Functional and Dissociative Neurological Symptoms : a patient's guide

Patterned Carpet

PPPD is often associated with discomfort in places with patterned surfaces

PPPD treatment

Separating Different Causes of Dizziness

Dizziness is a really difficult thing to describe to anyone, including doctors.

Ive added this section to help patients talk more easily about their dizziness with doctors. Most patients with PPPD have a mixture of several types of dizziness and it can help to think about how to describe it

One simple way of dividing up symptoms of dizziness is in to the following types

1. Lightheaded feeling that you're about to faint (Presyncope) - if you have ever fainted you will know what this is! If you haven't it may come as a new sensation to you. Typically this occurs when people are standing or if they have just stood up. It is a light headed feeling, sometimes with a rush of noise or fuzziness in the ears, a dimming of vision and often nausea. Doctors call this sensation presyncope. When someone actually passes out they call this syncope.

The causes of this include, standing up too quickly, painful stimuli (like having blood taken or being at the dentist). Its more likely to happen in hot places or if the person is eating. Men are especially prone to this when they are urinating while standing (especially in the middle of the night).

Faint feelings can also occur when people hyperventilate. This can happen during panic attacks but also a more longstanding symptom in relation to breathing too fast or deeply. This is usually called hyperventilation.

Presyncope is not a functional symptom, but its worth knowing what it is as presyncope can trigger off other functional symptoms

2. A feeling of movement (Vertigo) - This is when people describe a feeling of movement even when they are still. the movement may be a spinning rotating movement or a rocking movement like being on a boat. The medical term for this is vertigo.

Vertigo has lots of causes. The most common ones relate to problem with the structures in the ear which control balance. these are called semicircular canals. We have one set of semicircular canals in each ear. Most commonly bits of grit can get lodged in these and cause vertigo (this is called benign paroxysmal positional vertigo).

Migraine can also cause vertigo

Vertigo is not a functional symptom, but like presnycope knowing what it is can be helpful. Some patients develop vertigo which then triggers off other functional symptoms

Vertigo is especially likely to induce anxiety in the sufferer.

Patients with vertigo often develop an aversion to moving their head. This is because head movement leads to vertigo. The trouble is, the more they avoid moving their head, the more likely it is that they will develop a stiff neck which in turn can lead to a sore head.

So people often develop a combination of neck pain, headache and dizziness which may have started out with vertigo but is still present even when the vertigo has gone. See below.

3. A spaced out feeling (Dissociation)- This may be dissociation, a feeling that you are distant or detached either from your environment or your body. This is described in detail on the page on dissociation on this website

Patients with dizziness may have one or more of these types of dizziness. Sometimes patients, especially those with fatigue describe even more vague symptoms like having a 'foggy head' or a 'cotton wool head'.

4. A bodily feeling of unsteadiness (Dysequilibrium). This is a feeling sometimes compared to being on ice skates. Its not so much a feeling of dizziness in the head. More a general feeling of unsteadiness as is something is wobbling around inside and could lead to a fall.