Context and Definition
Patients frequently present to the emergency department (ED) complaining of dizziness. This term is used by patients to refer to a range of different symptoms and also includes patients with vertigo.
Classification
| Vertigo | An illusion of motion of either the subject or the environment |
| Presyncope | A feeling of impending faint or loss of consciousness |
| Disequilibrium | Impaired balance and gait in the absence of abnormal head sensation (dizziness of the feet!) |
| Light-headedness | A non-specific description of symptoms that cannot be identified as one of the above types |
Of these four types, vertigo accounts for approximately 30% of dizzy patients in primary care(1). Recent prospective studies using a large database reported dizziness as a presenting symptom in 47% to 75% of patients with posterior circulation strokes (2, 3).
This module considers vertigo, but it must be established as the presenting complaint and the other types of ‘dizziness’ excluded.
Distinguishing between the benign and serious causes of vertigo is essential. This requires an understanding of the features of these aetiologies, careful clinical assessment and appropriate investigations.
Furthermore, identification of the cause of vertigo enables the application of effective, evidence-based treatments, appropriate referral and follow up.
Definition
Vertigo is a false perception, experienced by the patient, of rotation or movement of the external world (objective vertigo) or of the individual in space (subjective vertigo).