Dizziness: sorting out the common causes

Describe the sensation precisely

Vertigo is a false sense of movement, usually spinning. Presyncope is feeling about to faint. Disequilibrium is unsteadiness while walking. Each points to a different set of causes.

The most common cause of true vertigo

Benign paroxysmal positional vertigo, where tiny crystals move into the wrong part of the inner ear. Attacks last under a minute and are triggered by turning in bed or looking up. A repositioning manoeuvre performed by a trained clinician cures most cases in one or two sessions.

Other frequent causes

• Vestibular neuritis: severe vertigo lasting days after a viral illness
• Meniere's disease: vertigo with hearing loss and ringing in one ear
• Low blood pressure on standing, often from medication or dehydration
• Anaemia, low blood sugar, anxiety with hyperventilation

Warning signs

Vertigo with double vision, slurred speech, facial or limb weakness, severe headache, or an inability to walk at all can indicate a stroke in the back of the brain and needs emergency assessment.