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Chapter 9 - Dizziness

from Section 2 - Common Neurologic Presentations: A Symptom-Based Approach

Published online by Cambridge University Press:  10 January 2024

Thomas P. Campbell
Allegheny Health Network, Pittsburgh
Kevin M. Kelly
Allegheny Health Network, Pittsburgh
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The evaluation of patients with the complaint of “dizziness” is a frequent occurrence in the ED. It accounts for 3.5–11% of ED visits. The word dizziness is a nonspecific term used by patients and healthcare professionals to describe a disturbed sense of wellbeing, usually perceived as an altered orientation in space. Vertigo is defined as an illusion of movement of oneself or one’s surroundings. It is usually experienced as a sensation of rotation or, less frequently, as undulation, linear displacement (pulsion), or tilt. Although vertigo usually suggests a vestibular disorder that can involve the inner ear or brain, this symptom itself cannot reliably localize the disorder. Dizziness or vertigo can result from numerous disorders of a complex human balance system. Despite the inherent complexities, the ED evaluation of dizziness or vertigo can be simplified by a systematic approach in history-taking, physical examination, and laboratory testing.

Publisher: Cambridge University Press
Print publication year: 2023

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Chen, R, Su, R, Deng, M, et al. A posterior circulation ischemia risk score system to assist the diagnosis of dizziness. J Stroke Cerebrovasc Dis 2018;27(2):506512.Google Scholar
Cheung, CS, Mak, PS, Manley, KV, et al. Predictors of important neurological causes of dizziness among patients presenting to the emergency department. Emerg Med J 2010;27(7):517521.CrossRefGoogle ScholarPubMed
Choi, JH, Oh, EH, Park, MG, et al. Early MRI-negative posterior circulation stroke presenting as acute dizziness. J Neurol 2018;265(12):29933000.CrossRefGoogle ScholarPubMed
Crespi, V. Dizziness and vertigo: an epidemiological survey and patient management in the emergency room. Neurol Sci 2004;25(1):S24S25.CrossRefGoogle ScholarPubMed
Edlow, JA, Gurley, KL, Newman-Toker, DE. A new diagnostic approach to the adult patient with acute dizziness. J Emerg Med 2018;54(4):469483.CrossRefGoogle Scholar
Epley, JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992;107(3):399404.CrossRefGoogle ScholarPubMed
Kattah, JC, Talkad, AV, Wang, DZ, Hsieh, YH, Newman-Toker, DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009;40(11):35043510.CrossRefGoogle ScholarPubMed
Kerber, KA. Vertigo and dizziness in the emergency department. Emerg Med Clin North Am 2009;27(1):3950.CrossRefGoogle ScholarPubMed
Kerber, KA, Newman-Toker, DE. Misdiagnosing dizzy patients: common pitfalls in clinical practice. Neurol Clin 2015;33(3):565575.CrossRefGoogle ScholarPubMed
Lammers, W, Folmer, W, Van Lieshout, EM, et al. Demographic analysis of emergency department patients at the Ruijin Hospital, Shanghai. Emerg Med Int 2011;2011:748274.CrossRefGoogle ScholarPubMed
Martin-Schild, S, Albright, KC, Tanksley, J, et al. Zero on the NIHSS does not equal the absence of stroke. Ann Emerg Med 2011;57(1):4245.CrossRefGoogle Scholar
Navi, BB, Kamel, H, Shah, MP, et al. Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department. Stroke 2012;43(6):14841489.CrossRefGoogle ScholarPubMed
Navi, BB, Kamel, H, Shah, MP, et al. Rate and predictors of serious neurologic causes of dizziness in the emergency department. Mayo Clin Proc 2012;87(11):10801088.Google Scholar
Newman-Toker, DE, Cannon, LM, Stofferahn, ME, et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007;82(11):13291340.CrossRefGoogle Scholar
Oppenheim, C, Stanescu, R, Dormont, D, et al. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 2000;21(8):14341440.Google Scholar
Parnes, LS, Price-Jones, RG. Particle repositioning maneuver for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1993;102(5):325331.CrossRefGoogle ScholarPubMed
Schneck, MJ. Current stroke scales may be partly responsible for worse outcomes in posterior circulation stroke. Stroke 2018;49(11):25652566.CrossRefGoogle ScholarPubMed
Smith, DB. Dizziness: a clinical perspective. In Kaufman, AI, Smith, DB (eds.) Neurologic Clinics: Diagnostic Neurotology. W. B. Saunders, 1990.Google Scholar
Tintinalli, J, Ma, OJ, Yealy, D, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9th ed. McGraw-Hill, 2019.Google Scholar

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