Evaluation of dizziness

Dizziness is the sensation of disturbed spatial orientation without a distorted sense of motion.[1]Bisdorff A, Von Brevern M, Lempert T, et al. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res. 2009;19(1-2):1-13. https://www.doi.org/10.3233/VES-2009-0343 http://www.ncbi.nlm.nih.gov/pubmed/19893191?tool=bestpractice.com Patients may use the term to indicate lightheadedness, imbalance (disequilibrium), presyncope 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.[2]Kerber KA, Callaghan BC, Telian SA, et al. Dizziness Symptom Type Prevalence and Overlap: A US Nationally Representative Survey. Am J Med. 2017 Dec;130(12):1465;e1-1465;e9. https://www.amjmed.com/article/S0002-9343(17)30714-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/28739195?tool=bestpractice.com

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.[3]Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008 Nov;14(6):355-64. http://www.ncbi.nlm.nih.gov/pubmed/19008741?tool=bestpractice.com [2]Kerber KA, Callaghan BC, Telian SA, et al. Dizziness Symptom Type Prevalence and Overlap: A US Nationally Representative Survey. Am J Med. 2017 Dec;130(12):1465;e1-1465;e9. https://www.amjmed.com/article/S0002-9343(17)30714-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/28739195?tool=bestpractice.com [4]Balatsouras DG, Koukoutsis G, Fassolis A, et al. Benign paroxysmal positional vertigo in the elderly: current insights. Clin Interv Aging. 2018;13:2251-2266. https://www.doi.org/10.2147/CIA.S144134 http://www.ncbi.nlm.nih.gov/pubmed/30464434?tool=bestpractice.com Dizziness accounts for approximately 5% of emergency department and unselected outpatient visits and up to 8% of primary care visits.[4]Balatsouras DG, Koukoutsis G, Fassolis A, et al. Benign paroxysmal positional vertigo in the elderly: current insights. Clin Interv Aging. 2018;13:2251-2266. https://www.doi.org/10.2147/CIA.S144134 http://www.ncbi.nlm.nih.gov/pubmed/30464434?tool=bestpractice.com [5]Bösner S, Schwarm S, Grevenrath P, et al. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care - a systematic review. BMC Fam Pract. 2018 Feb 20;19(1):33. https://www.doi.org/10.1186/s12875-017-0695-0 http://www.ncbi.nlm.nih.gov/pubmed/29458336?tool=bestpractice.com

The etiology is diverse and includes vestibular, cardiovascular, neurological and psychogenic causes.[6]Spiegel R, Kirsch M, Rosin C, et al. Dizziness in the emergency department: an update on diagnosis. Swiss Med Wkly. 2017;147:w14565. https://www.doi.org/10.4414/smw.2017.14565 http://www.ncbi.nlm.nih.gov/pubmed/29282699?tool=bestpractice.com 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 exam and, if needed, further investigations.