Unexplained Dizziness: Seeking Answers After Multiple Doctor Visits

Q: Unexplained Dizziness: Seeking Answers After Multiple Doctor Visits

Hello Mr. <br>Li： There are various causes of dizziness. <br>It is recommended to first visit a neurologist to arrange for a vascular ultrasound examination. <br>Identifying the cause is essential for determining the correct treatment direction.

After multiple consultations, the cause of the head dizziness has not yet been identified?

Hello Doctor: Last month (December 21, 2023) in the evening, due to the cold weather and wearing lighter clothing, I seemed to have caught a chill.
However, I did not exhibit any obvious cold symptoms.
Shortly after, I began experiencing dizziness in my head (I find it difficult to describe the actual situation, as I have searched online multiple times but have not found any clear descriptions of related symptoms).
The sensation of dizziness feels lighter than that of losing consciousness (and the duration is quite brief, even less than half a second; it can be described as almost instantaneous.
After the dizziness, I remained fully conscious and did not experience any facial or limb numbness or weakness.
My speech was clear, and I also performed a self-assessment for stroke-related finger tests, which showed no issues).
Most of the dizziness sensations come on too quickly for me to properly observe them, so I cannot accurately describe the dizziness situation.
However, there is a slight feeling of poor balance, which makes it difficult to compare and determine what the situation is.
I have never experienced anything similar before, making it hard to accurately communicate my symptoms to a doctor.
Due to my attention deficit issues, I have been using Adderall for treatment.
I also have hypertension, hyperlipidemia, and diabetes (my high blood pressure was determined by a doctor to be due to obesity, and the doctor indicated that it would decrease with blood pressure management).
The symptoms on that day arose because I had not been managing my diabetes (which was discovered around May-June 2020).
On that day (December 21, 2023), after taking my blood sugar medication, I took Adderall again.
I am unsure if there could be any interaction or possibility of side effects (I did not take them simultaneously; I took the blood sugar medication and after a period of time [about 30 minutes to an hour], I took Adderall).
The dizziness has persisted since the 21st of last month, and I still occasionally experience sudden brief moments of dizziness, which can last for several hours.
It tends to occur less frequently after I stand up and move around.
Additionally, since I work in game art and often look down to draw, I have noticed that after looking down for a while, it becomes easier to experience dizziness.
I am uncertain if this is due to my posture or because I have been drinking coffee.
I have undergone a neurological examination for nystagmus and an ECG in the emergency room, and both reports came back normal, so it is difficult to determine the cause.
I reported this situation to an ENT doctor, but they also found it challenging to assess the situation.
Therefore, I would like to inquire about the possible reasons for my symptoms.
I have already scheduled a brain examination, but I must wait until the 15th for the test.
However, the current situation is affecting my work efficiency, so I would like to ask if you have encountered similar cases.

Li Guanho, 20~29 year old female. Ask Date: 2024/01/10

Dr. Cai Zongzhang reply Neurology

Hello Mr.
Li: There are various causes of dizziness.
It is recommended to first visit a neurologist to arrange for a vascular ultrasound examination.
Identifying the cause is essential for determining the correct treatment direction.

Reply Date: 2024/01/10

More Info

Experiencing unexplained dizziness can be quite distressing, especially when it disrupts daily activities and work efficiency. Based on the details you've provided, it seems that you've already taken several important steps by consulting various specialists, including a neurologist and an ENT doctor, and undergoing tests such as an eye movement examination and an ECG, all of which returned normal results. However, the persistence of your symptoms warrants further exploration.

Dizziness can arise from a multitude of causes, and understanding the nature of your dizziness is crucial. You described the sensation as brief and not accompanied by other neurological symptoms such as facial drooping or weakness, which is reassuring. However, the fact that it has been ongoing since December 21, 2023, and is exacerbated by certain positions (like looking down) suggests that it could be related to several factors, including:
1. Vestibular Dysfunction: This refers to issues with the inner ear or central vestibular pathways that can cause balance disturbances. Conditions like benign paroxysmal positional vertigo (BPPV) could cause brief episodes of dizziness, especially with certain head movements.

2. Orthostatic Hypotension: Given your history of high blood pressure and diabetes, it's possible that changes in posture (like standing up quickly) could lead to dizziness due to a drop in blood pressure.

3. Medication Side Effects: You mentioned taking medications for diabetes and attention deficit disorder (ADD). While you spaced out the doses, it's still worth considering whether there could be interactions or side effects contributing to your dizziness. Some medications can cause dizziness or balance issues, especially if they affect blood pressure or have sedative effects.

4. Dehydration or Electrolyte Imbalance: If you have been experiencing changes in appetite or fluid intake, this could lead to dehydration, which can cause dizziness. Monitoring your hydration status and ensuring adequate fluid and electrolyte intake is essential.

5. Anxiety or Stress: Sometimes, psychological factors can manifest as physical symptoms. If you are experiencing stress or anxiety related to your health or work, this could contribute to feelings of dizziness.

6. Postural Changes: As you noted, spending long periods in a low head position while working could lead to temporary dizziness. This could be due to muscle tension or reduced blood flow to the brain when in certain positions.

Given that you have already undergone several tests, it may be beneficial to keep a detailed diary of your symptoms, noting when they occur, their duration, and any associated activities or positions. This information can be invaluable for your healthcare provider in determining the next steps.

If your symptoms persist or worsen, consider requesting further evaluations, such as:
- MRI or CT Scan of the Brain: To rule out any structural issues that may not have been evident in previous tests.

- Vestibular Testing: Specialized tests that assess the function of your inner ear and balance system.

- Blood Tests: To check for any metabolic or electrolyte imbalances, especially given your diabetes.

Lastly, if you feel that your current healthcare providers are not addressing your concerns adequately, seeking a second opinion from a different specialist, such as a neurologist or a specialist in vestibular disorders, may provide additional insights.

In conclusion, while the cause of your dizziness remains unclear, it is essential to continue advocating for your health. Keep track of your symptoms, maintain open communication with your healthcare providers, and do not hesitate to seek further evaluations if necessary. Your well-being is paramount, and understanding the underlying cause of your dizziness is key to finding effective management strategies.

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