Dizziness

Aka: Dizziness, Faintness, Light Headedness, Lightheaded, Lightheadedness, Dizziness Causes

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II. Definitions

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

III. Epidemiology

  1. Dizziness 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?
  6. Lightheadedness
    1. Sensation of Faintness or reeling when not characterized by Vertigo, Presyncope, Dysequilibrium
  7. Images
    1. DizzinessDDx.png

V. Precautions: Critical measures

  1. Prevent complications related to Dizziness
    1. See Fall Prevention in the Elderly
    2. 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 or Ataxia (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. Arrhythmia
  4. Lightheadedness (10%)
    1. Vague Sensations not fitting in above categories
    2. Examples
      1. Hyperventilation (e.g. Panic Disorder)
    3. Associated Conditions
      1. Anxiety Disorder
      2. Major Depression

VII. References

  1. Ondrejka (2014) Crit Dec Emerg Med 28(10): 11-7
  2. Post (2010) Am Fam Physician 82(4): 361-8 [PubMed]
  3. Kroenke (1992) Ann Intern Med 117:898-904 [PubMed]
  4. Bisdorff (2009) J Vestib Res 19(1-2):1-13 [PubMed]

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