Dizziness accounts for an estimated 5 percent of primary care
clinic visits. The patient history can generally classify
dizziness into one of four categories:
vertigo, disequilibrium,
presyncope, or
lightheadedness. The main causes of
vertigo are
benign paroxysmal positional vertigo,
Meniere disease,
vestibular neuritis, and
labyrinthitis. Many medications can cause
presyncope, and regimens should be assessed in patients with this type of
dizziness.
Parkinson disease and
diabetic neuropathy should be considered with the diagnosis of disequilibrium.
Psychiatric disorders, such as depression, anxiety, and
hyperventilation syndrome, can cause vague
lightheadedness. The differential diagnosis of
dizziness can be narrowed with easy-to-perform physical examination tests, including evaluation for nystagmus, the Dix-Hallpike maneuver, and orthostatic blood pressure testing. Laboratory testing and radiography play little role in diagnosis. A final diagnosis is not obtained in about 20 percent of cases. Treatment of
vertigo includes the Epley maneuver (canalith repositioning) and vestibular rehabilitation for
benign paroxysmal positional vertigo, intratympanic
dexamethasone or
gentamicin for
Meniere disease, and
steroids for
vestibular neuritis.
Orthostatic hypotension that causes
presyncope can be treated with alpha agonists,
mineralocorticoids, or lifestyle changes. Disequilibrium and
lightheadedness can be alleviated by treating the underlying cause.