Lightheadedness and Presyncope
When a patient complains of “dizziness,” it may not always be a vestibular issue. There are many non-vestibular causes of dizziness.
Lightheadedness and Presyncope are two symptoms that patients may be experiencing when they say they feel “dizzy.”
The vague complaint of “dizziness” is usually associated with lightheadedness from various medical causes.
The primary care provider is usually in the best position to manage this type of medically-related lightheadedness. The key is to manage the underlying health condition.
These complaints of dizziness typically require patient education by the treating physical therapist. Physical therapy case management, or coordinating the patient’s care with the physician, can also be a service provided by a physical therapist.
Common causes of lightheadedness and presyncope include medication side effects or interactions and cardiovascular disease. Some cardiac problems that can lead to lightheadedness include blood pressure issues (hypertension, hypotension and orthostatic hypotension) and cardiac arrhythmias like a-fib.
Also, lightheadedness can be caused by low oxygen levels.
Other common causes of lightheadedness include anxiety, blood sugar fluctuations and/or dehydration, along with other medical causes and stress.
Lightheadedness can also be psychogenic or idiopathic.
Idiopathic means “no known cause.”
If you are feeling lightheaded, you should talk to your doctor.
You may even want to consult with a vestibular physical therapist to rule out a vestibular cause.
Presyncope is a feeling of fainting and the impending loss of consciousness.
This is often described by patients as “feeling dizzy.”
Lightheadedness with presyncope is considered a symptom of cardiovascular disease.
If unaddressed, presyncope can evolve into “syncopal episodes” which are the loss of consciousness due to cerebral hypo-perfusion. That occurs when people faint or pass out, due to lack of blood flow to the brain.
Patients with syncopal episodes can have falls with the resulting consequence of new-onset of BPPV (Benign Paroxysmal Positional Vertigo) or intracranial hemorrhage (ICH) due to head trauma with the falls.
Both BPPV and ICH, along with other serious injuries that can result from falls.
Fall-related injuries exacerbate balance impairments, so it is important to identify and address dizziness from presyncope.
Skull fractures and brain injuries can occur due to fainting spells.
Talk to Your Doctor if you have Lightheadedness or Presyncope
If you feel like you might pass out or faint, you may have presyncope. You should talk to your doctor to get some testing and individual medical advice.
If suspected, lightheadedness and presyncope is best assessed by a physician or physician extender.
Your doctor will also perform a thorough clinical examination. They may order bloodwork to check your organs.
The physician may order testing with EKG and 24-hour Holter monitoring to rule out arrhythmias and vasovagal instability.
If you are experiencing lightheadedness and presyncope, talk to your doctor.
Make note of things like your body position at onset, duration, and frequency of symptoms, along with the time of day of onset and preceding events.
This information is helpful to share with your healthcare provider. This is helpful to differentiate the causes of lightheadedness and presyncope.
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
I would like to find someone that could help me with my dizziness vertigo and tinnitus
You can use this article to find two online directories that may help your search.
Hi…. I’m a 44 year old mother and wife desperately seeking help to stop my extreme lightheadedness, staring spells, weakness in legs, muscle constriction, anxiety and panic. I feel like I’m stuck in fight or flight mode 24/7.
When I feel lightheaded/dizziness it causes me to have major Panic attacks. I was diagnosed with anxiety/panic disorder in 2019, Diagnosed with Diabetes in 2020, just diagnosed with vestibular weakness on left ear/side yesterday 4/29/22. I cried all day.
I have a Neurologist- sent me for MRI of head and Neck. Results were normal. I have a Psychiatric Nurse Practitioner who proscribed Prozac, I also started seeing a Therapist. The ENT sent me for hearing/balance testing and now they said I need vestibular physical therapy. I wish I could all of them in a room to figure this out.
I woke up one day in Nov 2021 feeling dizzy/lightheaded/ off balance and I have been dealing with all this for over 6 months and it has been debilitating.
I’m the only one that can work in my house, as my husband is an epileptic and my daughter is just 13 yrs old. I just had to take leave from my job less then 30 days ago because I cant concentrate, and have dizzy spells when using my computer for work.
Any help, direction or being able to be treated/evaluated by you would be life changing.
If you have not already seen a vestibular doctor or physical therapist, that is a good next step.
You can use this article to find two online directories that may help you with your search.
If the vestibular care does not resolve your symptoms, you can also consult with a Neuro-Optometrist for a possible visual cause.
You can use the doctor locator here, at COVD.org.
I hope one or both of those specialty providers can help you!
If you want to learn more about other possible causes of dizziness and vertigo, you can watch my most popular video here.
To organize your story before consulting with a specialists, you can use this article to answer the questions I ask and outline your situation concisely.