Some Causes and Features of Dizziness
Cause | Common Features* | Diagnostic Approach |
|---|---|---|
Common causes | ||
Severe, brief (lasting less than 1 minute) spinning episodes triggered by moving the head in a specific direction, especially while lying down Sometimes nausea and vomiting Normal hearing and neurologic function | Doctor’s examination alone, typically including the Dix-Hallpike maneuver† | |
Multiple separate episodes of vertigo, each lasting 20 minutes to 2 hours, accompanied by ringing, hearing loss, and ear fullness/pressure usually in 1 ear only | Audiogram Gadolinium-enhanced MRI to exclude other causes | |
Vestibular neuronitis (probably caused by a virus) | Sudden, severe vertigo with no hearing loss or other findings Severe vertigo may last several days, with gradual lessening of symptoms and possible development of positional vertigo | Sometimes doctor’s examination alone† Sometimes gadolinium-enhanced MRI |
Labyrinthitis (viral or bacterial cause) | Sudden hearing loss with severe dizziness, often with tinnitus | Audiogram Temporal bone CT scan if doctors suspect a bacterial infection Gadolinium-enhanced MRI for people with hearing loss and ringing in ear to exclude a tumor |
Usually hearing loss in both ears Possible causative drug recently started | Audiogram Sometimes electronystagmography and rotary chair tests to look for abnormal eye movements suggesting inner ear injury | |
Drugs that affect the brain overall (particularly drugs for anxiety, depression, and seizures, as well as sedative drugs in general) | Symptoms unrelated to movement or position No hearing loss or other symptoms Possible causative drug recently started | Sometimes a doctor's examination alone† Sometimes measuring blood levels of certain causative drugs Sometimes stopping the drug to see whether symptoms stop |
Multiple, separate episodes of vertigo, or chronic dizziness, sometimes accompanied by nausea Headache or other migraine symptoms such as visual or other aura (altered sensations that come before the headache such as flashing lights) and sensitivity to light and/or noise Often history or family history of migraine | Sometimes doctor’s examination alone† Sometimes MRI to rule out other causes Sometimes a trial of drugs to treat and prevent migraine | |
Less common causes, typically with ear symptoms (hearing loss and/or ringing in the ear) | ||
Ear pain, sometimes discharge from the ear Abnormal appearance of the eardrum during examination | Audiogram Sometimes CT scan (for people with chronic infection) | |
Trauma (such as ruptured eardrum, skull fracture, or concussion) | Obvious recent trauma Other findings depending on location and extent of damage | Sometimes audiogram Sometimes CT scan |
Slowly progressive hearing loss and ringing in one ear Rarely, numbness and/or weakness of the face | Audiogram Gadolinium-enhanced MRI | |
Defect of the bone around a semicircular canal | Dizziness triggered by sound, low tone hearing loss | Audiogram with tympanometry Usually a CT scan Usually vestibular testing |
Less common causes, typically without ear symptoms | ||
Brain stem stroke | Sudden onset, continuous symptoms | Immediate gadolinium-enhanced MRI |
Bleeding in the cerebellum | Sudden onset, with continuous symptoms Difficulty walking and with tests of coordination Often headache Symptoms worsen rapidly | Immediate gadolinium-enhanced MRI (or CT scan) |
Multiple, separate episodes of neurologic symptoms such as weakness or numbness with different episodes affecting different parts of the body | Gadolinium-enhanced MRI of brain and spine | |
Low blood sugar (usually caused by drugs for diabetes) | Recent dose increase Sometimes sweating | Finger-stick glucose test (during symptoms if possible) |
Low blood pressure (such as caused by heart disorders, blood pressure drugs, blood loss, or dehydration) | Symptoms when rising, but not with head motion or while lying flat Symptoms of the cause often obvious (such as severe blood loss or diarrhea) | Testing directed at suspected cause |
Pregnancy (often not known by the person) | Sometimes late menstrual period and/or morning sickness No ear symptoms | Pregnancy test |
Chronic symptoms with on and off hearing loss in both ears and episodes of vertigo | Audiogram Syphilis blood test | |
Weight change Heat or cold intolerance | Thyroid function blood tests | |
* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. † Most people should have a full hearing test (audiogram). CT = computed tomography; MRI = magnetic resonance imaging. | ||