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

Clinical approach to patients with dizziness

• Park JH
• Do Y
• Kim JS

• KMID: 2405135
• DOI: http://doi.org/10.5124/jkma.2018.61.1.44

Abstract

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.

Keyword

Dizziness; Diagnostic approach; Diagnosis, differential

MeSH Terms

Benign Paroxysmal Positional Vertigo
Clinical Medicine
Diagnosis, Differential
Dizziness*
Humans
Referral and Consultation
Specialization
Stroke
Vertigo
Vestibular Neuronitis

Figure

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  Figure 1 Head impulse test (HIT). (A) The posture of HIT, subjects visually fixates on examiner's nose while head is grasped by examiner's hands. (B) In healthy subjects, (C) HIT (arrow) normally induces a rapid compensatory eye movement in the opposite direction, and steady fixation is attained. (D) In patients with right unilateral vestibulopathy, (E,F) HIT toward the affected side (large arrow) produces a corrective saccade (small arrows) after head rotation because the eyes move with the head due to inadequate vestibulo-ocular reflex, thus losing the target with head rotation to affected side. Informed consent was received from the patient.

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