UMEM Educational Pearls

Category: Neurology

Title: What Do You Mean By Dizzy?

Keywords: dizzy, dizzinesss, acute vestibular syndrome, triggered episodic vestibular syndrome, spontaneous episodic vestibular syndrome, HINTS, Dix-Hallpike (PubMed Search)

Posted: 4/13/2016 by WanTsu Wendy Chang
Click here to contact WanTsu Wendy Chang

What Do You Mean By Dizzy?

Patients with dizziness account for 3% of ED visits.
The traditional approach based on symptom quality (i.e. “What do you mean by dizzy”) is not reliable.
Drs. Edlow and Newman-Toker propose a new paradigm based on the timing and triggers of dizziness.

Acute vestibular syndrome begins abruptly or rapidly and continues for days. Patients’ dizziness may be exacerbated by movement but is not triggered by movement.
Triggered episodic vestibular syndrome are repetitive episodes of dizziness triggered by some event. Patients will be completed asymptomatic at rest and will develop dizziness that is reliably triggered by a specific event or postural shift.
Spontaneous episodic vestibular syndrome are multiple episodes of dizziness that occur without any clear identifiable trigger. Patients are asymptomatic between episodes.

Table 1 shows common benign and serious causes of these vestibular syndromes.

Utilizing the HINTS battery or the Dix-Hallpike maneuver, a “safe to go” algorithm for acute vestibular syndrome and triggered episodic vestibular syndrome is outlined in Figure 2.

References

Edlow JA, Newman-Toker D. Using the physical examination to diagnose patients with acute dizziness and vertigo. J Emerg Med. 2016;50(4):617-28.
Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504-10.

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Attachments

1604132308_20160413_Table_1.jpg (139 Kb)

1604132309_20160413_Figure_2.jpg (89 Kb)