Spatial disorientation may be expressed by the patient as dizziness, vertigo or feeling ‘light-headed’. True vertigo, however, is not experienced as a sensation of movement but as tilting or sloping of the environment, often characterised as the room spinning around them.

Causes

Episodic

  • Ménière’s disease *

  • Benign paroxysmal positional vertigo (BPPV)

  • Arrhythmia

  • Postural hypotension

  • Migraine/Vestibular migraine

  • Hyperventilation

  • Drugs (antihypertensives, antidepressants)

  • Hypoglycaemia

  • Posterior circulation TIAs

  • Anxiety

  • Seizures (partial)

  • Carbon monoxide poisoning (e.g. faulty heating)

  • Persistent postural-perceptual dizziness (PPPD)

Constant

Acute onset

  • Labyrinthitis *

  • Vestibular neuronitis

  • Acute alcohol or recreational drug intoxication

  • Head injuries *

  • Posterior circulation CVA

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