The scene is more common than it seems. Someone is fine, talking, walking, working, and suddenly the world seems to lose its bearings. The floor becomes unstable, the walls rotate, and the body sways uncontrollably. Dizziness is a little word that refers to a symptom that, when it appears, throws everything around it into disarray. It’s the kind of warning the body issues without asking for permission. The question immediately arises: is this dangerous?
Most often, the answer is no. Dizziness is usually a benign and transient symptom, often associated with dehydration, low blood pressure, or the effects of common medications. It is an organism’s way of indicating that something has gone off the rails. The maze, for example, integrates movement, position, and balance information. When it becomes inflamed, as in vestibular neuritis, or when the crystal dislodges, as in benign paroxysmal positional vertigo, the brain receives mismatched signals and interprets this as spin. Then the classic turn of the environment appears, often accompanied by nausea, cold sweat, and difficulty walking.
There is also a rotor that does not rotate but oscillates. This type of sensation is closely linked to low blood pressure, especially on hot days, after long periods of standing, not drinking enough water, or using antihypertensives and diuretics. When the pressure drops on standing, orthostatic hypotension appears, which is widely documented and very common in the elderly. This happens because the body cannot quickly adjust blood flow to the brain, creating this feeling of “impending shutdown.” This is often accompanied by visual darkening, weakness in the legs, and the need to rely on them. It’s common, but it shouldn’t be underestimated: falls associated with dizziness are a real risk, especially for those who already have fragile bones or limited mobility. Therefore, measuring pressure in different positions and reviewing medications used is an essential part of care.
The heart can also be the starting point. Arrhythmia, bradycardia, and some heart diseases temporarily reduce blood flow to the brain, generating a feeling of impending fainting. It is a dizziness that is less related to balance and more related to cerebral perfusion. It is usually accompanied by malaise, dark vision, or palpitations. In these cases, the recommendation is straightforward: any episode associated with palpitations, chest pain, or loss of consciousness requires immediate evaluation.
The brain, in turn, enters this equation. Strokes of the cerebellum, although less common, can start out just like this: sudden, intense, disabling dizziness. The difference lies in the warning signs that accompany the condition, such as difficulty coordinating movements, altered speech, and the inability to stand without support. The literature is clear in classifying this condition as an emergency.
Another related point is the role of stress. Many patients report dizziness in situations of emotional stress, important meetings, discussions, or moments of increased stress. In these attacks, breathing tends to speed up without the person realizing it. Hyperventilation reduces the level of carbon dioxide in the blood and causes a sensation of floating, light-headedness, tingling in the extremities, and instability. It is a mechanism well described in the literature, and although it appears to be endogenous, it is entirely physiological. The body reacts before awareness. When this occurs repeatedly, a cycle is created in which anxiety and dizziness feed off each other, making it difficult to distinguish between cause and effect. Body and mind are intertwined in the true symptoms, but they often confuse those who feel them and those who care about them.
Faced with so many possibilities, the central question is not just what causes dizziness, but when it deserves attention. The literature is consistent on three points. First: Dizziness accompanied by sudden neurological deficit is considered an emergency. Second: Dizziness with chest pain, palpitations, or fainting requires cardiac evaluation. Third: Persistent or recurring dizziness, without a clear cause, requires a neurological and ear examination.
Dizziness is scary because it reveals our weakness. But when listened to carefully, it also guides. It is the body that remembers that balance is not just posture. It is hydration, sleep, care and attention to the signs. It is an opportunity to realign the axis before it is lost forever.