the dizzy patient (dizziness)

see also:

• postural hypotension (orthostatic hypotension)
• ED Mx of vertigo and BPV

• the symptom of dizziness is a very common cause of presentation to the ED in adults
• the clinician must make every effort to distinguish between the two main groups of causes of dizziness:
  • lightheadedness
    • this highly suggests persistent or transient hypotension as a cause and requires a very different clinical assessment and workup to the alternate cause of vertigo
    • it is usually improved by lying down and head movements generally do not make it worse and pathologic nystagmus is absent (unless it is chronic)
    • see postural hypotension (orthostatic hypotension), the shocked patient and syncope / near syncope
  • vertigo
    • this is very different to lightheadedness and has a very different and wide range of aetiologies
    • this will be suggested by a clear history of the room spinning on moving the head and supported by the presence of pathologic nystagmus when symptomatic
    • see ED Mx of vertigo and BPV
    • a potential confusion is “systemic vertigo” where symptoms of vertigo occur due to systemic issues such as:
      • hypotension
      • hypoglycaemia
      • etc