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Diagnosing Dizziness: We Are Teaching the Wrong Paradigm!

I believe that the problem with diagnosing dizziness is that we are taught (and are teaching) the wrong diagnostic paradigm… We are taught to ask, “What do you mean, dizzy?” The patient's response of “vertigo,” “lightheadedness” or “near faint,” “disequilibrium,” or “other,” then determines the differential diagnosis, testing, and treatment. This symptom quality paradigm dates back to research done 45 years ago. An important article in 1972, to a modern eye, it has serious methodologic flaws...

So rather than base the evaluation of a dizzy patient purely on the symptom quality, using this same “timing and triggers” approach (that we use for every other chief complaint) is far more…

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  As the World Turns: Dizziness and Vertigo in the ED

We're gonna switch around our thinking of dizziness and how to approach it in the emergency department. We're gonna reclassify the causes of dizziness and then summarize pearls and pitfalls so that we can all take them back with us to clinical practice.

 A Simplified Approach to the Patient with Dizziness

The dizzy patient is both a common complaint and source of anxiety for the emergency physician. The differential diagnosis is broad and riddled with dangerous pathology. It is further complicated by the fact that patients have a challenging time providing an accurate history regarding this chief complaint, leading to difficulty narrowing down your considerations.

 The Dizzy Patient in the Urgent Care Setting

The problem of dizziness can be one of the most exasperating in the practice of medicine. Physicians all know that sinking feeling elicited by the patient who sits down and, when one asks “What can I do for you?”, says, “I’m dizzy.” The goal of this article is to offer urgent care practitioners a reasoned approach to dizziness that will lead expeditiously to diagnosis and effective therapy.

 The Timing-and-Triggers Approach to the Patient With Acute Dizziness

Although dizziness is common in the ED, there is incomplete understanding of the fundamentals of physical examination findings in dizzy patients. By using this new “timing-and-triggers” approach instead of the old “what do you mean, ‘dizzy?’” approach, you can more confidently make the correct diagnosis and ensure that patients with central causes of dizziness receive appropriate care quickly.

Articles of Interest

Approach to dizziness in the emergency department

Acute dizziness/vertigo is among the most common causes for visiting the emergency department. The traditional approach to dizziness starts with categorizing dizziness into four types: vertigo, presyncope, disequilibrium, and nonspecific dizziness.

Dizziness in an Elderly Lady

This patient presented with dizziness only. Beware that older patients and females may have an atypical presentation, as demonstrated by this case.

Don’t overlook subtle signs for vertigo in the elderly

First and foremost, what were they doing when the dizziness started? A key indicator with vertigo is that it involves some sort of change in positioning of the head, and symptoms are exacerbated with head movement. Many times patients will tell me the symptoms began or were made worse when they were rolling over in bed.

Unraveling the Mystery of Dizziness in the ED: A Guide for the Student Clerkship

Dizziness is the third most common complaint reported in the ED. Asking the right questions and teasing out the details of this vague complaint can lead to proper management and reduced negative outcomes.

Vertigo and dizziness in the elderly

The prevalence of vertigo and dizziness in people aged more than 60 years reaches 30%, and due to aging of world population, the number of patients is rapidly increasing.

Vertigo in the Elderly: What Does It Mean?

Elderly patients have multiple reasons for losing their balance. Muscles are weaker, spines start to twist, bones may become brittle. Add vascular problems, vision loss, polypharmacy, and a sedentary lifestyle, and it’s no wonder that complaints of vertigo or dizziness affect some 70% of individuals age 65 or older. Figure. Vertigo or dizziness affects 70% of individuals age 65 or older. click for large version Figure. Vertigo or dizziness affects 70% of individuals age 65 or older. Treating balance ailments can be challenging in patients of any age, but several factors make diagnosing and treating inner ear disorders in older patients particularly complicated.

Worsening Dizziness in an Elderly Man

The hallmark of autonomic nervous system disorders is an inappropriate response of the autonomic system to a stimulus, which can lead to orthostatic intolerance with such symptoms as dizziness and, in more extreme cases, syncope. Not all autonomic nervous disorders have an orthostatic component, and other stimuli may be able to trigger the same untoward symptoms. Some of these inappropriate syndromes include reflex/situational syncope (often blamed for micturition syncope), vasovagal syncope, postural orthostatic tachycardia syndrome, and carotid sinus hypersensitivity (CSH).