Rationale
Dizziness is a common, but imprecise complaint. Physicians need to determine whether it refers to vertigo, which may be a symptom of significant intracranial disease, or a non-specific symptom that could be related to non-vestibular causes.
Causal Conditions
(list not exhaustive)
- Vertigo
- Peripheral vestibular dysfunction
- Benign positional vertigo
- Peripheral vestibulopathy
- Ménière’s disease
- Drugs (e.g., aminoglycosides)
- Acoustic neuroma
- Peripheral vestibular dysfunction
- Central vestibular dysfunction
- Cerebrovascular
- Multiple sclerosis
- Drugs (e.g., anticonvulsants, hypnotics, alcohol)
- Other dizziness
- Hyperventilation
- Disequilibrium (e.g., poor mobility, peripheral neuropathy)
- Presyncope
- Anxiety or panic disorder
Key Objectives
Given a patient complaining of dizziness, the candidate will discriminate between vertigo and other causes.
Enabling Objectives
Given a patient with dizziness or vertigo, the candidate will
- list and interpret critical clinical findings, including
- distinguish clinically between amongst vertigo, gait disturbances, orthostatic light-headedness, and other disorders;
- differentiate patients with central versus peripheral causes of vertigo on the basis of history and physical examination;
- list and interpret critical investigations, including
- selection of patients requiring specialized testing;
- construct an effective initial management plan, including
- determine which patients with central vertigo require more urgent management;
- describe the symptomatic management of patients with benign causes of vertigo;
- counsel and educate patients with benign causes of dizziness or vertigo;
- select patients in need of specialized care.