Dizziness is a topic covered in the 5-Minute Emergency Consult.

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  • Patients’ descriptions of symptom quality (vertigo, lightheadedness, disequilibrium, or “other”) are frequently misleading and should not be the basis of clinical decision making.
  • An approach based on associated symptoms, timing and triggers of the dizziness followed by a targeted physical exam looking for telltale signs is less prone to subjective errors of language and possibly more likely to yield a specific diagnosis.
  • There are 4 “timing and triggers” categories:
    • Acute vestibular syndrome (AVS)
    • Abrupt onset of persistent dizziness
    • Episodic vestibular syndrome (EVS)
    • Spontaneous episodes of dizziness lasting many minutes to hours
    • Positional vestibular syndrome (PVS)
    • Very brief episodes (usually lasting 20–50 sec) that are triggered by head or body position movement
    • Chronic vestibular syndrome (CVS)
    • Gradual onset of dizziness lasting weeks to months or longer


  • General medical (49%):
    • Arrhythmia
    • Hypoglycemia and other toxic metabolic causes
    • Hypovolemia of any cause
    • Sepsis and infections
    • Low cardiac output states of any cause
  • Otologic/vestibular (33%):
    • Benign paroxysmal positional vertigo (BPPV)
    • Labyrinthitis and vestibular neuritis
  • Neurologic (11%):
    • Stroke and transient ischemic attack (TIA)
    • Vestibular migraine
  • Psychiatric (7%):
    • Anxiety and depression

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