Walking on a rope: what to do if you are worried about dizziness when walking?

“Staggering”, “leading away”, “turning the wrong side” – this is how people describe this unpleasant condition.^1-3 Dizziness is only a symptom. It can signal from an minor issue to life-threatening condition requiring immediate medical intervention.³

Dizziness can be caused by a wide range of things:^4,5

• vestibular
• central and peripheral nervous system
• cardiovascular
• caused by injuries of the head and spine
• emotional and mental disorders

Let’s look at the most characteristic and common causes.

Disruption of the vestibular apparatus

With vestibular (systemic or true) dizziness, which is called vertigo, a person feels as if the surrounding world revolves around him or he himself rotates in relation to the world.⁶ Also, tinnitus, nausea, vomiting, hearing loss are usually attached.⁷

Vertigo is characteristic for diseases of the inner ear, where the peripheral part of the vestibular apparatus is located.⁶

These are disorders such as:⁸

• benign paroxysmal positional vertigo (BPPV)
• Meniere’s disease
• vestibular neuritis (inflammation of the vestibular nerve)

It is impossible to walk during attacks of vertigo without help – the head spins even in the supine position. But with BPPV and Meniere’s disease, even after the disorder recedes, imbalance may persists for a long time when walking.^8,9 For elderly patients with chronic BPPV, imbalance in consequence may be its only symptom and leads to falls.^10,11

Disorders of the peripheral vestibular respond well to treatment with drugs and special exercises.¹⁰

Shakiness when walking, dizziness with a sense of rotation, which are accompanied by neurological disorders, may indicate a violation of the functions of the central part of the vestibular apparatus, which is located in the brain stem and cerebellum.^11,12

For example, with vertebro-basilar insufficiency (VBS) – circulatory disorders of these parts of the brain, in addition to loss of balance and dizziness, can be observed: shortening and unevenness of the step, uncoordinated movements, decreased sensitivity of the face and limbs, double vision, difficulty swallowing.^13,14 These are serious disorders that require urgent medical attention.

Dysfunctions of the central and peripheral nervous system

Dizziness and unsteadiness when walking, as well as loss of balance without vertigo develop with disruptions in the work of some parts of the central (brain and spinal cord) nervous system.^12,15

It can be:

• parkinsonism¹⁶
• myelopathy (damage to the nervous tissue in the spinal cord)¹⁷
• pathologies of the cerebellum^4,18
• brain injuries^12,18
• complications after central nervous system infections (meningitis, encephalitis)¹⁸
• demyelinating diseases of the central nervous system, such as multiple sclerosis^18,19
• neoplasms of the brain¹⁹

Imbalance without dizziness can also be caused by conduction failures in the peripheral nervous system – in nerve fibers located outside the central nervous system.^8,12

Weakness and dizziness when walking can occur with following diseases:

• atherosclerosis of cerebral vessels¹⁸
• ischemia (inadequate blood supply) of the brain¹⁸
• orthostatic hypotension¹⁵
• hypertension (high blood pressure)¹⁸
• complaints of sickness, light-headedness, brain fog, reduced clarity of vision^1,7,15
• Shortness of breath and dizziness when walking are signs of heart failure. If these symptoms are accompanied by pain behind the sternum, this may indicate a pre-infarction state or heart attack.^6,15 This condition requires immediate medical attention!
• Unsteadiness, gait changes, tingling in the limbs, a decrease in the sensitivity of parts of the body indicate a lack of blood supply to the brain and the threat of a stroke.^14,15,20,21 In this case urgent medical care is required.

Psychogenic dizziness

The second most common among all causes of dizziness is psychogenic, which means that it has the psychogenic nature.^7,22

Sweating, palpitations, shortness of breath, a feeling of fear may also take place. Psychogenic dizziness is usually associated with other phobic and anxiety disorders, depressions, panic attacks.²³

Diagnosis and treatment

It is necessary to treat not a consequence – dizziness – but a disease that causes symptoms. If you suffer from nausea, dizziness and weakness, you have to consult a physician.^7,13 He will study the problem and refer you to a narrow specialist – a cardiologist or neurologist. The doctor will establish the cause and prescribe treatment for the cause of unpleasant symptoms. You can be examined and get appointments in the nearest clinic.