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Dizziness

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Clinical Autonomic Dysfunction

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Abstract

In general, there are four conditions that directly lead to dizziness or lightheadedness: vestibular dysfunction, arrhythmia, orthostatic dysfunction, and syncope. Only the last three may involve the autonomic nervous system. Which, by the way, is the main reason for augmenting vestibular testing with autonomic testing in geriatrics, where there is rarely a single cause for dizziness. Ultimately, all three non-vestibular causes of dizziness involve marginal or poor perfusion of the brain due to decreased of insufficient blood flow to the brain. It has been our experience that a significant number of people (about 40 % of those reporting dizziness or lightheadedness) are simply dehydrated. Dehydration is most often due to a lack of proper daily hydration; too many sugary (including sugar substitutes), caffeinated, or alcoholic drinks; or excessive use of diuretics. Preclinical or subclinical orthostatic dysfunction, and perhaps preclinical syncope, may not yet actually involve dizziness or lightheadedness. Rather, due to marginal brain perfusion, it often involves afternoon fatigue, headache, reduced cognitive function, and evening edema. These may also be signs of insufficient volume or in appropriate volume distribution. The autonomics are not the only reason for dizziness. Vascular function (“lazy” walls or damaged valves in the veins) and cardiac function (damaged valves, holes in walls, or carotid or renal artery stenoses) may also be involved. If autonomic responses to head-up postural change are normal or autonomic therapy, after at least 3 months, is not sufficient, additional testing may be indicated to also treat the end organ(s).

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Authors and Affiliations

  1. Autonomic Laboratory Department of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA

    Joseph Colombo PhD

  2. ANSAR Medical Technologies, Inc., Philadelphia, PA, USA

    Joseph Colombo PhD

  3. Department of Medicine, Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  4. Department of Cardiology, The Chicago Medical School, North Chicago, IL, USA

    Rohit Arora MD, FACC, FAHA, FACP, FSCAI

  5. Department of Cardiology, Hahnemann Hospital Drexel University College of Medicine, Philadelphia, PA, USA

    Nicholas L. DePace MD, FACC

  6. Department of Medicine, Eastern Virginia Medical School Strelitz Diabetes Research Center, Norfolk, VA, USA

    Aaron I. Vinik MD, PhD, FCP, MACP

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Colombo, J., Arora, R., DePace, N.L., Vinik, A.I. (2015). Dizziness. In: Clinical Autonomic Dysfunction. Springer, Cham. https://doi.org/10.1007/978-3-319-07371-2_23

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