Dizziness Center

Dizziness – Vertigo is a term used to describe a series of sensations, such as feelings of fainting, dizziness, weakness or insecurity. Dizziness that creates a false sense that you or your surroundings are spinning or moving is called dizziness.

Dizziness is one of the most common reasons why adults visit doctors. Frequent dizziness or constant dizziness can significantly affect your life.

Vertigo is a common accompanying symptom of various systemic diseases and conditions, but also a symptom of diseases of the balance centers and much more serious diseases of the brain, blood vessels and nerves.

Dizziness Center

The Dizziness Center within the Pulse Cardiology Center provides diagnosis and treatment of disorders related to dizziness and balance. The specialists of the Pulse Cardiology Center have a lot of experience in diagnosing and treating the most severe cases of dizziness. Our multidisciplinary approach relies on fast scheduling and accurate diagnostics.

The team of doctors of the Center for Dizziness consists of neurologists, radiologists, cardiologists and if necessary, doctors of other specialties who perform diagnostic and therapeutic procedures in a modern way.

Treatment for vertigo depends on the cause and your symptoms. Treatment is usually effective, but the problem can recur.


The most common symptoms that our patients report are:

Dizziness, subjective feeling of instability, dizziness during sudden body movements, tinnitus, hearing loss, double vision in front of the eyes and blurred vision.

People who have dizziness can describe it as any of a series of sensations, such as:

  • False feeling of movement or rotation (dizziness)
  • Unconsciousness
  • Instability or loss of balance
  • Feeling of floating, weakness or fainting

These feelings can be triggered or worsened by walking, straightening or moving your head. Your dizziness may be accompanied by nausea or be so sudden or strong that you have to sit or lie down. The episode can last a few seconds or days and can be repeated.

Treatment of vertigo

Treatment of vertigo depends on their cause. In case of severe dizziness accompanied by nausea and vomiting, symptomatic therapy is required, which consists of rehydration (replacement of fluid in the mouth or in infusions), use of anti-nausea drugs and sedatives.

If the cause is peripheral, no other therapy is usually needed, except in cases of inflammation when antibiotics are given. In systemic diseases, the method of treatment determines the type of disease. When it comes to dizziness that is provoked by head positions, after calming down the difficulties, it is recommended to perform specially profiled exercises.

The central causes of dizziness are most often cerebral infarction, ie. stroke in the area of the brainstem or cerebellum, and therapy is carried out according to the principles of stroke treatment.

In demyelinating diseases, therapy specific to them is applied, and when it comes to tumors, the therapy is surgery.

The Pulse Cardiology Center has a specially created examination package for the diagnosis and treatment of vertigo.

Dizziness package

  • Neurlogical examination
  • Doppler ultrasound – blood vessels of the neck
  • TCD
  • Cardiologist examination
  • Lab analysis
  • Head CT scan

PACKAGE PRICE: 36.000 dinars


Because the causes of vertigo are different, the examination of patients with vertigo usually requires the cooperation of neurologists, internists – cardiologists, ENT specialists, radiologists and ophthalmologists.

The usual diagnostic procedure for vertigo involves:

  • Basic laboratory biochemical blood tests and blood count
  • Ultrasound examination of the circulation of blood vessels that supply the brain with blood
  • Transcranial Doppler – TCD and Color Doppler sonography of blood vessels of the neck
  • ECG – electrocardiogram, echocardiography-ultrasound of the heart,
  • Audio vestibulometry, Videonistagmoscopy and ENG – electronystagmography, audiometry, BAER – evoked potentials of the brainstem,
  • CT scan of the head / cervical spine or MRI (magnetic resonance imaging) of the brain.

When to see a doctor

Generally, contact our team of specialists if you have any recurrent, sudden, severe or prolonged and unexplained fainting or dizziness. Seek emergency medical help if you experience new, severe dizziness, with any of the following:

  • Sudden, severe headache
  • Chest pain
  • Hard breathing
  • Numbness or paralysis of the arms or legs
  • Unconsciousness
  • Double vision
  • Rapid or irregular heartbeat
  • Confusion or slurred speech
  • Stumbling or difficulty walking
  • Constant vomiting
  • Attacks
  • Sudden change in hearing
  • Stiffness or weakness of the face

Causes of dizziness

The most important causes of dizziness are: central or peripheral disorders and damage, a feeling of threatening fainting (syncope), disequilibrium syndrome and poorly defined dizziness.

The causes of dizziness can be different. If it is a matter of damage to various brain structures, the cause is of central origin, while damage to the structures of the inner ear is the cause of peripheral origin. Dizziness that occurs e.g. due to the use of some drugs, drop in blood pressure and other various causes, infections, diseases of the endocrine glands, vasculitis, blood diseases such as anemia, polycythemia or dysproteinemia, are causes of systemic origin.

Peripheral damage with dizziness is more often accompanied by hearing loss, nausea, vomiting, sweating and a specific neurological sign – nystagmus (ie involuntary twitching of the eyeball in a certain direction), which is an indicator of impaired balance of the inner ear. Depending on the place of damage, the speed and direction of involuntary twitching of the eyeball is different. Central causes of dizziness are less common.

If there is a sudden and strong attack of dizziness with drift to the side of the lesion-damage, followed by nausea, vomiting and fear, it is most likely vestibular neuronitis, inflammation of the vestibular nerve. Symptoms worsen when the position of the body and head changes. Apart from instability, there are usually no other neurological outbursts. Sometimes a peripheral weakness of the seventh cerebral nerve, the so-called facial nerve. The cause can be a viral infection, and it can occur at any age. Acute vertigo usually resolves spontaneously after a few hours, but may return in a few days or weeks. Some patients then have chronic imbalance problems.


Sudden onset of dizziness with hearing loss is typical of labyrinthitis. In most cases, the cause is unknown, although it is sometimes suspected that the potential cause is a viral manifest or non-manifest infection, or it is an autoimmune disease. Bacterial labyrinthitis occurs with meningitis, mastoiditis, or middle ear disease, followed by severe dizziness, nausea, vomiting, and hearing loss, and fever, headache, or pain behind the ear. The therapy is antibiotic.

When turning the head to a certain side, benign positional vertigo and nystagmus occur. There is a short-lived dizziness lasting a few seconds with a feeling of rotational movement, often accompanied by nausea, but without tinnitus. The cause is the deposition of otoliths in the posterior semicircular canal of the ear. The symptoms are short-lived and it is possible to break down the sediment with certain exercises of the head position, after which the dizziness disappears.

Systemic causes may involve peripheral and / or central structures. Except in cases where dizziness is caused by toxic products, there are usually other neurological signs and outbursts. If a brainstem or cerebellar infarction is suspected, hospital treatment is necessary.

Dizziness has many potential causes, including inner ear disorder, motion sickness, and medication effects. Sometimes dizziness is caused by a basic health condition, such as poor circulation, infection or injury.

The way you feel due to dizziness and what triggers the dizziness give clues about possible causes. How long the dizziness lasts and all the other symptoms you have also help to determine the cause of the dizziness.

Categories of vertigo

Dizziness is divided into several categories, namely: vertigo, syncope and presyncope, balance disorder and indeterminate dizziness.


By vertigo we mean the illusion of movement of the patient or his environment. The feeling of such dizziness is described as turning around the axis, rocking or leaning, often accompanied by vegetative symptoms such as nausea, vomiting and fear, then imbalance and nystagmus with or without blurred vision. Underlying is a disorder of the middle or peripheral nerve pathways of the vestibular apparatus (balance center). The association of vertigo and vegetative symptoms is attributed to numerous connections between vestibular and autonomic centers.

Syncope or presyncope

Syncope or presyncope implies a feeling of immediate loss of consciousness or unconsciousness. They are often accompanied by discomfort, nausea, fear and transient mutual vision loss. Such a disorder occurs in cases when the amount of circulation in the brain is insufficient for its supply of oxygen and glucose. Syncope or presyncope is usually the result of a circulatory disorder or heart rhythm disorder.


In patients who have a mismatch in the entry of information from the organs that serve the spatial orientation, it is a matter of imbalance, ie a feeling of imbalance, insecurity or “drunkenness” without dizziness. The cause of this condition is a disorder of the balance system in the inner ear, the vision system, deep and superficial sensibility, as well as damage to the cerebellum or parts of the brain that are responsible for involuntary movements.

Indeterminate dizziness

In patients with emotional disorders, indeterminate dizziness appears, and it occurs as a consequence of hyperventilation, ie. rapid breathing. It is usually “slight dizziness”, dizziness or fear of falling, which is different from the dizziness, presyncope or imbalance described above. All forms of dizziness can cause fear.

Inner ear problems that cause dizziness

Your sense of balance depends on the combined input signals of different parts of your sensor system. This includes your:

  • Eyes, which help you determine where your body is in space and how it moves
  • Sensory nerves, which send messages to the brain about body movements and postures
  • Inner ear with sensors that help detect gravity and back and forth moving

Vertigo – dizziness is a false feeling that your surroundings are spinning or moving. With inner ear disorders, your brain receives signals from the inner ear that are not in line with what your eyes and sensory nerves receive. Vertigo is what results while your brain works to resolve the confusion.

Benign paroxysmal positional vertigo (BPPV). This condition causes an intense and brief but false feeling of spinning or moving. These episodes trigger rapid changes in head movement, such as when you turn in bed, sit down, or experience a blow to the head. BPPV is the most common cause of dizziness.

Infection. A viral infection of the vestibular nerve, called vestibular neuritis, can cause intense, constant dizziness. If you also have sudden hearing loss, you may have Labyrinthitis.

Meniere’s disease. This disease involves excessive accumulation of fluid in the inner ear. It is characterized by sudden episodes of dizziness lasting several hours. You may also experience fluctuating hearing loss, tinnitus, and a feeling of blockage

Migraine. People who experience migraines may have episodes of dizziness or other forms of dizziness even when they do not have a severe headache. Such episodes of vertigo can last from a few minutes to a few hours and may be associated with headaches as well as sensitivity to light and noise.

Blood circulation problems that cause dizziness

You may feel dizzy, faint or unbalanced if your heart does not pump enough blood to your brain. Causes include:

  • Drop in blood pressure. A dramatic drop in systolic blood pressure – multiple blood pressure readings – can result in brief dizziness or a feeling of fainting. It can happen after sitting or getting up too fast. This condition is also called orthostatic hypotension.
  • Poor circulation. Conditions such as cardiomyopathy, heart attack, cardiac arrhythmia and transient ischemic attack can cause dizziness. And a decrease in blood volume can cause inadequate blood flow to the brain or inner ear.

Other causes of dizziness

Neurological conditions. Some neurological disorders – such as Parkinson’s disease and multiple sclerosis – can lead to progressive loss of balance.

Medications. Dizziness can be a side effect of certain medications – such as anti-seizure medications, antidepressants, sedatives and tranquilizers. In particular, medicines to lower blood pressure can cause fainting if they lower blood pressure too much.

Anxiety disorders. Certain anxiety disorders can cause dizziness or fainting – a feeling often called dizziness. These include panic attacks and the fear of leaving home or staying in large open spaces (agoraphobia).

Low iron levels (anemia). Other signs and symptoms that can occur along with dizziness if you have anemia include fatigue, weakness and pale skin.

Low blood sugar (hypoglycemia). This condition mainly affects people with diabetes who use insulin. Dizziness (vertigo) may be accompanied by sweating and anxiety.

Carbon monoxide poisoning. Symptoms of carbon monoxide poisoning are often described as “flu-like” and include headache, dizziness, weakness, stomach upset, vomiting, chest pain, and confusion.

Overheating and dehydration. If you are active at high temperatures or if you do not drink enough fluids, you may feel dizzy from overheating (hyperthermia) or from dehydration. This is especially true if you are taking certain heart medications.


Risk factors for dizziness

Factors that may increase the risk of dizziness include:

Age – Older adults are more likely to have health conditions that cause dizziness, especially a feeling of imbalance. Older people are also more likely to take medications that can cause dizziness.

Previous episodes of vertigo – If you have had vertigo before, you are more likely to feel dizzy again in the future.

Complications of dizziness

Dizziness can increase the risk of falls and injuries. Dizziness while driving a car or working with heavy machinery can increase the likelihood of an accident. You may also experience long-term consequences if the existing medical condition that may be causing your dizziness is not treated.

Diagnoses we treat in our Dizziness Center

We treat many disorders and problems, including:

  • Dizziness – Vertigo
  • Benign paroxysmal positional vertigo (BPPV)
  • Imbalance
  • Vestibular neuritis
  • Labyrinthitis
  • Vestibular hypofunction
  • Vestibular migraine
  • Meniere’s disease
  • Persistent postural vertigo perception (3PD)
  • Stroke
  • Cervicogenic vertigo
  • Dizziness associated with anxiety
  • Disassembly (MDD)
  • Visually induced dizziness
  • Nausea while driving
  • Dizziness after chemotherapy radiation

Several centers of excellence have been established within the Pulse Cardiology Center.  You can get more information about our Centers by clicking on the links:

Chest pain Center

Dizziness Center

Headache Center

Stroke Center

Arrhythmia Center

Center for Atherosclerosis

Pacemaker Center