Vertigo (Dizziness): Symptoms, Complaints, Signs

The following symptoms and complaints may occur along with Vertigo (vertigo):

Leading symptom

  • Vertigo
    • Spinning dizziness (“as if in a merry-go-round”)
    • Gait unsteadiness (without noticed sensations “in the head“).
    • Swaying vertigo (“like boating”).
    • Drowsiness and syncopal feeling (impending fainting, black before the eyes).

Associated symptoms

  • Nausea (nausea)/vomiting
  • Nystagmus – involuntary but rapid rhythmic eye movements.
  • Positional instability
  • Gait ataxia (gait disorders)
  • Hearing loss / tinnitus (ringing in the ears)

Common causes of dizziness in old age

Disease Symptoms
Benign paroxysmal positional vertigo (BPLS)(synonym: benign peripheral paroxysmal positional vertigo, BPPV).
  • Spinning attacks of vertigo lasting no more than 30 seconds (1 min) (when lying down, turning the head, looking up or down; frequent occurrence at night); attacks repeat several times a day and/or for days at a time
Bilateral vestibulopathy (BV)(complete or incomplete).
  • Gait and stance insecurity*
  • Motion-dependent staggering vertigo
  • Oscillopsia (visual disturbance in which the affected person perceives objects fixed with the eyes as trembling or swaying) during head movements
  • Insecurity in standing*
  • Disturbances of spatial memory

* Increase in the dark and on uneven ground.

Meniere’s disease Leading symptoms (Meniere’s triad)

* Dizziness usually lasts minutes (> 20 min.) to 12 hours and repeats at irregular intervals.

Orthostatic vertigo
  • Temporary dizziness in the course of changing from a lying, sitting, or kneeling position to an upright position; possibly also after taking medication
Central vertigo
  • Usually permanent vertigo with clinical neurological abnormalities (e.g., oculomotor function, coordination, extrapyramidal motor function); typical clinical symptoms include visual, swallowing, or speech disturbances, or also insensations of the sense of touch or paralysis of the face or arms. Causes are:
    • Focal lesions (e.g., apoplexy/stroke, multiple sclerosis).
    • Cerebral microangiopathies (diseases of the small vessels supplying the brain; acquired in about 90% of cases and genetic in 10% of cases)
    • Neurodegenerative diseases (e.g., cerebellar ataxia/small-brain gait disorders).

Note: Gaze direction nystagmus and vertical deviation of the axis of both eyes are present only in brainstem infarction.

Note: In elderly patients with chronic vertigo, there is often a combination of central and peripheral causes with accompanying psychological factors.

Warning signs (red flags)

  • Anamnestic information:
    • Chronic alcohol consumption
    • Otitis media (inflammation of the middle ear), acute and chronic.
    • Visual, speech and swallowing disorders or other neurological deficits.
  • In patients aged 20 to 40 years with episodic dizziness and vague neurologic symptoms → think of: Multiple sclerosis (MS)
  • Gaze direction nystagmus and/or vertical deviation of the axis of both eyes → think of: Brainstem infarction
  • Gait ataxia → think of: Transient ischemic attack (TIA) or apoplexy (stroke).
  • Syncope (brief loss of consciousness due to reduced blood flow to the brain, usually accompanied by loss of muscle tone).
  • Sudden hearing loss (within 72 hours) or progressive (rapidly progressing) symptomatology
    • With /without sudden hearing loss (sudden onset, unilateral, near-total hearing loss) → think of: Acoustic neuroma