Dizziness is the sensation of disturbed spatial orientation without a distorted sense of motion. Patients may use the term to indicate lightheadedness, imbalance (disequilibrium), pre-syncope, or vertigo. These symptom types overlap substantially and patients most often report feeling off-balance or unsteady. Over 60% of patients experience more than one type of dizziness.
Dizziness is a common symptom: the prevalence in the general population ranges from 15% to 30%, and approaches 50% for patients aged over 85 years. Dizziness accounts for approximately 5% of emergency department and unselected outpatient visits and up to 8% of primary care visits.
The aetiology is diverse and includes vestibular, cardiovascular, neurological, and psychogenic causes. A detailed history, paying particular attention to timing and triggers of the patient’s symptoms, will narrow down the differential diagnosis, which can be confirmed with clinical examination and, if needed, further investigations.
- Benign positional paroxysmal vertigo (BPPV)
- Meniere's disease
- Vestibular neuritis
- Vestibular migraine
- Orthostatic hypotension
- Postural orthostatic tachycardia syndrome
- Diabetes mellitus
- Superior semi-circular canal dehiscence
- Perilymphatic fistula
- Persistent postural-perceptual dizziness (PPPD)
- Posterior fossa tumour
- Multiple sclerosis
- Posterior circulation stroke
- Vertebrobasilar insufficiency
- Arnold-Chiari malformation type 1
- Wallenberg's syndrome (Lateral medullary infarction)
- Vertebral artery dissection
- Paraneoplastic cerebellar degeneration
- Idiopathic intracranial hypertension
- Normal pressure hydrocephalus
- Mal de debarquement syndrome
- Psychophysiological dizziness
- Psychogenic dizziness
- Systemic lupus erythematosus (SLE)
- Cogan's syndrome
- Granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis)
- Behcet's disease
- Carbon monoxide poisoning
- Secondary syphilis
Susan A. Douglas, MBBS (Hons) UWI, FRCSEd, FRCS (ORL-HNS)
Consultant Otolaryngologist and Otologist
Rotherham NHS Foundation Trust
SAD declares that she has no competing interests.
Dr Susan Douglas would like to thank Professor William Gibson, a previous contributor to this topic. WG is an author of one of the references cited in this topic.
Joel Goebel, MD, FACS
Professor and Vice Chairman
Residency Program Director
Dizziness and Balance Center Director
Otolaryngology-Head and Neck Surgery
Washington University School of Medicine
JG is an author of a number of references cited in this topic.
Iain Swan, MD, FRCS
Senior Lecturer in Otolaryngology
Honorary Consultant Otolaryngologist
Glasgow Royal Infirmary
IS declares that he has no competing interests.
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