- Dizziness, 3–4% of ED visits, costing US >$4 billion/yr, difficult symptom to diagnose, often misdiagnosed
- Patients use various words to describe their experience including:
- Vertigo (the illusory sense of movement)
- Weakness, fainting
- Key point: The word that patients use (e.g., vertigo vs. dizziness vs. lightheadedness) is not diagnostically important. It is the timing and triggers that drive the evaluation (see below)
- To best find the cause, rather than focusing on the descriptor the patient uses, take a standard history focusing on trying to see if the patient has some toxic-metabolic-infectious cause (e.g., a GI bleed or a systemic infection or a dysrhythmia), which is the case in 50% of ED patients with dizziness
- If not obvious cause, use timing and triggers to place the patient into one of 3 categories:
- Acute vestibular syndrome (AVS) – acute onset of continuous dizziness
- Triggered episodic vestibular syndrome (t-EVS) – brief episodes of dizziness triggered, usually by movements of the head or body
- Spontaneous episodic vestibular syndrome (s-EVS) – longer episodes of dizziness not triggered by anything
- Toxic-metabolic-infectious causes:
- Toxins and many medications
- Electrolyte disturbances and dehydration
- Systemic infections
- Most common cause – vestibular neuritis and labyrinthitis
- Posterior circulation stroke
- Multiple sclerosis
- Orthostatic hypotension
- Rarely central positional paroxysmal vertigo (CPPV)
- Vestibular migraine
- TIA (posterior circulation)
- Ménière disease
- Panic attacks
- Rarely, intermittent low flow states (e.g., dysrhythmias or PE)
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Schaider, Jeffrey J., et al., editors. "Dizziness/vertigo." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307723/all/Dizziness_vertigo.
Dizziness/vertigo. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307723/all/Dizziness_vertigo. Accessed May 29, 2023.
Dizziness/vertigo. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307723/all/Dizziness_vertigo
Dizziness/vertigo [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 May 29]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307723/all/Dizziness_vertigo.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Dizziness/vertigo ID - 307723 ED - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307723/all/Dizziness_vertigo PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -