The word dizziness expresses a subjective symptom, difficult to measure, that reflects very different sensations, produced by mechanisms also different. Usually, and in its broadest sense, it translates an alteration of the person with respect to outer space. This sensation of altered orientation in the space supposes one of the reasons of consultation more frequent to the general doctor, increases with the age and constitutes a classic problem of the primary attention in geriatrics.
Over the course of a year, practically 20% of 60 people who experience dizziness are intense enough to see a doctor. It is estimated that it represents almost 1% of the total number of clinical consultations attended by the family doctor.
Practical management of dizziness by the family doctor is complex and difficult. Patients, especially the elderly, who complain of dizziness are often directed to different specialists (otolaryngologists, traumatologists, neurologists, psychiatrists, etc.) without adequate basic guidance. Thus begins a long pilgrimage to which are added false diagnoses, favors the appearance of problems arising from the performance of doctors and increases the anguish of the patient (and that of the doctors who attend him). In this way, the symptoms can become chronic and the feeling of dizziness perpetuate over time.
The primary care physician is the professional who is in the best conditions to adequately and early guide the patient who suffers from dizziness. When an elderly person consults with his or her primary care physician about this problem, the doctor should ask him / her a detailed question about what is happening to him / her, which will allow him / her to clarify what the patient understands by dizziness.
The doctor will ask the patient to tell or describe exactly what has happened to him or how he feels, so that he explains in his own words the discomfort he suffers. If the patient has difficulties to define them, his doctor will help him with guiding questions to deepen the investigation of the symptom trying to concretize the sensation of dizziness. It will ask you questions to find out how to start, what activity you were doing at the time of the dizziness, the intensity of it, its duration and frequency, and the factors that triggered or modified it.
In addition, in order to focus the problem, the physician must ask about the patient’s previous illnesses, the medical treatments he is receiving and even about the family history, which may be useful. Also, the doctor will try to find out the symptoms associated with dizziness and that the patient should list in detail.
Physical examination will often provide the keys to diagnosis. On physical examination and in general, the doctor will examine blood pressure and pulse, perform auscultation of the heart, examination of the skin and mucous membranes for coloration, visual acuity, examination of the ears and a Neurological examination.
The doctor may include this dizziness in one of these four major sections:
- Vertigo or feeling of rotation or displacement
- Instability or imbalance (difficulty maintaining balance)
- Vahido, presyncope or prelipotimia (sensation of going to lose the conscience)
- Other undefined sensations (insecurity, buoyancy, stun, brief environmental disconnection)
In light of the findings that the doctor will find in the evaluation, the doctor will probably request an electrocardiogram as the first test to be performed in addition to a blood test.
Presyncopal numbness is a feeling of impending fainting that is often described as a kind of obnubilation often associated with lack of balance or falls. This type of sensation is caused by the lack of transient oxygenation of the brain, generally due to a decrease in the arrival of blood to it. Most adults, and especially the elderly, experience this type of transient sensation when they rise quickly from a lying position to a sitting position.
In general, the cause is a problem of blood vessels outside the skull or decreased blood volume, although not always the diagnosis is of vascular origin, existing causes such as some medicines, infections caused by viruses, acute hemorrhages or others.
We talk about orthostatic hypotension when we detect a decrease in systolic blood pressure (the maximum) equal to or greater than 20 mm Hg. Or a decrease in diastolic blood pressure (the minimum) equal to or greater than 10 mm Hg with changes in position (from lying down to standing).
Some patients say that the feeling they have is as if at any given moment they were falling and feel the need to lean. This sensation lasts a few seconds and passes quickly. These episodes occur several times throughout the day.
Vertigo may be caused by several dease:
- Diseases of the vestibular system (balance organ): benign positional vertigo, Ménière’s disease, laberintitis, acoustic neurinoma, drug or toxic poisonings.
- Diseases of the cervical spine: trauma, inflammation.
- Diseases of the central nervous system: tumors, multiple sclerosis, lesions due to blood deficit, cerebellar or cerebral cortex lesions.
Causes of disturbance of balance
- By alterations of vision.
- By alterations of vestibular system (organ of the balance).
- By alterations of the brainstem, cerebellum or pathways and cerebral cortex.
- By alterations of the peripheral nervous system.
- By alterations of the locomotor apparatus (osteoarticular or muscular).
Significant blood loss from bleeding.
- Reduction of venous return volume (cough, urination).
- Decrease in the volume of blood that expels the heart from diseases of its valves, lack of oxygen supply to the heart itself, arrhythmias of the heart, etc.
- Decrease in the blood of substances or cells that are important for the functioning of the brain, such as sugar (hypoglycemia), oxygen (hypoxia), red blood cells (anemia).
- Diseases of blood vessels in the brain, such as thrombosis and bleeding.
- Undefined feelings of dizziness.
- Causes of psychological origin: anxiety, neurosis, depression.
- Disorder of the organs of the senses: ear, vision.
- Deterioration of the superior functions.
The treatment of dizziness will depend on the cause that caused it. There are, however, many factors that can be prevented or treated in the elderly:
In the case of so-called orthostatic hypotension, we will recommend progressive postural changes, avoiding jerky maneuvers. The use of elastic stockings in the legs may increase the volume of venous blood returning to the heart. In some of these cases, drinking plenty of fluids can be helpful.
Here are some advices that may be useful:
- Identifying and correcting the number of drugs being taken or reducing their dose.
- Maintaining a good nutritional and hydration level.
- Looking for a good control of the blood pressure.
- Taking the necessary measures in the home to prevent falls, etc.