Unexplained Dizziness: Causes and Necessary Tests

Intermittent dizziness?

Hello Doctor: Recently, I have been experiencing frequent dizziness over the past month.
It starts with sudden shortness of breath, followed by a feeling that something is not quite right with my body.
Then, I experience discomfort in my stomach and abdomen (some pain or bloating), after which the dizziness occurs.
Sometimes, I feel like my vision is fading to white, and my consciousness slowly blurs, resembling a fainting sensation.
This lasts about 10 to 15 minutes, after which I feel very fatigued, start yawning, and have a strong desire to sleep.
Occasionally, I break out in cold sweats that soak my clothes, while other times I do not.
The time from the onset of symptoms to feeling normal and energetic again is about an hour.
I have experienced these episodes after brisk walking and then boarding a bus, or sitting down to eat and having an episode 20 minutes later.
There was also an incident while walking to buy dinner and another while walking home after getting off the bus.
I have tried eating candy to prevent fainting.
Blood and urine tests have returned normal results.
Due to the unpredictable nature of my dizziness, I now feel very anxious about going out.
I would like to ask what tests I should undergo to determine the cause.
Thank you very much for your response.

Xiao Lu, 20~29 year old female. Ask Date: 2016/01/17

Dr. Gao Chunde reply Neurology

It may be related to the blood supply to the brain and transient discharges.
At your age, it is important to consider intracranial vascular abnormalities.
There may be a reduction in blood flow distribution to the brain during activity or after meals, leading to a steal phenomenon, which can result in symptoms or further complications due to discharges.
It is recommended to consult a neurologist for further examination and to arrange relevant tests to determine the cause and treatment.

Reply Date: 2016/01/17

More Info

Dizziness can be a perplexing and distressing symptom, and understanding its underlying causes is crucial for effective management. Based on your description, it seems you are experiencing episodes of dizziness accompanied by feelings of lightheadedness, abdominal discomfort, and fatigue. These symptoms can be indicative of various medical conditions, and it is essential to approach them systematically.

Potential Causes of Dizziness
1. Vestibular Disorders: Conditions affecting the inner ear, such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease, can lead to dizziness. These disorders often present with spinning sensations or imbalance.

2. Cardiovascular Issues: Dizziness can arise from orthostatic hypotension (a drop in blood pressure upon standing), arrhythmias, or other heart-related conditions. Symptoms like cold sweats and fatigue may suggest a cardiovascular component.

3. Neurological Conditions: Migraines, transient ischemic attacks (TIAs), or other neurological disorders can manifest as dizziness. The transient nature of your symptoms could align with migraine-associated vertigo.

4. Metabolic or Endocrine Disorders: Conditions such as hypoglycemia (low blood sugar) or thyroid dysfunction can cause dizziness. Your mention of eating candy to alleviate symptoms suggests that blood sugar levels may play a role.

5. Anxiety and Stress: Psychological factors can also contribute to dizziness. Anxiety can lead to hyperventilation, which may cause lightheadedness and a feeling of impending faintness.

Recommended Tests and Evaluations
Given the complexity of your symptoms, a thorough evaluation is warranted. Here are some recommended tests and assessments:
1. Blood Pressure Monitoring: Regular monitoring of your blood pressure in different positions (lying down, sitting, and standing) can help identify orthostatic hypotension.

2. Blood Tests: While you mentioned that your blood tests were normal, it may be beneficial to check for specific conditions such as thyroid function tests, blood glucose levels, and electrolyte panels.

3. Electrocardiogram (ECG): An ECG can help identify any arrhythmias or other heart-related issues that might contribute to your symptoms.

4. Vestibular Testing: If inner ear disorders are suspected, tests such as videonystagmography (VNG) or electronystagmography (ENG) can assess vestibular function.

5. Imaging Studies: If neurological issues are a concern, a brain MRI or CT scan may be warranted to rule out structural abnormalities.

6. Referral to Specialists: Depending on the findings, referrals to a neurologist, cardiologist, or an ear, nose, and throat (ENT) specialist may be necessary for further evaluation.

Lifestyle Modifications
In addition to medical evaluations, consider the following lifestyle modifications:
- Hydration: Ensure you are well-hydrated, as dehydration can exacerbate dizziness.

- Dietary Adjustments: Eating regular, balanced meals can help maintain stable blood sugar levels. Avoiding excessive caffeine and alcohol may also be beneficial.

- Stress Management: Techniques such as mindfulness, yoga, or counseling may help manage anxiety and stress, which can contribute to dizziness.

Conclusion
Dizziness can stem from a variety of causes, and a comprehensive approach is necessary to identify the underlying issue. It is essential to communicate openly with your healthcare provider about your symptoms and any triggers you notice. By working together, you can develop a tailored plan for diagnosis and management, ensuring that you regain your confidence and well-being in daily activities. If your symptoms persist or worsen, do not hesitate to seek immediate medical attention.

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