Dizziness and Nausea: When to See a Neurologist

Please ask your question?

Hello Doctor: Since the beginning of this month, I have been experiencing dizziness and nausea (actually, I have had these symptoms before).
The symptoms are milder during the day but I still feel dizzy and nauseous.
In the evening, the symptoms become more severe.
Last week, one night, while lying down, I felt extremely dizzy, very nauseous, my heart was racing, and I had difficulty breathing as if I was about to suffocate.
I also felt weak all over, and my arms had little strength.
The next day, I visited a neurologist who suggested that it might be due to inner ear imbalance.
However, this week when I saw an ENT specialist, the doctor mentioned it could be low blood pressure caused by anemia.
I really don’t know what to do.
Should I continue seeing a neurologist? Additionally, I often feel a lump in my throat, experience bloating, and have little appetite; I feel very full and want to vomit after eating just a little.
I would like to know what might be causing these symptoms and how I can prevent them.

shan, 20~29 year old female. Ask Date: 2010/03/18

Dr. Lin Zijing reply Neurology

Symptoms caused by anemia or low blood pressure are more likely to occur when standing or being active, and tend to improve when lying down.
Based on your symptoms, in addition to dizziness, the presence of nausea, vomiting, rapid heartbeat, loss of appetite, and bloating suggests a strong correlation with visceral issues.
Therefore, it is possible that, in addition to inner ear imbalance, there may also be a combination of autonomic nervous system dysfunction.
However, before confirming autonomic nervous system dysfunction, it is essential to consult a cardiologist and a gastroenterologist to rule out any potential underlying conditions in those specialties (such as arrhythmias, gastritis, or gastroesophageal reflux disease).
Only after these evaluations can autonomic nervous system issues be considered.
It is recommended to reduce stress, maintain a regular routine, engage in regular exercise, and ensure adequate sleep to help stabilize the nervous system.

Reply Date: 2010/03/18

More Info

Dizziness and nausea can be distressing symptoms that significantly impact daily life. Understanding the underlying causes and when to seek medical attention is crucial for effective management. Based on your description, it seems you have been experiencing these symptoms intermittently, with an increase in severity during the evenings. You also mentioned feelings of weakness, rapid heartbeat, and difficulty breathing, which can be concerning.

Possible Causes
1. Vestibular Disorders: Your neurologist suggested that your symptoms might be related to inner ear imbalances. Conditions like benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease can cause dizziness and nausea. These conditions often arise from issues within the inner ear, which is responsible for balance.

2. Anemia and Low Blood Pressure: The ENT specialist's suggestion of anemia leading to low blood pressure is also plausible. Anemia can cause fatigue, weakness, and dizziness due to insufficient oxygen delivery to tissues. Low blood pressure can exacerbate these symptoms, especially when standing up quickly or after prolonged periods of sitting or lying down.

3. Anxiety and Panic Attacks: The feelings of rapid heartbeat and difficulty breathing could indicate anxiety or panic attacks, which can also present with dizziness and nausea. Stress and anxiety can manifest physically, leading to a cycle of symptoms that may worsen over time.

4. Gastrointestinal Issues: Your symptoms of bloating, loss of appetite, and the sensation of fullness could suggest gastrointestinal problems, such as gastritis, gastroesophageal reflux disease (GERD), or even food intolerances. These conditions can lead to nausea and discomfort, further complicating your symptoms.

When to See a Neurologist
Given the complexity of your symptoms, it may be beneficial to continue consulting with a neurologist, especially if:
- Your symptoms persist or worsen despite initial evaluations.

- You experience additional neurological symptoms, such as headaches, visual disturbances, or changes in coordination.

- There is a significant impact on your daily activities or quality of life.

Diagnostic Steps
1. Blood Tests: A complete blood count (CBC) can help assess for anemia, while other tests can evaluate electrolyte levels and thyroid function.

2. Imaging Studies: If your symptoms persist, your doctor might recommend imaging studies, such as an MRI or CT scan, to rule out any structural issues in the brain or inner ear.

3. Vestibular Testing: Specialized tests can assess the function of your inner ear and balance systems.

Management and Prevention
1. Hydration and Nutrition: Ensure you are well-hydrated and consuming a balanced diet. If anemia is a concern, iron-rich foods or supplements may be necessary.

2. Avoid Triggers: Identify and avoid any specific triggers that exacerbate your symptoms, such as certain movements or stressful situations.

3. Physical Therapy: Vestibular rehabilitation therapy can be beneficial for those with balance issues, helping to retrain the brain to compensate for inner ear problems.

4. Stress Management: Techniques such as mindfulness, meditation, or cognitive-behavioral therapy can help manage anxiety and stress, potentially alleviating some of your symptoms.

Conclusion
In summary, your symptoms of dizziness and nausea could stem from a variety of causes, including vestibular disorders, anemia, anxiety, or gastrointestinal issues. It is essential to follow up with your healthcare providers, including both neurologists and ENT specialists, to explore these possibilities further. Keeping a symptom diary can also be helpful in identifying patterns and triggers, which can aid in diagnosis and treatment planning. If your symptoms worsen or new symptoms arise, do not hesitate to seek immediate medical attention.

Similar Q&A

Understanding Dizziness: When to See a Neurologist

Hello Doctor, I have been experiencing frequent dizziness or a sensation of floating, and one morning I even fell due to the dizziness. I visited an otolaryngologist, but the doctor said my ears are normal and there is no damage. I would like to ask if I should see a neurologist....

Dr. Lin Zijing reply Neurology
Hello, dizziness is an uncomfortable sensation that can make a person feel as if the surrounding environment is moving, or that they themselves are moving when they are not; at times, it may also feel like a heavy sensation in the head, or even a feeling of darkness in front of t...

Understanding Dizziness and Nausea: When to See a Neurologist

Hello doctor, I have been experiencing sudden dizziness and nausea over the past few days, but I do not have any symptoms of a cold or heatstroke. Which specialty should I consult for this?

Dr. Jiang Junyi reply Neurology
Based on your description, it may be necessary to consider common types of vertigo. The patient's dizziness occurs when turning the head, tilting the head back, or getting up from a lying position. It is recommended to first rehydrate or consult a neurologist for further eva...

Persistent Dizziness and Nausea: When to See a Doctor?

Hello doctor, I often feel dizzy and nauseous, which has been ongoing for about two years. I had a minor concussion from a car accident last November. This morning when I woke up, the dizziness worsened, and I still felt dizzy while lying in bed. It feels somewhat like being in a...

Dr. Lan Shengxing reply Neurology
Dear Sunny, this symptom should be evaluated by a physician. You can consult either an otolaryngologist or a neurologist, but I recommend seeing an otolaryngologist first. Wishing you a speedy recovery! Best, Lan Shengxing.

Should We Consult a Neurologist for Mom's Dizziness and Pain?

I would like to ask, my mother has recently reported a feeling of heaviness in her head, along with episodes of intermittent dizziness that occur at no specific time. In the past two nights, she has experienced generalized pain while sleeping. Should she see a neurologist, or is ...

Dr. Zeng Kongyan reply Neurology
Dear Xiao Zhou, In the situation described, if the symptoms have recently occurred, it is likely that there is an issue with the inner ear balance. Common symptoms include dizziness and vomiting, which may worsen with changes in posture. Possible causes could be vestibular neuri...