J Korean Med Assoc.  2018 Jan;61(1):44-48. 10.5124/jkma.2018.61.1.44.

Clinical approach to patients with dizziness

  • 1Department of Neurology, Daegu Catholic University Hospital, Daegu Catholic University College of Medicine, Daegu, Korea.
  • 2Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. jisookim@snu.ac.kr


Although dizziness is common, it is one of the most challenging symptoms in clinical medicine. Defining the type of dizziness has been considered the first step when approaching patients with dizziness. This approach was based on the belief that each type of dizziness reflects a specific underlying mechanism. A more recent approach involves grouping patients into 4 major categories: 1) acute prolonged spontaneous dizziness, 2) recurrent spontaneous dizziness, 3) recurrent positional dizziness, and 4) chronic persistent dizziness and imbalance. Vestibular neuritis and strokes are the most common causes of acute prolonged spontaneous dizziness, and neuro-otologic examination findings play a key role in the differential diagnosis. Careful history-taking is extremely important in diagnosing the disorders that cause recurrent spontaneous dizziness since the findings of the clinical examination and laboratory evaluations are often negative without a confirmatory diagnostic tool. Benign paroxysmal positional vertigo is a predominant cause of recurrent positional vertigo and can easily be treated with canalith-repositioning maneuvers. Chronic persistent dizziness and imbalance occur in various degenerative or psychiatric disorders that frequently require a referral to a specialist. This new approach may be more practical for managing patients with dizziness.


Dizziness; Diagnostic approach; Diagnosis, differential

MeSH Terms

Benign Paroxysmal Positional Vertigo
Clinical Medicine
Diagnosis, Differential
Referral and Consultation
Vestibular Neuronitis
Full Text Links
  • JKMA
export Copy
  • Twitter
  • Facebook
Similar articles
    DB Error: unknown error