[18F] Experiencing dizziness, derealization, tinnitus, and visual disturbances

Patient Description

An 18-year-old female reports experiencing a combination of symptoms including lightheadedness, particularly when moving too quickly or standing up from a squatting position, which is worse when starting work and before leaving. She describes a feeling of unreality, as if watching from the outside, accompanied by pressure in the head, lasting at least 5 minutes and occurring mostly upon standing up from sitting or lying down. This has been ongoing for approximately 2 weeks. Additionally, she has been hearing a high-pitched ringing in her ears, rated at a severity of 7 out of 10, which started recently and persisted even when lying down. Visual disturbances in the form of small black and white dots have been noted for 1 week, which become more apparent when looking around. She also mentioned having headaches 2 weeks ago, occasional chest pain, a clogged nose, and significant nasal pain. She has no known pre-existing conditions, is not on any medications, and has a history of seasonal allergies.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible explanations for your symptoms include:

  • Orthostatic Hypotension: This is a form of low blood pressure that happens when you stand up from sitting or lying down. It could explain your dizziness and lightheadedness, especially when you stand up quickly.

    • Treatment usually involves lifestyle changes like standing up slowly, drinking plenty of fluids, and avoiding alcohol.
  • Anxiety or Panic Disorder: These conditions can cause a variety of physical symptoms, including dizziness, chest pain, and feelings of unreality or detachment from oneself (derealization).

    • Treatment often involves a combination of therapy and medication.
  • Migraine: Migraines are severe headaches that can cause a variety of symptoms, including visual disturbances (like seeing dots), ringing in the ears, and pressure in the head.

    • Treatment typically involves medication to relieve symptoms and prevent future attacks.
  • Sinusitis: This is an inflammation or swelling of the tissue lining the sinuses, which can cause a blocked nose and facial pain.

    • Treatment usually involves rest, hydration, and over-the-counter remedies. If symptoms persist, antibiotics may be prescribed.

What you can do

  1. Try standing up slowly from a sitting or lying position to help manage symptoms of orthostatic hypotension.
  2. Stay hydrated and avoid alcohol to help maintain your blood pressure.
  3. Consider seeking help from a mental health professional if you're experiencing symptoms of anxiety or panic disorder.
  4. Over-the-counter pain relievers can help manage symptoms of migraines and sinusitis.
  5. Rest and stay hydrated to help your body recover from sinusitis.

What you should look out for

Please seek immediate medical attention if you experience any of the following:

  • Severe headache or headache that is different from your usual migraines
  • Sudden or severe abdominal pain
  • Difficulty breathing or shortness of breath
  • Fainting or loss of consciousness
  • Sudden, severe chest pain

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care.

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11 mo ago

People Also Ask


What is orthostatic hypotension and how can it be managed?

Orthostatic hypotension is a condition where blood pressure drops significantly when standing up from a sitting or lying position, causing dizziness or lightheadedness. It can be managed by standing up slowly, staying hydrated, and avoiding alcohol.


How can anxiety or panic disorders cause physical symptoms like dizziness and chest pain?

Anxiety or panic disorders can trigger the body's 'fight or flight' response, leading to physical symptoms such as dizziness, chest pain, and feelings of unreality. Treatment often includes therapy and medication to manage symptoms.


What are the common symptoms of migraines and how are they treated?

Migraines are severe headaches that can cause symptoms like visual disturbances, ringing in the ears, and head pressure. Treatment typically involves medications to relieve symptoms and prevent future attacks.


What are the signs of sinusitis and what treatments are available?

Sinusitis is the inflammation of the sinus lining, causing symptoms like a blocked nose and facial pain. Treatments include rest, hydration, over-the-counter remedies, and sometimes antibiotics if symptoms persist.


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