5,7 A number of these drugs can cause orthostatic hypotension, which may manifest as dizziness. Psychotropic agents, antihypertensives, anti-inflammatory agents, and muscle relaxants are also reported to cause lightheadedness and disequilibrium in patients ( TABLE 2). The administration of certain drugs (e.g., acetyl-salicylic acid, amiodarone, cisplatin, ethacrynic acid, furosemide, gentamicin, quinine, streptomycin, tobramycin) may result in direct ototoxicity and should be discontinued in patients experiencing vertigo. 3,7,12Ī comprehensive review of a patient’s medication history should be performed to determine whether therapy must be altered. It has a gradual onset and is associated with neurologic symptoms such as visual changes (e.g., diplopia, hemianopsia), weakness, numbness, dysarthria, ataxia, and loss of consciousness. In central vertigo, autonomic symptoms are less severe and hearing loss is uncommon. It may also be associated with tinnitus, hearing loss, auditory fullness, or facial nerve weakness. Typical features of peripheral vertigo include a short or episodic time course, a precipitating factor, and the presence of autonomic symptoms (e.g., sweating, pallor, nausea, or vomiting). Peripheral vertigo occurs more frequently and is primarily due to infection, inflammation, and/or stimulation of various auditory nerves and organs. Central vertigo is commonly due to migraines, cerebrovascular disease, or cerebellopontine angle tumors. If vertigo is suspected, it is important to determine whether the cause is central or peripheral ( TABLE 1).
Patient History: A common feature of true vertigo is a spinning sensation that may present as objective (patients complain of objects moving around them) or subjective vertigo (patients feel they are spinning). If dizziness is not due to vertigo, other medical conditions (e.g., cardiac arrhythmia, diabetes, thyroid disorder) should be investigated. It may be described as feeling disconnected from the environment. The fourth type is lightheadedness, which is an indistinct term used to describe symptoms that do not fit the other categories. The third type is disequilibrium, or impaired balance and gait. The second type is a presyncopal episode, or the feeling of imminent fainting or loss of consciousness. The first type involves an illusion of movement, also described as a spinning sensation and termed vertigo. 5ĭue to the generality of the term dizziness, the classification of this condition has been proposed. 1,3,7,9 Common causes of dizziness include benign paroxysmal positional vertigo (BPPV), fear of falling, migraines, sensitivity to motion, and vestibular loss. It is also important to note the onset, duration, number of episodes, triggers, and any associated auditory and neurologic signs. 7,8Īssessment of a patient with complaints of dizziness requires a thorough history and physical examination in order to determine the actual issue. 1 Chronic dizziness and vertigo can result in loss of function, falls, and injuries that can lead to nursing home placement, stroke, and death.
5 Less than half of patients who experience dizziness have true vertigo. 6 Dizziness affects >50% of the elderly population and is the most common reason for physician visits among patients >75 years of age. 2 In 80% of these cases, the effects of dizziness are severe enough to necessitate medical intervention, 5 though causes remain unexplained 40% to 80% of the time. 4 An estimated 5 out of 1,000 people consult their primary care physician annually for vertigo, and 10 out of 1,000 for dizziness.
Thus, it is important to understand the etiology of dizziness and vertigo in order to properly evaluate and manage patients.ĭizziness is the third most common complaint among outpatients. 1-3 Dizziness is a common complaint among patients, particularly in the elderly, and is often difficult to describe. Vertigo is medically defined as an illusion of movement, or any abnormal sensation of motion between a patient and his or her surroundings. It encompasses a wide range of symptoms that vary from violent, spinning vertigo to vague symptoms of unsteadiness, lightheadedness, imbalance, disorientation, incoordination, and clumsiness. Dizziness is a nonspecific term used by patients to describe a sensation of altered spatial orientation.
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