Dizziness: When It's a Stroke, When It Settles

Key takeaways

According to CDC, dizziness, loss of balance or trouble walking that comes on SUDDENLY is one of the signs of stroke, and means calling emergency services now. “Vestibular trouble” is a label families apply themselves — and it is where a stroke gets missed.
ONE sign is enough — dizziness with one side of the face drooping, weakness in one arm, slurred speech, double vision, or the worst headache of your life — call 115. Do not wait to see whether it eases.
Episodes that change with POSITION, spinning for a few tens of seconds then easing once you lie still, repeating the same way each time, with no other sign at all — that group is usually harmless and can be watched at home.
Dizziness with chest heaviness, difficulty breathing, cold sweating or an erratic heartbeat points to the heart, not the ear — go now.
The single most useful thing to do at home while dizzy is to SIT DOWN where you are. Falling is the commonest complication, particularly in older adults.
Dizziness that is NEW after a change of medication: according to CDC, ask a doctor or pharmacist to review the list for anything that causes dizziness or drowsiness. Do not stop medication yourself.

“Vestibular trouble” (bệnh tiền đình) is the label people in Vietnam tend to put on any dizzy spell, before buying something at a pharmacy and waiting for it to pass. Most dizzy spells genuinely are harmless. But according to CDC, dizziness and loss of balance that come on SUDDENLY are a sign of stroke — call emergency services now.

Recognising it: which kind of dizziness

Two different sensations go by the same word. One is SPINNING: the room, or you, going round, often with nausea. The other is feeling LIGHT-HEADED, greying out, about to faint, usually on standing up. The usually-harmless group is recognised like this:

Episodes that change with POSITION: rolling over in bed, lying down, sitting up or tipping the head back brings the spinning on, it lasts a few tens of seconds and then eases, and lying still stops it.
Several similar episodes in one day; between episodes the person is normal and can walk about.
No weakness, no numbness, no slurred speech, and none of the signs in the red-flag box below.

What it gets confused with

Stroke — the costliest mistake. Dizziness from a stroke comes on SUDDENLY, it does not come and go with position the way an inner-ear episode does, and it usually comes with veering to one side when walking.
The heart — according to CDC, feeling weak, light-headed or about to faint along with cold sweating is one of the signs of a heart attack, and means calling emergency services now.
Dehydration or heat illness — after diarrhoea, vomiting, fever or working outdoors in the sun. According to CDC, dizziness is one of the signs of heat exhaustion.

What to do straight away

SIT or lie down where you are, in the safest spot available. Do not try to make it to the bed — falling while dizzy is the commonest complication.
Lie still, keep your eyes open, and look at one fixed point. Closing the eyes usually makes the spinning feel worse.
Ask someone else to try the three stroke checks: ask the person to smile, ask them to hold both arms straight out, ask them to repeat a sentence. Anything uneven on any of the three means calling 115 (the emergency number in Vietnam).
Note the time the episode started, how long it lasted, and what the person was doing at the time — the doctor will ask straight away.
Sip water if swallowing is still normal. If there is a lot of nausea, do not force it.
Stand up in three stages: sit up first, stay sitting for a while, then stand and hold on to something solid.

What NOT to do

Do NOT call it “vestibular trouble” yourself and then take old medicine or someone else's. Medicine that suppresses the symptom blurs the signs while the cause is still there; many of them also cause drowsiness, so an older adult is then even more likely to fall. Medicine is for a doctor or pharmacist to decide.
Do NOT use coin-rubbing (cạo gió), pricking the fingertips to let blood, or cupping (giác hơi) to “get blood to the brain”. None of that works, and it takes away the most valuable thing here: time.
Do NOT drive yourself, do not carry someone who is dizzy on a motorbike, and do not let them shower alone.
Do NOT follow head-turning or head-shaking exercises found online. The right exercises are chosen by a trained person after an examination — the wrong ones for your type of dizziness can make it worse.
Do NOT dismiss an episode that has already resolved. A neurological sign that appeared and went away still needs emergency care — it can be the warning before a major stroke.

Older adults: preventing falls, per CDC

Clear everything that can catch a foot out of the walking routes: cables, rugs that slip, things left on the floor.
Add lights or fit brighter bulbs, especially on night-time routes and in the bathroom.
Fit grab bars inside and outside the shower or bath, and beside the toilet.
Have an eye test every year; ask a doctor to assess the risk of falling, and ask a doctor or pharmacist to review the medication list.

When you must go to hospital

CALL 115 NOW — do not wait to see whether it eases — if dizziness comes on SUDDENLY with ANY of the following: loss of balance, veering to one side, unable to stand steadily · one side of the face drooping · weakness or numbness of one arm or leg · slurred speech, or not understanding what others say · blurred or double vision · the worst headache of your life · confusion, drowsiness, hard to rouse · seizures · fainting. ONE sign is enough; and a sign that has already resolved completely still means going to emergency care now. Also call 115 if there is chest pain or heaviness, difficulty breathing, cold sweating or an erratic heartbeat; if there is fever with a stiff neck; or if after a blow to the head there is repeated vomiting, or one pupil larger than the other. — BE SEEN THE SAME DAY, do not leave it until tomorrow, if: vomiting so much that water will not stay down; sudden hearing loss in one ear; a fall caused by the dizziness; a first severe episode in an older adult. — BE SEEN SOON, within one to three days at the latest, if: episodes are recurring or getting worse; they started after a change of medication; there is ringing in the ear or gradual hearing loss; the person has heart disease, high blood pressure or diabetes.

What can be done at home, and when to go in

Position-related episodes with a known cause can be followed up at home. At your address, a Y Te Xanh (GreenCare) doctor takes the history and examines at the bedside, measures blood pressure lying down and standing, tests muscle strength and sensation on both sides, and then says clearly whether this case can keep being watched or needs hospital.

If it is not clear whether to go in, start with a remote consultation. After a hospital discharge, if there is still loss of balance or weakness down one side, a nurse and a physiotherapist can come to the house to work on movement and on walking safely. If a sign in the box above is present, go to hospital first and call afterwards.

According to the US CDC, dizziness, loss of balance or loss of coordination that comes on SUDDENLY is one of the signs of stroke; call emergency services now and note the time the first sign appeared. The other causes described in this article are ordinary clinical knowledge, not CDC recommendations.

This article passes the above on and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.

Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.

Sources

Frequently asked questions

What kind of dizziness should make me think stroke rather than an inner-ear problem?

The dividing line is the word SUDDEN, and whether other signs come with it. According to CDC, dizziness, loss of balance or trouble walking that comes on suddenly is already one of the signs of stroke. If it comes with one side of the face drooping, weakness or numbness of one arm or leg, slurred speech, not understanding what others say, double vision or the worst headache of your life, call 115 now — one sign is enough. Conversely, a spinning episode that arrives when you change position, lasts a few tens of seconds, eases once you lie still and comes with nothing else is usually harmless — but it is still worth being seen to establish the cause.

What should I do first while I am dizzy?

Sit or lie down where you are; do not try to make it to the bed. Falling while dizzy is the commonest complication and also the most serious one in older adults. Then lie still, keep your eyes open and look at one fixed point; closing the eyes usually makes the spinning feel worse. Ask whoever is with you to try the three stroke checks: ask you to smile, ask you to hold both arms straight out at once, ask you to repeat a simple sentence. Then note the time the episode started and how long it lasted.

Should I take something for dizziness bought at a pharmacy?

Do not choose it yourself. Many medicines for dizziness and nausea cause drowsiness, so in older adults they raise the risk of falling rather than lowering it. More importantly, medicine that suppresses the symptom blurs the signs while the cause remains, so a stroke can be hidden behind “the tablet seemed to help”. Which medicine and for how long is for a doctor or pharmacist to decide, once the cause is known.

Is dizziness with a lot of vomiting dangerous?

A lot of vomiting with dizziness happens both with harmless inner-ear episodes and with stroke, so the vomiting itself does not tell the two apart. Look for any other sign: veering to one side, unable to sit steadily, double vision, slurred speech, weakness down one side — if any is present, call 115. If there is no other sign and only vomiting, but the vomiting is bad enough that water will not stay down, be seen the same day, because dehydration will make the dizziness worse. Dizziness with repeated vomiting after a blow to the head is emergency care now.

What should an older person who gets dizzy on standing up do?

Change how they stand up first: sit up, stay sitting for a while, then stand and hold on to something solid. Next, make the home safer along the lines CDC sets out above: clear anything that catches a foot, add brighter lights for night-time routes and the bathroom, fit grab bars, have an eye test every year. And ask a doctor or pharmacist to review the medication list, because some medicines, and some combinations, cause dizziness and drowsiness.

Dizziness started after a change of medication — should I stop the medicine?

Do not stop it yourself, particularly blood pressure, heart or diabetes medication — stopping on your own can be more dangerous than the dizziness. What to do is write down the names of everything being taken, bring the boxes too, note the times of doses and the time the dizziness began, then contact a doctor or pharmacist to review the list. If it comes with fainting, nearly fainting, an erratic heartbeat or chest heaviness, go now rather than waiting for an appointment.