“Does it feel like either the room is spinning or that you are spinning?” and/or “Is it triggered or worsened by turning your head or rolling over in bed?”

• Yes = vertigo

  • BENIGN PAROXYSMAL POSITIONAL VERTIGO (most common)

    • brief, recurrent episodes (seconds to minutes), +/- nausea and vomiting

  • Vestibular Neuritis

    • rapid onset, severe, persistent (days), N/V, imbalance

  • Ménière’s Disease

    • recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness

  • Vestibular Toxicity

    • aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin

• No = other forms of dizziness

  • Presyncopal Dizziness – “feels like nearly fainting or blacking out”

    • ECG

    • Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice)

      • If yes to any, suspect cardiac etiology. Refer to Emergency

      • If no, orthostatic hypotension?

        • Yes = investigate underlying cause. meds/alcohol? Consider CBC/lytes

        • No = likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo)

  • Disequilibrium Dizziness – “unsteadiness while walking”

    • Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, etc

  • Nonspecific Dizziness – “woozy”, “giddy”, “light-headed”

    • DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, alcohol/drugs, menstruation, previous head trauma

Ask about: onset, duration, nausea, vomiting, hearing loss, tinnitus, headache, imbalance, aural fullness, ear pain, rash, facial paralysis, medications