![]() Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Newman-Toker DE, Cannon LM, Stofferahn ME, Rothman RE, Hsieh YH, Zee DS. TiTrATE: a novel, evidence-based approach to diagnosing acute dizziness and vertigo. Urinary and gastrointestinal antispasmodicsīleeding complications (anticoagulants), bone marrow suppression (antithyroid agents)ĥ to 10 mg orally every 6 hours, or 5 to 10 mg slowly IV every 6 hoursĪkathesia, atrioventricular block, bradycardia, bronchospasm, dizziness, drowsiness, dystonic reaction, gynecomastia, nausea, tardive dyskinesiaĥ to 10 mg orally or IM every 6 to 8 hoursĪgitation, dizziness, drowsiness, dystonic reaction, extrapyramidal symptoms, photosensitivity, tardive dyskinesiaĪnorexia, blurred vision, dizziness, drowsiness, nauseaīlurred vision, drowsiness, fatigue, headache, vomitingĢ5 mg every 6 hours orally, IM, or rectally every 4 to 12 hoursĪgitation, bradycardia, confusion, constipation, drowsiness, dizziness, dystonia, extrapyramidal symptoms, gynecomastia, photosensitivity, urinary retentionĢ to 10 mg orally or IV every 4 to 8 hoursĪmnesia, drowsiness, slurred speech, vertigoĪmnesia, dizziness, drowsiness, slurred speech, vertigo Sodium–glucose cotransporter-2 inhibitorsĬardiac effects: hypotension, postural hypotension, torsades de pointes, other arrhythmias Initially episodic, then often continuous episodes of dizziness without another cause and associated with psychiatric condition (e.g., anxiety, depression, bipolar disorder)Ĭontinuous episodes of dizziness without another cause and associated with a possible medication adverse effectĪcute episodic symptoms that are not associated with any triggersĪcute episodic symptoms associated with a change in position from supine or sitting to standingĪnti-infectives: anti-influenza agents, antifungals, quinolonesĪttention-deficit/hyperactivity disorder agents Spontaneous episodes of vertigo associated with migraine headachesĬontinuous spontaneous episodes of vertigo caused by arterial occlusion or insufficiency, especially affecting the vertebrobasilar systemĬerebellopontine angle and posterior fossa meningiomasĬontinuous spontaneous episodes of dizziness caused by vestibular schwannoma (i.e., acoustic neuroma), infratentorial ependymoma, brainstem glioma, medulloblastoma, or neurofibromatosis Spontaneous episodes of vertigo caused by abnormal bone growth in the middle ear and associated with conductive hearing loss Spontaneous episodes of vertigo associated with unilateral hearing loss caused by excess endolymphatic fluid pressure in the inner ear Spontaneous episodes of vertigo caused by inflammation of the vestibular nerve or labyrinthine organs, usually from a viral infection Transient triggered episodes of vertigo caused by dislodged canaliths in the semicircular canals Symptoms of vestibular neuritis are relieved with vestibular suppressant medications and vestibular rehabilitation. ![]() Treatment of Meniere disease includes salt restriction and diuretics. Benign paroxysmal positional vertigo can be treated with a canalith repositioning procedure (e.g., Epley maneuver). Laboratory testing and imaging are not required and are usually not helpful. The physical examination includes orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver. The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies. Central etiologies often require urgent treatment. ![]() Peripheral etiologies are usually benign. ![]() Evaluation focuses on determining whether the etiology is peripheral or central. Episodic vertigo not associated with any trigger may be a symptom of vestibular neuritis. Vertigo with unilateral hearing loss suggests Meniere disease. Episodic vertigo triggered by head motion may be due to benign paroxysmal positional vertigo. Patients have difficulty describing the quality of their symptoms but can more consistently identify the timing and triggers. However, the distinction between these symptoms is of limited clinical usefulness. It was traditionally divided into four categories based on the patient's history: vertigo, presyncope, disequilibrium, and light-headedness. Dizziness is a common yet imprecise symptom. ![]()
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