Symptoms

The signs of a dizzy spell include, of course, the dizziness itself, but also poor performance, severe fatigue and possibly headaches. Some patients shiver and complain of cold hands and feet. Sometimes there may be a strong palpitations or a stabbing of the heart.

Blackness before the eyes or even brief moments of fainting (syncope) are also possible. Sometimes coordination difficulties and “clumsiness” can be observed long before the onset of vertigo. In some cases, vertigo patients develop a so-called pathological nystagmus.

A nystagmus is a jerky movement of both eyes in one direction followed by a slow backward movement in the opposite direction. In many cases this phenomenon is completely normal (physiological nystagmus). For example, a nystagmus helps to fix a certain point of view by turning the head and naturally changing the position of the eyes. However, if such a nystagmus occurs without a known cause (turning the head, driving a train), it is often an indication of a neurological disorder that could be related to dizziness or a disorder of the organ of balance in the ear. Depending on the type of vertigo that triggers the vertigo attack, different symptoms can occur, some of which can be influenced better and some of which are more difficult to control.

Diagnosis

If a doctor is looking for the appropriate cause and a diagnosis for a patient with vertigo, he first bases his assumptions on a specific questioning of the patient (anamnesis). Important previous illnesses such as cardiovascular diseases, lung problems, but also diabetes mellitus and neurological characteristics are asked. The intake of certain medications and common stimulants (nicotine, alcohol) is also important.

Last but not least, the attending physician will ask about previous accidents and injuries as well as moments of fainting. Some forms of vertigo can then be limited or excluded by specific questions in the following. For example, if the dizziness improves with closed eyes, it is most likely a so-called ocular dizziness that requires treatment by an ophthalmologist.

If the dizziness was preceded by a sudden straightening or standing up, orthostatic dysregulation.In this case, a simple test quickly provides information about the patient’s orthostasis ability: In the Schellong test, the patient first lies quietly on a couch. Every 2 minutes the pulse and blood pressure are measured and recorded. This is done for 10 minutes.

Afterwards the patient is asked to stand up quickly. Now both pulse and blood pressure are measured every minute. Normally, the systolic blood pressure should remain about the same and the diastolic blood pressure as well as the pulse should only rise a little and then settle at its new level.

A deviation from this norm pattern usually has a cause. This must then be found in the further diagnostic procedure. In a vertigo outpatient clinic, which is offered by some clinics and practices, many different examinations and tests can be carried out to find the cause of the vertigo.

Patients who feel dizziness only in certain places or in special situations (bridges, large crowds of people…) are likely to suffer from a type of phobic vertigo. Regardless of the suspicion that the doctor will already have after all these questions, a physical examination will follow. Both blood pressure and pulse will be measured once in a lying and standing position.

This should be done on both sides in comparison. Then the heart and lungs are examined to rule out serious diseases. When listening to the heart, one pays attention to signs that may indicate a narrowing of the aorta or heart failure.

In addition, the carotid arteries are examined. During the examination, additional attention is paid to varicose veins or swollen legs (edema), which may be signs of heart disease. If even a brief neurological examination is inconspicuous and there is suspicion of a disturbance of the vestibular system, the Romberg test can be performed.

For this, the patient stands with closed feet in the middle of the room. He is asked to close his eyes. If the patient does not succeed in stopping because he becomes unsteady or even threatens to fall, this is called a positive Romberg sign, which indicates a disturbance of the organ of equilibrium.

However, if the Romberg test is inconspicuous, the Unterberg treading test can follow. The patient should walk with closed eyes on the spot. It is important that the feet are clearly lifted off the ground.

A healthy test person remains straight forward. Diseases that are related to the sense of balance, the patient turns on his own axis as the test progresses. Further examinations are then carried out depending on the existing suspicion.