II. Definitions

  1. Dizziness
    1. Non-motion Sensation of impaired spatial orientation

III. Epidemiology

  1. Accounts for 2.5% of emergency department visits

IV. History: Types by Characteristic

  1. Vertigo
    1. Do you feel as if the room is spinning, or that you are on an amusement park ride?
  2. Presyncope
    1. Do you feel suddenly light headed as you may fall to the ground, as if you arose too fast?
  3. Vasovagal Syncope?
    1. Is it brought on with prolonged standing, sitting, heat or stress and associated with sweats and Nausea?
  4. Dysequilibrium
    1. Do you have difficulty maintaining your balance when standing or walking?
  5. Muscle Weakness
    1. Do you feel generally Fatigued or tired?

V. Precautions: Critical measures

  1. Prevent complications related to Dizziness
    1. Falls and other accidents
  2. Identify serious causes of Dizziness
    1. Presyncope (14% of Dizziness presentations)
    2. Cerebrovascular Accident
      1. CNS Lesions (especially posterior CVA) account for 3% of Dizziness presentations
      2. Dizziness is a presenting symptom in up to 25% of Cerebrovascular Accidents
      3. Factors more suggestive of Central DIzziness cause
        1. Atrial Fibrillation
        2. Vague non-whirling Dizziness Sensation
        3. Advanced age
          1. Age 50-70: 3.5% central cause
          2. Age 70-80: 7.4% central cause of Dizziness
          3. Age 80-90: 16.7% central cause of Dizziness
      4. References
        1. Lee (2014) Emerg Med J 31(8): 641-4 [PubMed]

VI. Types: Dizziness Causes

  1. Vertigo (45-54%)
    1. Definition
      1. Sense of motion (e.g. spinning) despite being still
      2. False or distorted Sensation of self-motion in any direction
    2. Peripheral Vertigo is always episodic
      1. Continuous Dizziness is due to behavioral phenomenon
    3. Peripheral Vertigo examples
      1. Benign Paroxysmal Positional Vertigo
      2. Vestibular Neuronitis
      3. Meniere Disease
      4. Vestibular Migraine
    4. Pitfalls: Central Vertigo
      1. Posterior Circulation (vertebrobasilar) Cerebrovascular Accident
      2. Non-Vascular Central Causes of Vertigo (e.g. Acoustic Neuroma, Brainstem lesions, MS)
    5. Associated Conditions
      1. See Medication Causes of Vertigo
      2. Hearing Loss
      3. Migraine Headaches
  2. Dysequilibrium (16%)
    1. Off-balance or Unsteadiness (Postural)
    2. Examples
      1. Parkinsonism
      2. Peripheral Neuropathy
  3. Presyncope (14%)
    1. Sensation of loss of consciousness
    2. Examples
      1. Orthostatic Hypotension
    3. Associated Conditions
      1. See Medication Causes of Orthostatic Hypotension
      2. Coronary Artery Disease
      3. Cerebrovascular Disease
  4. Lightheadedness (10%)
    1. Vague Sensations not fitting in above categories
    2. Examples
      1. Hypoventilation Syndrome
    3. Associated Conditions
      1. Anxiety Disorder
      2. Major Depression

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Related Studies

Ontology: Dizziness (C0012833)

Definition (ICF) Sensation of motion involving either oneself or one's environment; sensation of rotating, swaying or tilting.
Definition (ICF-CY) Sensation of motion involving either oneself or one's environment; sensation of rotating, swaying or tilting.
Definition (NCI_CTCAE) A disorder characterized by a disturbing sensation of lightheadedness, unsteadiness, giddiness, spinning or rocking.
Definition (NCI) A sensation of lightheadedness, unsteadiness, turning, spinning or rocking.
Definition (MSH) An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness.
Concepts Sign or Symptom (T184)
MSH D004244
SnomedCT 206740007, 158144005, 139526005, 69096003, 162257004, 267176004, 271789005, 404640003
LNC LA7428-1
English Dizziness, WOOZINESS, [D]Dizziness (context-dependent category), [D]Dizziness, dizziness (symptom), dizziness, Woozy, Dizzyness, Dizziness [Disease/Finding], wooziness, dizzy, dizzying, woozy, Dizziness symptom, [D]Dizziness (situation), DIZZINESS, Dizzy, Dizziness (finding)
French ETOURDISSEMENT, Etat nébuleux, Etat vertigineux, SENSATION DE TETE QUI TOURNE, Étourdissement, Sensation vertigineuse
Portuguese TONTURA, Com tonturas, Embriagado, ALCOOLIZACAO, Tonturas, Tontura
German SCHWINDEL, schwindlig, schwummrig, BENEBELTSEIN, Schwindelgefuehl, Schwindel
Dutch licht in het hoofd, duizelig, duizeligheid, Duizeligheid
Italian Intontito, In preda a capogiro, Capogiro
Spanish Mareado, Aturdido, [D]mareos (categoría dependiente del contexto), ATURDIMIENTO, MAREO, [D]mareos (situación), [D]mareos, Aturdimiento, mareo (hallazgo), mareo, Mareo
Japanese 浮動性めまい, ふらふら感, メマイカン, フラフラカン, フドウセイメマイ, めまい感, 眩暈感
Swedish Svindel
Czech závrať, Závrativý, Malátný, Závrať
Finnish Heitehuimaus
Polish Oszołomienie
Hungarian Szédülés, Szédülékenység, Bizonytalan
Norwegian Svimmelhet

Ontology: Syncope (C0039070)

Definition (MEDLINEPLUS)

Fainting is a temporary loss of consciousness. If you're about to faint, you'll feel dizzy, lightheaded, or nauseous. Your field of vision may "white out" or "black out." Your skin may be cold and clammy. You lose muscle control at the same time, and may fall down.

Fainting usually happens when your blood pressure drops suddenly, causing a decrease in blood flow to your brain. It is more common in older people. Some causes of fainting include

  • Heat or dehydration
  • Emotional distress
  • Standing up too quickly
  • Certain medicines
  • Drop in blood sugar
  • Heart problems

When someone faints, make sure that the airway is clear and check for breathing. The person should stay lying down for 10-15 minutes. Most people recover completely. Fainting is usually nothing to worry about, but it can sometimes be a sign of a serious problem. If you faint, it's important to see your health care provider and find out why it happened.

Definition (NCI) A spontaneous loss of consciousness caused by insufficient blood supply to the brain.
Definition (NCI_CTCAE) A disorder characterized by spontaneous loss of consciousness caused by insufficient blood supply to the brain.
Definition (NCI_FDA) Extremely weak; threatened with syncope.
Definition (NCI_CDISC) Sudden loss of consciousness with loss of postural tone, not related to anesthesia, with spontaneous recovery as reported by patient or observer. A subject may experience syncope when supine. Syncope is often caused by insufficient blood supply to the brain.
Definition (NCI) Extremely weak; threatened with syncope.
Definition (MSH) A transient loss of consciousness and postural tone caused by diminished blood flow to the brain (i.e., BRAIN ISCHEMIA). Presyncope refers to the sensation of lightheadedness and loss of strength that precedes a syncopal event or accompanies an incomplete syncope. (From Adams et al., Principles of Neurology, 6th ed, pp367-9)
Definition (CSP) fainting due to a sudden fall of blood pressure below the level required to maintain oxygenation of brain tissue.
Concepts Sign or Symptom (T184)
MSH D013575
ICD9 780.2
ICD10 R55
SnomedCT 206727002, 206725005, 206731008, 271594007, 271211004, 29423006, 158137001, 158135009, 271785004, 158133002, 139532000, 162263008, 309585006, 272030005
LNC MTHU020851, LA16987-2
English Fainting, Syncope, Syncopes, COLLAPSE TRANSIENT, FAINTNESS, FALLING OUT, Fainted, PASSED OUT, SWOONING, Syncope and collapse NOS, [D]Syncope, [D]Syncope and collapse, [D]Syncope and collapse NOS, A faint, Passed out, [D]Fainting (context-dependent category), [D]Syncope and collapse (context-dependent category), [D]Syncope and collapse NOS (context-dependent category), [D]Fainting, fainting (syncope), syncope, fainting, fainting (symptom), Syncopal attack, Falling out, Swooning, Faint, Syncope [Disease/Finding], attacks syncopal, disorders syncope, fainting episodes, falls out, Attack(s);fainting, collapse syncope, faint, fainted, faints, syncope attack, out pass, pass out, attacks fainting, out passed, syncopes, fainting/syncope, Swoon, syncope fainting, faintness, swoons, out passes, swooning, passed out, syncope collapse, fainting syncope, [D]: [fainting] or [collapse] (disorder), [D]Syncope and collapse NOS (situation), Syncope (finding), [D]: [fainting] or [collapse] (situation), [D]Syncope and collapse (situation), [D]Fainting (situation), Fainting (finding), Fainting [D], Faint symptom, [D]: [fainting] or [collapse], SYNCOPE, FAINT, FAINTING, Syncope and collapse, Syncope symptom, Syncope attack, Syncope (disorder), Syncope and collapse (disorder), Syncope symptom (disorder), Fainting/syncope, attack; syncope, attack; unconsciousness, collapse; general, fainting; fit, fit; fainting, general; collapse, loss of consciousness; attack, syncope; syncope, unconsciousness; attack, Syncope, NOS, Faintness, Collapse fleeting, Collapse transient, fainting attacks, swoon
French SYNCOPE, Collapsus passager, Tendance lipothymique, Syncope et collapsus, Evanouissements, Collapsus transitoire, Chutes fréquentes, Pâmoison, Lipothymie, COLLAPSUS TRANSITOIRE, DECES, ETAT SYNCOPAL, EVANOUISSEMENT, PERTE DE CONNAISSANCE, A perdu connaissance, Syncope, Évanouissement
Portuguese SINCOPE, DESMAIO, Síncope e colapso, Ataque de síncope, Colapso transitório, Esvaimento, Perda de consciência, Desmaiado, Colapso passageiro, COLAPSO TRANSITORIO, DEBILIDADE, DESFALECIMENTO, DESMAIADO, Desmaio, Síncope
Spanish DESVANECIMIENTO, SINCOPE, DESMAYO, Colapso transitorio, Desfallecimiento, Episodio sincopal, Síncope y colapso, Privación de sentido, Alferecía, Pérdida de conocimiento, Desvanecimiento, Colapso fugaz, [D]desvanecimiento (categoría dependiente del contexto), [D]síncope y colapso (categoría dependiente del contexto), [D]síncope y colapso SAI (categoría dependiente del contexto), CAIDA, COLAPSO TRANSITORIO, DESFALLECIMIENTO, desvanecimiento, desvanecimiento (hallazgo), [D]síncope y colapso SAI, [D]desvanecimiento (situación), síncope (hallazgo), [D]síncope y colapso SAI (situación), [D]síncope y colapso (situación), [D]desvanecimiento, [D]síncope y colapso, desmayo, síncope (trastorno), síncope - síntoma (trastorno), síncope - síntoma, síncope y colapso (trastorno), síncope y colapso, síncope, Desmayo, Síncope
German SYNKOPE, ohnmaechtig, Kollaps fluechtig, synkopale Attacke, bewusstlos werden, Synkope und Kollaps, Kollaps voruebergehend, schwummrig, ohnmaechtig werden, Ohnmachtsanfall, BEWUSSTLOSIGKEIT FLUECHTIG, KOLLAPS KURZDAUERND, OHNMACHT, OHNMAECHTIG WERDEN, SCHWAECHEANFALL, Ohnmacht, Synkope
Dutch kortdurende collaps, flauwte, flauw, flauwteaanval, flauwvallen, voorbijgaande collaps, syncope en collaps, uitvallen, flauwgevallen, aanval van syncope, Flauwvallen/syncope, aanval; bewusteloosheid, aanval; syncope, algemeen; collaps, bewusteloosheid; aanval, bewustzijnsverlies; aanval, collaps; algemeen, flauwvallen; toeval, syncope; aanval, toeval; flauwvallen, Syncope en collaps, syncope, Collaps, Flauwvallen, Syncope
Italian Attacco sincopale, Sfaldarsi, Sincope e collasso, Collasso transitorio, Malore, Svenuto, Svenimento, Sincope
Japanese 卒倒, 一過性虚脱, 浮動性めまい感, 失神発作, シッシン, イッカセイキョダツ, ソットウ, シッシンホッサ, フドウセイメマイカン, キゼツ, 脳貧血, 気絶, 失神
Swedish Svimning
Czech synkopa, Tranzientní kolaps, Synkopický záchvat, Omdlívající, Mdloba, Synkopa a kolaps, Synkopa, Výpadek, Upadnout do bezvědomí, Pocit závratě, mdloba
Finnish Pyörtyminen
Korean 실신 및 허탈
Croatian SINKOPA
Polish Zapaść, Omdlenie
Hungarian Ájult, Syncopés roham, Syncope és collapsus, Átmeneti collapsus, Ájulásérzés, Múló collapsus, Syncope, Ájulás, Elájulás, Összeesés
Norwegian Synkope, Besvimelse