Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-30T03:02:10.143Z Has data issue: false hasContentIssue false

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
Affiliation:
Allegheny Health Network, Pittsburgh
Kevin M. Kelly
Affiliation:
Allegheny Health Network, Pittsburgh
Get access

Summary

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.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×