- Vertigo (spinning or other illusion of movement such as tilting, floating, or impulsion). Vertigo is generally caused by an inner ear disturbance, but can also be cause by a central (brain) disturbance.
- Lightheaded sensation, impending faint. Lightheadedness is generally caused by low blood pressure, and may be associated with orthostatic hypotension or syncope .
- Confusion. Generally caused by metabolic (blood chemistry) disturbances.
- Spatial discomfort. This category encompasses all types of dizziness not specifically covered by the above, and is especially applicable to dizziness caused by psychiatric disorders.
Overview: These words are often used in a general way and cover a large number of categories of disease. One must be more specific in order to narrow down to a smaller potential subset of disorders.
Causes of Dizziness.
- Otologic (inner ear related, about 50% of all dizziness)
Central or Neurologic (brain related, 5% of dizziness in general)
- Stroke , Migraine and other disturbances of circulation to the brain (50% of neurologic dizziness)
- Seizure (5% of the 5% -- i.e. verry rare)
- MS and other disorders of the white matter (1%)
- Cerebellar degeneration , Chiari malformation , and other disorders of the cerebellum (about 2%)
- Mal de Debarquement syndrome (rare)
- Others (all unusual)
- Medical (5-10%)
- anxiety and panic disorder
- somatization syndrome
- Chronic Subjective Dizziness (CSD)
- Phobic positional vertigo
- Unknown causes or diagnoses so vague as to be meaningless (25%)
Overview: The proportion of dizziness attributed to these categories varies considerably, but roughly 50% of all dizziness is caused by inner ear disturbances, about 5% by medical and neurological problems each, about 15% by psychological disturbances, and the remainder of patients (about 25%) the diagnosis is essentially unknown.
- Sensory disturbances (loss of position sense, vestibular sense, visual sensation, or a combination of all three). Any source of dizziness can cause imbalance.
Central, brain disturbances, including the same causes of central dizziness listed above, plus
- Migraine (common)
- Multiple small strokes (common)
- Cerebellar degeneration , Chiari malformation , and other disorders of the cerebellum (moderately common)
- Parkinsonism and related disorders of the basal ganglia (moderately common)
Peripheral (weakness such as caused by muscle disease), or spinal cord disorders.
- These are common disorders but generally other symptoms than imbalance dominate the picture
Spinal cord compression (uncommon).
- Tinnitus and dizziness can be associated with neck disease causing some diagnostic confusion
Overview: In dizzy patients, most imbalance is caused by inner ear disturbances. When dizziness is not present, most imbalance is central. In older patients, multisensory disturbances are the most common. In younger patients, central problems are more common.
Causes of Hearing Disturbances
- Conductive type (mechanical)
- Sensorineural type (hair cells or nerve)
Central type (brain)
- auditory cortex
- Psychological (malingering)
- Mechanism usually unclear
Overview: The great majority of hearing disturbances are sensorineural, either associated with aging or noise exposure. Conductive hearing losses can generally be fixed by surgery. Central hearing losses are very rare. Psychological hearing losses are also very uncommon.