Simple Dizziness or Something Serious?

Igor Rybinnik, MD

(Credit: RWJBarnabas Health)

Dizziness can be unsettling with individuals feeling unsteady on their feet as the world swirls around them. There are many root causes of dizziness – some benign and some serious. It’s important to recognize the difference between the two and when you should seek a higher level of care.

According to Igor Rybinnik, MD, an associate professor in the Division of Stroke and Neurocritical Care at Rutgers Robert Wood Johnson Medical School (RWJMS) and an attending neurologist at Robert Wood Johnson University Hospital (RWJUH), dizziness is a generic term to describe a change in the way a person perceives their environment.

Rybinnik explained that patients may describe dizziness in the following ways:

• I feel wobbly on my feet, like I am on a ship.
• I feel like the world is spinning around me.
• I feel dizzy with a constant feeling of nausea and desire to vomit.
• I feel lightheaded, faint, and weak all over.
• I feel like I am constantly being pushed when I walk.
• I feel lightheaded with difficulties focusing and blurry vision.
• The world around me appears ‘wavy’ or ‘turned on its side.

While dizziness can be caused by many factors including medication side effects, a special type of dizziness – vertigo – has a shorter list of causes.

“Vertigo is a type of dizziness where a stationary person feels like the world is moving,” Rybinnik told to NeurologyLive^®. Rybinnik noted that vertigo may be caused by migraines, problems with the vestibular apparatus in the inner ear, and more rarely, stroke.

He added that there are other less common, but potentially serious causes of dizziness that require a higher level of care.

“Problems with blood delivery to the brain resulting from an irregular heartbeat or heart attack are serious causes,” Rybinnik explained. “Injury to brain areas responsible for balance caused by multiple sclerosis and tumors can lead to dizziness.”

“BEFAST is a good mnemonic to remember when deciding that dizziness warrant a visit to a doctor or emergency department,” Rybinnik said.

BEFAST stands for:

1. “B” stands for balance, and sudden balance problems are concerning.
2. “E” stands for eyes. A sudden double vision, vision loss or difficulties with eye movements are concerning.
3. “F” stands for facial droop.
4. “A” stands for arm weakness, which can be detected by having a person put both arms in front of their body and noting if either arm drifts down.
5. “S” stands for speech. Come to the doctor or emergency department if you have sudden difficulties finding words or understanding language, or if you are slurring your words.

“Most dizziness does not have a dangerous or serious cause,” Rybinnik said. “However, it’s important to seek the opinion of a qualified medical professional to address it.”

Igor Rybinnik, MD, is an associate professor in the Division of Stroke and Neurocritical care at the department of neurology, Rutgers Robert Wood Johnson Medical School. Rybinnik completed his graduate medical education at SUNY Downstate Medical Center in Brooklyn, NY in 2006. He remained at SUNY Downstate Medical center for his internal medicine internship and Neurology residency, which he completed in 2010 and where he served as the chief resident during the senior year. Rybinnik then completed his fellowship training in Vascular Neurology at the University of Pennsylvania in Philadelphia, PA in 2011. He currently serves as the Neurology Clerkship director and the Vice Chair of the Curriculum Committee at the Rutgers Robert Wood Johnson Medical School. His research interests include treatment of acute ischemic and hemorrhagic stroke.