Lightheadedness: A Warning Sign Of Stroke?

Feeling lightheaded is a common complaint, especially among older adults. While it is usually not caused by anything life-threatening, it could be a symptom of a more serious condition, such as a stroke.

Dizziness is a non-specific term that may refer to lightheadedness, vertigo, presyncope, anxiety, or just not feeling well. Although dizziness is often benign, the differential diagnosis includes potentially life-threatening conditions such as a stroke.

According to the American Stroke Association, a lack of adequate blood flow may cause people to experience dizzy spells or feel lightheaded. This could be due to atrial fibrillation, cardiomyopathy, or some types of stroke.

Therefore, it is important to seek medical attention if you are experiencing lightheadedness, as it could be a warning sign of a stroke or another underlying health condition.

Dizziness as a symptom of stroke

Dizziness is a common symptom, accounting for 3.5% to 11% of emergency department (ED) visits. While most cases of dizziness are not caused by strokes, dizziness can sometimes be a symptom of a stroke or transient ischaemic attack (TIA). Strokes are longer-lasting neurological disturbances, associated with permanent damage to the brain, while TIAs are temporary.

Dizziness can be caused by a reduction in blood supply to the back part of the brain. Other symptoms of vertebrobasilar TIA and stroke include visual disturbances, drop attacks, unsteadiness or incoordination, weakness, confusion, headache, hearing loss, numbness, speech disturbance, abnormal noise in the ears, and numbness around the mouth.

The diagnosis of a TIA or stroke is usually made by a neurologist and is based on a combination of compatible symptoms, the exclusion of other reasonable causes, and the identification of a cause of reduced blood flow. Testing for this may include blood tests, MR or CT angiograms, hearing tests, and EEGs, among others.

It is important to note that strokes causing dizziness or vertigo will rarely have limb ataxia or other focal signs. In addition, strokes can present with true vertigo symptoms, and acute dizziness/vertigo is usually exacerbated by head movement, whether the cause is peripheral or central. Therefore, it is crucial to differentiate triggers from exacerbating factors when evaluating dizziness.

While most dizziness is not caused by strokes, it is important to seek medical help if symptoms last more than 15 minutes, as lightheadedness can sometimes be a sign of a heart attack or stroke, especially in older adults.

Lightheadedness as a symptom of atrial fibrillation

Lightheadedness can be a symptom of atrial fibrillation (AF or afib), a condition characterised by abnormal electrical activity in the upper chambers (atria) of the heart, causing it to beat quickly and irregularly. This irregular beating results in too little blood being pumped throughout the body and can lead to symptoms such as fatigue, shortness of breath, and chest pain.

The first sign of atrial fibrillation for Roger, a 67-year-old man with no prior health issues or family history of heart disease, was a few dizzy spells while playing golf. Roger's experience is not unique, as lightheadedness and dizziness are common symptoms of AF. However, these symptoms can also be indicative of other serious conditions, such as stroke or heart attack, so it is important to seek medical attention if they persist or are accompanied by other concerning symptoms.

The goals of AF treatment are to restore the heart's natural rhythm and rate, prevent blood clots, and reduce the risk of stroke. This can be achieved through lifestyle changes, medication, nonsurgical procedures, or surgery. Lifestyle changes that may help address AF include heart-healthy eating, physical activity, stress management, limiting or avoiding alcohol and drugs, and not smoking. Medications such as beta-blockers or calcium channel blockers can help control the heart rate, while antiarrhythmic drugs may be used to restore the heart's normal rhythm. In cases where medications are ineffective, nonsurgical procedures such as electrical cardioversion or catheter ablation may be recommended. If other treatments are unsuccessful, surgery, such as a maze procedure, may be necessary.

While lightheadedness can be a symptom of AF, it is important to note that AF itself can also increase the risk of stroke. Therefore, seeking medical attention for lightheadedness and getting a proper diagnosis is crucial.

Lightheadedness as a symptom of cardiomyopathy

Lightheadedness is a common feeling of faintness, often accompanied by clouded vision and nausea. It is caused by insufficient blood flow to the brain and can affect anyone. However, it is a very common symptom for patients with hypertrophic cardiomyopathy (HCM).

Cardiomyopathy and Lightheadedness

According to the American Stroke Association, lightheadedness may be a symptom of cardiomyopathy, a condition that makes it harder for the heart to pump blood to the rest of the body. Cardiomyopathy causes the heart muscle to become enlarged, thick, or rigid, and in rare cases, the muscle tissue is replaced with scar tissue. As the condition worsens, the heart becomes weaker and less able to pump blood effectively, leading to reduced blood flow to the brain and resulting in lightheadedness.

Other Causes of Lightheadedness

While lightheadedness can be a symptom of cardiomyopathy, it can also be caused by various other factors. Dehydration is a common cause, as it leads to a decrease in blood volume, which lowers blood pressure and reduces blood flow to the brain. Additionally, certain medications, particularly those that lower blood pressure or increase urination, can contribute to lightheadedness. Orthostatic hypotension, or standing up too quickly, can also cause a temporary drop in blood pressure and reduced blood flow to the head, resulting in lightheadedness. This is more likely to occur in individuals with a slow heart rate or dehydration.

Addressing Lightheadedness

Lightheadedness can be a concerning symptom, and it is always a good idea to report it to your doctor. If the lightheadedness is accompanied by other symptoms, such as chest pain, shortness of breath, or sudden confusion, it could be indicative of a more serious condition like a heart attack or stroke, and immediate medical attention is advised. To alleviate mild cases of lightheadedness, it is recommended to lie down, elevate the feet, or put the head between the knees to increase blood flow to the brain. Staying hydrated by drinking water or other fluids with electrolytes can also help prevent and alleviate lightheadedness.

Lightheadedness as a symptom of dehydration

Dehydration is a condition that occurs when the body does not have a sufficient amount of fluids, primarily water, to function effectively. It can be caused by a variety of factors, including inadequate water intake, fever, vomiting, diarrhoea, excessive sweating due to exercise or hot weather, and certain medications or health conditions. Dehydration can lead to a range of symptoms, one of which is lightheadedness.

When dehydrated, the body struggles to perform essential tasks such as breathing and digestion. This is because dehydration leads to reduced blood pressure or lower blood volume. As a result, the brain may not receive an adequate supply of blood, causing lightheadedness. This sensation of lightheadedness is the body's way of signalling that something is wrong and that fluids are needed.

In addition to lightheadedness, dehydration can cause a range of other symptoms, including:

• Increased thirst: Thirst is the body's way of signalling that it needs more fluids.
• Reduced urination: When dehydrated, the body signals the kidneys to retain fluids, resulting in less frequent urination.
• Dark urine: Well-hydrated individuals typically have clear or pale yellow urine. Dark urine indicates dehydration as it becomes more concentrated.
• Fatigue: Dehydration makes it harder for the body to function normally, leading to increased feelings of tiredness or lethargy.
• Constipation: The large intestine absorbs water from food, so dehydration results in harder stools and constipation.
• Headache: Dehydration-induced headaches are common and can be relieved by drinking water.

If you suspect that lightheadedness is due to dehydration, it is important to take the following steps:

• Rehydrate: Replenish lost fluids as soon as possible, primarily by drinking water. Sports drinks or oral rehydration solutions can also help restore lost electrolytes.
• Sit down: Moving to a sitting position can help prevent falls and provide relief from dizziness. Get up slowly once the dizziness has passed.
• Move slowly: Even after the dizziness subsides, continue to move cautiously to minimise the risk of falling.
• Avoid certain activities: Driving, operating machinery, or climbing can be dangerous when feeling dizzy, posing a risk to yourself and others.

While dehydration-induced lightheadedness usually passes without incident, it can sometimes indicate a more serious issue. Seek immediate medical attention if you or someone you know experiences the following:

• Rapid heart rate
• Confusion or disorientation
• Difficulty walking or moving
• Persistent diarrhoea or vomiting lasting more than 24 hours

Severe dehydration can lead to serious complications, including urinary and kidney problems, seizures, heat exhaustion, heatstroke, and hypovolemic shock, a life-threatening condition caused by low blood volume. Therefore, it is crucial to recognise the signs of dehydration and take preventive measures to stay hydrated, especially during exercise, hot weather, or illness.

Lightheadedness as a symptom of medication side effects

Lightheadedness and disorientation are among the most common side effects of prescription drugs. Medication side effects can cause lightheadedness, especially those that lower blood pressure or increase urination. If the medication is too strong, it can lower blood pressure too much and cause lightheadedness. This can be fixed by adjusting the dosage or switching to a different drug.

An impressive list of drugs may cause lightheadedness or dizziness, including anticonvulsants, antihypertensives, antibiotics, antidepressants, antipsychotics, and anti-inflammatories. Anticonvulsants such as lamotrigine, oxcarbazepine, carbamazepine, lacosamide, and clonazepam may cause lightheadedness or dizziness. Antihypertensives like amlodipine and the combination of irbesartan and hydrochlorothiazide can also cause these side effects. Antidepressants such as mirtazapine, paroxetine, and sertraline can induce lightheadedness or dizziness accompanied by asthenia. Antibiotics like ciprofloxacin and the combination of amoxicillin and clavulanic acid may also lead to these adverse reactions.

Other drugs that can cause lightheadedness or dizziness include silodosin, pantoprazole, lornoxicam, aripiprazole, and atazanavir. It is important to note that the appearance of lightheadedness or dizziness for several drugs may be under-reported, as these side effects are already known and often disappear during treatment. However, all adverse reactions represent a reduction in quality of life and can indirectly lead to serious adverse events, such as falls, fractures, or other traumas. Therefore, it is crucial to consult a doctor if you experience lightheadedness, as they may adjust the dosage or switch your medication.

Frequently asked questions