an ENT specialist and received medication.
I have no tinnitus, and my blood pressure is normal.
Although my vomiting and headache symptoms have lessened, I still feel dizzy and have no appetite.
I often forget where I placed things and need to search for them, and my concentration is poor, making it more difficult than usual.
My occipital region feels heavy and swollen, and I have a stiff neck.
When I look down to write and then look up, I feel even dizzier for a moment.
Lying in bed with my eyes closed does not make me feel dizzy.
At work, looking at the screen makes it hard to concentrate, and I frequently make typing errors.
Occasionally, I experience pain on the right side of my head, but the location varies.
If my head is resting against something, the dizziness decreases.
I saw a neurologist, but after taking the medication, I felt even dizzier and nauseous, with goosebumps.
Later, I switched to taking Guanfacine, Ondansetron, and Diphenhydramine, which helped slightly; the dizziness has lessened but has not completely disappeared.
During my first visit, the neurologist suggested it might be vestibular neuritis or vestibular migraine.
During my second visit, they mentioned it could be autonomic nervous system dysregulation.
I am still experiencing dizziness, which has lasted longer than I have ever experienced before.
In the morning, I wake up with a heavy, slightly dizzy feeling in the back of my head, and about 1-2 hours after getting up, the dizziness worsens.
I feel dizzy both at home and at work, and working on the computer at the office exacerbates the dizziness, leading to frequent mistakes, which is quite distressing.
Even after returning home and taking a shower at night, I continue to feel dizzy.
I am in a constant state of dizziness throughout the day, and only resting in bed alleviates it.
I would like to ask the doctor what these symptoms might indicate.
Is there a necessity for a CT scan? I had surgery last year to remove a 5 cm lung tumor from my right lower lobe, which was benign, but the cause of its formation is unknown, and I am concerned about whether anything else has developed.
I had a CT scan of my lungs in July this year, and I wonder if getting a CT scan of my head would impose too much of a burden on my body.
I also had two CT scans of my chest and abdomen last year.
Thank you, doctor.

Sherry, 30~39 year old female. Ask Date: 2023/09/08

Dr. Peng Shiwei reply Neurology

Hello, whether you need to undergo a CT scan should be discussed with your attending physician.
Thank you for your question.

Reply Date: 2023/09/08

More Info

Persistent dizziness can be a challenging symptom to evaluate, especially when it has lasted for two weeks and is accompanied by other concerning symptoms such as headaches, nausea, and difficulty concentrating. Based on the information provided, there are several potential causes for your symptoms, and it is crucial to consider a comprehensive approach to diagnosis and management.

Possible Causes of Your Symptoms
1. Vestibular Disorders: Given the dizziness and associated symptoms, vestibular disorders such as vestibular neuritis or labyrinthitis could be potential causes. These conditions often arise from viral infections and can lead to prolonged dizziness, imbalance, and sometimes nausea.

2. Migraine-Associated Dizziness: Your symptoms could also be indicative of vestibular migraine, especially since you mentioned a history of headaches. This condition can cause episodes of dizziness that may be triggered by visual stimuli, such as looking at a computer screen.

3. Cervical Issues: The mention of neck stiffness and increased dizziness when looking down or up suggests that cervical spine issues could be contributing to your symptoms. Cervical vertigo can occur due to neck strain or injury, leading to dizziness.

4. Neurological Concerns: Given your history of lung surgery and the concern about potential growths, it is essential to rule out any neurological issues. Symptoms such as persistent dizziness, headaches, and cognitive difficulties warrant a thorough neurological evaluation.

5. Anxiety and Stress: Psychological factors can also contribute to dizziness and cognitive difficulties. Anxiety can manifest physically, leading to symptoms like dizziness, nausea, and difficulty concentrating.

Next Steps
1. Neurological Evaluation: Since you have already seen a neurologist, it may be beneficial to follow up with them, especially if your symptoms persist or worsen. They may recommend further testing, such as MRI or CT scans, to rule out any structural issues in the brain.

2. Vestibular Testing: If vestibular disorders are suspected, a referral to a specialist in vestibular rehabilitation may be appropriate. They can perform specific tests to assess your balance and inner ear function.

3. Cervical Assessment: Consider consulting a physical therapist or chiropractor who specializes in cervical spine issues. They can evaluate your neck and provide exercises or treatments to alleviate stiffness and improve symptoms.

4. Monitoring Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing the issue.

5. CT Scan Consideration: Regarding your concern about undergoing a CT scan, it is essential to discuss this with your healthcare provider. They can weigh the risks and benefits based on your medical history and current symptoms. If there is a significant concern about neurological issues, the benefits of imaging may outweigh the risks.

Conclusion
Persistent dizziness can stem from various causes, and a multidisciplinary approach may be necessary for effective management. It is essential to communicate openly with your healthcare providers about your symptoms and concerns. They can help guide you through the diagnostic process and develop a tailored treatment plan. Remember to prioritize your health and seek immediate medical attention if you experience any new or worsening symptoms.

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