Dizziness Presyncope

About Dizziness Presyncope

Dizziness is one of the most common reasons for medical visits, particularly in older adults. The term encompasses multiple distinct sensations that must be differentiated for proper treatment. Vertigo, a false sense of spinning or movement, suggests vestibular disease BPPV, vestibular neuritis, Meniere disease, central lesions. Presyncope, a feeling of impending faint, suggests cardiovascular causes orthostatic hypotension, arrhythmias, aortic stenosis, vasovagal syncope, volume depletion. Disequilibrium, a sense of unsteadiness or imbalance without spinning, suggests neurological causes peripheral neuropathy, Parkinsons disease, cerebellar disease, normal pressure hydrocephalus, multiple small strokes. Lightheadedness, a vague floating sensation often associated with anxiety, may have psychological causes, but these are considered only after physical causes have been excluded. The history is the most important diagnostic tool, with physical examination including orthostatic vital signs, cardiovascular examination, neurological examination, head impulse test, and Dix Hallpike maneuver guiding evaluation. Red flags requiring urgent evaluation include sudden onset, accompanying neurological symptoms, chest pain, palpitations, severe headache, and focal neurological deficits. Dizziness with chest pain, fainting, sudden severe headache, facial drooping, slurred speech, or limb weakness is a medical emergency; call your local emergency number. ECG is indicated for cardiac syncope suspicion. Holter or event monitors detect intermittent arrhythmias. MRI is indicated for central neurological findings. Treatment addresses the underlying cause. Dizziness is common in older adults, significantly affecting quality of life and fall risk.