Dizziness and Vertigo

Dizziness is an extremely common yet complex neurologic symptom that reflects a disturbance of normal balance perception and spatial orientation. An estimated 7.5 million patients with dizziness are seen each year in ambulatory care settings. Dizziness is also one of the most common principal complaints in the emergency department (ED) and is responsible for 2.5% of all ED visits. Among patients older than 60 years, 20% have experienced dizziness severe enough to affect their daily activity. “Dizziness” is an imprecise descriptor. Patients use the term to describe a variety of experiences, including sensations of motion, weakness, lightheadedness, unsteadiness, and depression. Even clinical experts do not uniformly agree to precise definitions, with some defining it broadly and others more narrowly. Dizziness is historically categorized into one of four categories based on symptom quality: vertigo (illusion of motion, often spinning), near syncope (feeling of impending faint), disequilibrium (loss of equilibrium when walking), and nonspecific dizziness. Dizziness can be caused by a myriad diseases. In older persons it is associated with a variety of cardiovascular, neurosensory, and psychiatric conditions and with the use of multiple medications. The challenge for the emergency physician is to sift out the rare patient with a dangerous underlying disorder from the many others who have benign causes.