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Description of the Symptom

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This chapter describes pathology that may lead to dizziness. Dizziness is described as a sensation of movement of self or surroundings (vertigo), light-headedness (presyncope), or imbalance (disequilibrium).

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Special Concerns

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Dizziness in the presence of any of the following symptoms and signs:

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  • Chest pain

  • Irregular heartbeat

  • A new onset of, or a change in, neurological status, including:

    • Weakness or paralysis in the face, arm, or leg, especially on one side of the body

    • Tremor

    • Change in mental status, such as confusion, memory loss, hallucinations

    • Difficulty talking

    • Difficulty understanding speech

    • Trouble seeing with one or both eyes

    • Loss of coordination

    • Loss of balance

    • Nystagmus that is spontaneous (resting), direction changing, or gaze evoked

    • Oculomotor abnormalities including abnormal smooth pursuit and saccades.

    • Loss of sensation

  • History of head or neck trauma and concerns of:

    • Changes in neurological status, as noted above

    • Long tract signs elicited by head or neck movements

    • Dizziness with sustained head or neck positions

    • Unwillingness to move the neck

    • Facial numbness or paresthesias

  • Palpitations that are:

    • Followed by loss of consciousness

    • Associated with significant shortness of breath, chest discomfort, light-headedness, or presyncopal symptoms

    • Associated with marked hypertension (ie, >220/110) or hypotension (ie, <90/60 in an individual who is typically normotensive)

    • Of sudden onset and last longer than 15 to 20 minutes

    • Occurring in an individual with a family history of sudden death.

  • Fever, chills, accompanied by a very stiff neck or other signs of infection

  • Unrelenting headache

  • Hyperpnea or dyspnea

  • Anxiety

  • Sudden hearing loss

  • Ear pain

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CHAPTER PREVIEW: Conditions That May Lead to Dizziness

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