What is… Dizziness?

Dizziness is one of the most common symptoms reported in both GP surgeries and emergency departments. Yet it remains one of the most misunderstood, not just by patients, but sometimes by professionals too.

What exactly is dizziness? Is it the same as vertigo? And when should it raise clinical or legal red flags?

In this article, we’ll break down the key concepts, causes, and medico-legal relevance of dizziness, clearly and without the jargon.

First Things First: What Do People Mean by “Dizziness”?

“Dizziness” isn’t a diagnosis, it’s a symptom. And it’s subjective, meaning people use it to describe a range of very different sensations. That’s why the first clinical task is always to clarify what the patient actually means.

The four most common interpretations of dizziness are:

1. Vertigo

A false sensation of movement, often described as spinning, swaying, or tilting. It’s usually caused by inner ear or vestibular disorders.

2. Presyncope

A feeling of light-headedness or near-fainting, often due to reduced blood flow to the brain (e.g. low blood pressure, arrhythmia).

3. Disequilibrium

A sense of unsteadiness or imbalance, particularly when walking. This may be related to problems with proprioception, vision, or cerebellar function.

4. Non-specific dizziness

A vague feeling of being “off,” “woozy,” or “foggy” - sometimes linked to anxiety, medication, or systemic illness.

Understanding these distinctions is crucial to accurate diagnosis and treatment.

Why This Matters Medically and Legally

Because dizziness is so common and sometimes vague, it’s also easy to miss or misdiagnose. In medico-legal contexts, it often features in:

• Missed strokes (especially posterior circulation strokes)

• Inappropriate discharge from A&E

• Falls and head injuries

• Negligent prescription or polypharmacy cases

• Claims involving chronic conditions like Menière’s disease or vestibular migraine

Proper assessment, documentation, and follow-up are key. A failure to act on red flags or conduct appropriate neurological exams can have serious consequences for patient safety and legal liability.

Common Causes of Dizziness (Grouped by System)

Here’s a breakdown of common causes, grouped to help with clinical reasoning:

Ear (Peripheral Vestibular)

• Benign paroxysmal positional vertigo (BPPV)

• Vestibular neuritis or labyrinthitis

• Menière’s disease

• Acoustic neuroma (rare)

Central Neurological

• Stroke (especially brainstem or cerebellar)

• Multiple sclerosis

• Tumours or trauma

Cardiovascular

• Postural hypotension

• Cardiac arrhythmias (e.g. atrial fibrillation, heart block)

• Vasovagal syncope

• Structural heart disease

Systemic / Other

• Anaemia

• Hypoglycaemia

• Medication side effects (e.g. antihypertensives, sedatives)

• Anxiety or panic disorders

How Is Dizziness Assessed?

A good dizziness assessment requires careful listening and focused examination. Key steps include:

• Detailed history: onset, duration, triggers, associated symptoms (e.g. hearing loss, palpitations)

• Orthostatic blood pressure measurements

• Neurological and vestibular exam: including Romberg test, head impulse test, and cerebellar signs

• Cardiac assessment: pulse check, ECG, possibly Holter monitoring

• ENT examination: if hearing loss or tinnitus is involved

Dizziness in the Medico-Legal World

In the legal space, dizziness may feature in:

1. Delayed Diagnosis Claims

For example, a patient presents with vertigo and unsteadiness, but is misdiagnosed with BPPV when the underlying cause is a posterior circulation stroke. Failure to perform neurological exams or recognise red flags can be the basis for a negligence claim.

2. Medication Errors

Elderly patients started on multiple antihypertensives may develop postural hypotension and fall, sustaining injuries. Dizziness here could have been predicted and monitored.

3. Occupational Injury or Disability Claims

Chronic vestibular disorders like Menière’s or vestibular migraine can cause long-term disability, and expert evidence may be required to comment on functional capacity or prognosis.

Final Thoughts

Dizziness might seem like a minor complaint, but in both medicine and law, it’s often the canary in the coal mine. Properly assessing and interpreting it can be the difference between reassurance and life-changing harm.

For clinicians, it’s about curiosity and caution. For legal professionals, it’s about understanding when something that sounds benign was actually a warning sign missed.

And for patients? It’s often about being believed and carefully listened to.