Dizziness - Causes of loss of balance

Authored by Dr Mary Harding, 26 Jul 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Louise Newson, 26 Jul 2017

Your brain constantly receives nerve messages from various parts of the body to tell you where you are and what position you are in. The three main sources of these nerve messages are:

  • Your eyes - what you look at helps your brain to tell what position you are in and how you are moving.
  • Nerve messages from your skin, muscles and joints help your brain to tell the positions of your arms, legs and other parts of your body.
  • Your inner ears. The inner ear includes the cochlea, vestibule and semicircular canals in which there is a system of narrow fluid-filled channels called the labyrinth. The cochlea is concerned with hearing. The three semicircular canals help to control balance and posture. Head movements are sensed because when you move your head, the fluid in the labyrinth within the semicircular canals moves too. The movement of the fluid moves tiny fine hairs that are on the inside lining of the labyrinth. When the hairs move, this triggers messages to be sent to the brain via a nerve called the vestibular nerve. This gives the brain information about the movement and position of your head, even when your eyes are closed.
Cross-section of the ear

To be free of dizziness and to have good balance, it is best to have all of these (eyes, nerve signals from the skin muscles and joints, and inner ears) working normally. However, if you shut your eyes, you will normally still have a good sense of balance and know the position of your head and other body parts. This is because of the nerve messages that are sent to your brain from your inner ears, and other parts of your body.

In this type of dizziness you do not have vertigo and are not light-headed or feeling faint. However, you feel unsteady on your feet and feel as if you may fall over when you walk, due to unsteadiness.

This can be caused by various conditions. These include the following:

Ear problems

Some inner ear conditions can cause balance problems without the spinning sensation of vertigo - for example, an inner ear injury.

Nerve disorders

Various disorders which cause the nerves in the legs not to work properly can cause unsteadiness. For example, peripheral neuropathy, multiple sclerosis, etc.

Brain disorders

Various problems in the brain, such as a stroke, or a brain tumour, can cause balance problems. These occur if the affected part of the brain is a part that helps to control posture and balance. There will usually be other symptoms too.

General frailty

General frailty and/or being seriously ill with another illness may lead to loss of balance. You will usually have other symptoms in addition to problems with balance.

Alcohol and drugs

Your balance can be affected by drinking too much alcohol or taking some street drugs.

Further reading and references

  • Vertigo; NICE CKS, April 2010 (UK access only)

  • Huh YE, Kim JS; Bedside evaluation of dizzy patients. J Clin Neurol. 2013 Oct9(4):203-13. doi: 10.3988/jcn.2013.9.4.203. Epub 2013 Oct 31.

  • Kaski D, Bronstein AM; Making a diagnosis in patients who present with vertigo. BMJ. 2012 Sep 3345:e5809. doi: 10.1136/bmj.e5809.

  • Post RE, Dickerson LM; Dizziness: a diagnostic approach. Am Fam Physician. 2010 Aug 1582(4):361-8, 369.

  • Kerber KA, Baloh RW; The evaluation of a patient with dizziness. Neurol Clin Pract. 2011 Dec1(1):24-33.

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