[28F] Experiencing sudden onset of lightheadedness and dizziness

Patient Description

A 28-year-old female has been experiencing lightheadedness and dizziness all day, feeling almost as if she might pass out. The severity of the lightheadedness is rated as 5 out of 10. These symptoms are exacerbated by activities such as walking, standing up, sitting down, and any head or eye movements, but are relieved by lying down. The lightheadedness came on suddenly and has not been experienced recently before today, with episodes lasting only a few seconds to a minute. Additionally, the patient has felt nauseous today and has experienced a dull headache, blurred vision, and weakness in her legs. There have been no difficulties with speech or understanding speech, but there is some difficulty with coordination and balance, particularly when walking. The patient is currently taking Cymbalta (60mg daily) and has not recently changed the dosage or missed any doses. She does not consume alcohol, caffeine, or use recreational drugs. There have been no recent changes in diet, fluid intake, physical activity levels, or exposure to new environments, chemicals, or allergens. She has not traveled recently. There is no history of heart disease, diabetes, or neurological conditions, and no pre-existing conditions or chronic illnesses. The patient is not taking any other prescription medications, over-the-counter medications, supplements, or herbal remedies, but has an allergy to Augmentin.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

  1. Orthostatic Hypotension:

    • Rationale: This condition occurs when your blood pressure drops significantly upon standing up, leading to dizziness, lightheadedness, and sometimes fainting. It can be exacerbated by dehydration, certain medications, or prolonged bed rest.
    • Typical Treatments/Testing: Your doctor may check your blood pressure in different positions (lying down, sitting, and standing) and may recommend increasing fluid and salt intake, wearing compression stockings, or adjusting your medications.
  2. Vestibular Disorders:

    • Rationale: Conditions affecting the inner ear, such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis, can cause dizziness, lightheadedness, and balance issues, especially with head movements.
    • Typical Treatments/Testing: Your doctor may perform specific maneuvers to diagnose BPPV or recommend vestibular rehabilitation exercises. Medications to reduce dizziness and nausea may also be prescribed.
  3. Medication Side Effects:

    • Rationale: Cymbalta (duloxetine) can sometimes cause dizziness, nausea, and blurred vision as side effects.
    • Typical Treatments/Testing: Your doctor may review your medication regimen to determine if Cymbalta or any other factors are contributing to your symptoms. They may adjust your dosage or switch medications if necessary.

What you can do

Lightheadedness and Dizziness:

  • Immediate Steps:
    • Sit or lie down immediately when you feel lightheaded to prevent falls.
    • Avoid sudden movements, especially when changing positions.
    • Stay hydrated by drinking plenty of water throughout the day.
  • Long-term Management:
    • Monitor your symptoms and note any patterns or triggers using the MDandMe journal.
    • Wear compression stockings if recommended by your doctor.
    • Ensure you are eating regular, balanced meals to maintain blood sugar levels.

Nausea:

  • Immediate Steps:
    • Eat small, frequent meals instead of large ones.
    • Avoid spicy, fatty, or greasy foods.
    • Sip on ginger tea or eat ginger candies, as ginger can help alleviate nausea.
  • Long-term Management:
    • Keep a symptom diary to track what foods or activities might be triggering your nausea.
    • Discuss with your doctor if anti-nausea medications are appropriate for you.

Fatigue:

  • Immediate Steps:
    • Ensure you are getting adequate rest and sleep.
    • Take short breaks throughout the day to avoid overexertion.
  • Long-term Management:
    • Engage in light physical activity, such as walking, to boost energy levels.
    • Maintain a balanced diet rich in fruits, vegetables, and whole grains.

What you should look out for

Given the severity of your symptoms and the potential for serious underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Fainting or loss of consciousness.
  • Severe or worsening headache.
  • Persistent or worsening blurred vision.
  • Significant weakness or numbness in your limbs.
  • Difficulty with coordination or balance that does not improve.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can use MDandMe to journal your symptoms, track your progress, get insights, and share your medical notes with your provider.

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4 mo ago


People Also Ask


What is orthostatic hypotension and how is it diagnosed?

Orthostatic hypotension is a condition where blood pressure drops significantly upon standing, causing dizziness or fainting. It is diagnosed by measuring blood pressure in different positions: lying down, sitting, and standing.


What are vestibular disorders and how can they affect balance?

Vestibular disorders affect the inner ear and can cause dizziness, balance issues, and lightheadedness, especially with head movements. Conditions like BPPV or vestibular neuritis are common examples.


Can Cymbalta cause dizziness and nausea as side effects?

Yes, Cymbalta (duloxetine) can cause dizziness, nausea, and blurred vision as side effects. It's important to discuss these symptoms with a doctor to determine if the medication is the cause.


What immediate steps can be taken to manage lightheadedness and dizziness?

To manage lightheadedness and dizziness, sit or lie down immediately to prevent falls, avoid sudden movements, and stay hydrated by drinking plenty of water. Monitoring symptoms and noting triggers can also help in long-term management.

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