Merck Manual

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Some Causes and Features of Dizziness or Light-Headedness When Standing Up

Some Causes and Features of Dizziness or Light-Headedness When Standing Up

Cause

Common Features*

Tests

Central nervous system† disorders

Muscle stiffness

Slow, shaky movements

Loss of coordination and/or balance

Incontinence or inability to urinate

A doctor's examination

Sometimes MRI

Muscle stiffness

Tremor

Slow, shaky movements and a shuffling gait

Difficulty walking

Only a doctor's examination

Strokes if several have occurred

In people who are known to have had strokes

Only a doctor's examination

Spinal cord disorders

Intense, stabbing pains in the legs that come and go

Unsteady walking

Decreased sensation in the legs and numbness or tingling

Blood tests and sometimes a spinal tap (to obtain cerebrospinal fluid) to check for syphilis

Tumors

Back pain

Muscle weakness and decreased sensation in the legs

MRI

Peripheral nerve† disorders

Numbness, tingling, and weakness

Biopsy

Nerve damage caused by diabetes, excessive alcohol use, or nutritional deficiencies

Often burning pain and/or numbness in the feet and hands

Sometimes weakness

Usually in people who are known to have a disorder that can cause nerve damage

Nerve conduction testing and electromyography

Sometimes decreased sweating and intolerance of heat

Constipation or loss of control over bowel movements (fecal incontinence)

Difficulty emptying the bladder

A doctor's examination

Blood tests

A decreased volume of blood (hypovolemia)

Thirst, decreased urination, and confusion

Only a doctor's examination

Excessive loss of blood

Usually in people who have had an injury or surgery

Blood in stool or black, tarry stool

A doctor's examination, including testing stool for blood

A complete blood count

An underactive adrenal gland

Weakness and fatigue

Blood tests

Heart and blood vessel disorders

Chest pain

Palpitations (awareness of heart beats)

Fatigue

Shortness of breath

Symptoms often occur suddenly

Event monitor

Chronic venous insufficiency (causing blood to pool in the legs)

Long-lasting swelling in one or both legs

Chronic mild discomfort or aching in the ankles or legs but no pain

Sometimes reddish brown, leathery areas on the skin and shallow sores, usually on the lower legs

Often varicose veins

A doctor's examination

Shortness of breath and fatigue

A doctor's examination

Sometimes echocardiography (ultrasonography of the heart)

Heart attack (myocardial infarction)

Chest pain or pressure

Shortness of breath or fatigue

Sometimes in people who are known to have had a recent heart attack

ECG and blood tests to measure substances that indicate heart damage (cardiac markers)

Heart valve disorder

Shortness of breath

Chest pain or pressure

Echocardiography

High levels of the hormone aldosterone (hyperaldosteronism or pheochromocytoma, usually caused by a tumor in the adrenal gland)

Weakness, tingling, muscle spasms, high blood pressure, and headache

Blood tests

Drugs

Drugs for high blood pressure or angina: Calcium channel blockers, clonidine, diuretics (such as furosemide), methyldopa, nitrates, prazosin, or rarely beta-blockers

In people known to use one of these drugs

A doctor's examination

Sometimes stopping the drug to see if symptoms go away

Drugs that affect the central nervous system: Antipsychotics (particularly phenothiazines), monoamine oxidase inhibitors, or tricyclic or tetracyclic antidepressants

In people known to use one of these drugs

Only a doctor's examination

Sedatives: Alcohol or barbiturates

In people known to use one of these drugs

Only a doctor's examination

Other drugs: Quinidine or vincristine

In people known to use one of these drugs

Only a doctor's examination

Other problems

Age-related changes in blood pressure regulation

In older people

No other symptoms

Only a doctor's examination

Bed rest if prolonged

In people who have been at bed rest for a long time

Only a doctor's examination

A low level of potassium in the blood

Muscle weakness and cramping

Pins-and-needles sensation

Blood tests

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† The central nervous system includes the brain and spinal cord. The peripheral nervous system includes the nerves outside the brain and spinal cord.

CT = computed tomography; ECG = electrocardiography; MRI = magnetic resonance imaging.