Dizziness is a nonspecific term and may be used by patients to indicate true vertigo, lightheadedness, imbalance, or a form of syncope. The prevalence of dizziness in the general population ranges from 20% to 30%.  True vertigo is described as a rotary sensation of the patient or surroundings, and is often of vestibular origin.
The etiology varies from vestibular, to neurologic, to cardiovascular pathology. The most common causes of vertigo are migraine-related vertigo, benign positional paroxysmal vertigo (BPPV), and Meniere disease. Cerebellar infarct or vestibular schwannoma (acoustic neuroma) may also cause dizziness.
It is important to take a detailed history of the patient's symptoms. True vertigo often indicates vestibular pathology (e.g., BPPV, labyrinthitis, or Meniere disease). Central pathology, such as a cerebellar ischemic stroke, needs to be ruled out. A description of the typical attacks including their nature, duration, and associated auditory symptoms (e.g., hearing loss; tinnitus and aural pressure) should be determined. Physical exam includes an ear and neurologic exam plus an exam of the vestibular system. Neurologic exam is important to rule out central pathology. The Dix-Hallpike test should be carried out if BPPV is suspected.
The diagnosis of dizziness is usually made on the basis of the history and exam only. Investigations may not be necessary. MRI of the brain and internal auditory meatus should be done if there is concern that there may be central pathology. Vestibular function tests are indicated in some cases. Tests of cardiovascular function may be necessary if a cardiovascular cause is suspected.
Consultant Otolaryngologist and Otologist
Rotherham NHS Foundation Trust
SAD declares that she has no competing interests.
Professor of ENT
Sydney Cochlear Implant Centre
WG is a co-author of one reference cited in this monograph.
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 monograph.
Senior Lecturer in Otolaryngology
Honorary Consultant Otolaryngologist
Glasgow Royal Infirmary
IS declares that he has no competing interests.
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