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Dizziness

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

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Basics

Description

  • 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

Etiology

  • 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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Citation

Rosen, Peter, et al., editors. "Dizziness." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307498/all/Dizziness.
Dizziness. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307498/all/Dizziness. Accessed April 25, 2019.
Dizziness. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307498/all/Dizziness
Dizziness [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307498/all/Dizziness.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Dizziness ID - 307498 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307498/all/Dizziness PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -