Chapter 2
Diagnosing Dizziness and Vertigo: The History
Dennis Poe MD

Mass Eye & Ear Infirmary
Boston, Massachusetts

The definition of dizziness itself is quite troublesome. We in the medical field tend to think of the word dizzy as being a general catch-all term for not feeling whole, alert, well and in balance. The term is far too broad to be useful. We prefer to try to use other words with more limited definitions to start narrowing down what you may be feeling when you’re complaining of dizziness. Many patients will admit that they feel “lightheaded” or “heavy-headed.” Although still quite vague, these terms convey some sense that a patient is not feeling entirely alert or in control of their sense of well-being. We sense that if these symptoms worsened, it might induce fatigue, drowsiness or somehow alter your sense of awareness of surroundings. More severe lightheaded or fatigue symptoms might lead you to feel faint—a sensation that you may be close to blacking-out (that is, losing consciousness entirely).

A near faint is often experienced when you stand up too quickly and feel a “rush” in your head while your heart and blood vessels are rapidly responding to your head’s change in elevation and trying to get the blood up into your head as quickly as possible. This type of lightheadedness is quickly relieved usually by simply putting your head back down or sitting down temporarily. If you don’t put your head down and the symptoms continue to worsen, you could be in danger of fainting or losing consciousness. . .

The most common type of vertigo is a spinning or whirling sensation as noted in the dictionary definition above. This spinning is most commonly in the horizontal plane (that is, level with the ground), but sometimes people will feel rotation in a vertical plane or from front to back. Vertigo can also mean rocking motion such as commonly experienced when one disembarks from a boat. When you close your eyes after riding on a rolling sea you can often feel as though you’re still aboard the ship for hours or days afterwards. Someone with a vertigo condition may be driving a car and stop at a traffic light and yet feel the vehicle is still in motion when he or she knows it isn’t. When you fall asleep and suddenly feel as though you’re falling, this can be a normal occurrence, but still defined within the term of vertigo. Vertigo is not actually a fear of heights or that sense of ill feeling in the pit of your stomach when you peer over the edge of an unprotected height as we saw in the movie “Vertigo” by Alfred Hitchcock. . .

Dysequilibrium or imbalance are similar terms. They refer to a sense that your balance or equilibrium is not functioning properly. You do not have to experience a hallucination of motion. You may find that you’re having trouble simply walking and that you need to touch surrounding walls for reassurance. Some people feel they are constantly drifting to the right or left of the centerline of a corridor as they walk or bump into things excessively. Turning the head in one direction or another or even looking upwards or lying down may produce a sense of losing stability without actually provoking a sensation of motion. Some people have a sense of dysequilibrium at all times while others experience it only when they’re moving in some way.

Feeling faint, as though you may black out (lose consciousness) is called pre-syncope. A complete fainting spell in which you lose consciousness or black out is called syncope (pronounced sin’-ka-pee). Most vestibular conditions or balance disorders will not actually cause someone to lose consciousness. When this occurs it strongly implies there may be a problem with your . . .