What Dizziness Is Actually Telling You & When to Take It Seriously

I look forward to hearing what you have to say.

I know when I speak with trainees and people who've been doing this for a long time, dizziness often comes up as one of the most frustrating things to assess.

And I'm just curious, you know, why do you think dizziness is so challenging for doctors to evaluate?

I think it's very challenging because dizziness, one, it can mean different things to different patients.

So you first have to understand what the patient means when they say they're dizzy.

So that's the first.

But also, dizziness in its many forms, and even if it's pure vertigo, which has a particular definition, can come from many different things.

So I think that's where the difficulty comes in.

And it's also a field that requires, I believe, it requires the doctor to see the patient.

You have to assess what they mean by dizziness.

The examination is extremely important.

That can range from doing the eye movements, the positioning, watching their gait, their balance, doing particular tests that give me hints as to where the dizziness is coming from.

So for all those reasons, I think it can be extremely difficult to assess.

The first thing when a patient comes to me and says, they're dizzy, the very first thing I do is understand what they mean by dizziness.

So I might ask them, does it feel like the room is spinning? If you're seated still, does it look like the room is spinning around you or the room is moving? Because there is, besides rotational vertigo, there is what I call to and fro vertigo, which it looks like the room is moving to and fro.

So that's a vertigo.

And that has a particular set of diagnosis or issues that can cause that type of vertigo or that type of dizziness, meaning where there's actually movement of the environment.

If they say, I feel dizzy when I stand up and I try to walk, I always ask them, well, do you feel dizzy if you're seated? Or if you're lying down, and they might say, never, never.

I'm perfectly fine if I'm seated or I'm lying down.

But the minute I stand up, I feel dizzy.

So then it's a question, is it their balance? Is it their gait and balance? Or is it that they're lightheaded? So it could be either of those.

And then that diagnosis then leads to different causes.

So if they're lightheaded, it would be when they first stand up very often and they feel like, then I ask, do you feel like, you know, you might faint or you feel like things are kind of whiting out? And that's a hint that it might be from lightheadedness, which could be the orthostatic, which is very common in the older population, that it's an orthostatic type of blood pressure drop that's causing their dizziness, what they call dizziness.

Sometimes what they say is, when I walk, I feel like I'm unstable.

That's a gait instability, and that has a whole different set of... types of diagnoses that that would be associated with.