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{{Dizziness}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{MUT}}; {{VR}}
{{CMG}} {{AE}}{{Debduti}}{{FB}}{{SI}}{{Norina Usman}}
==Overview==
Dizziness is a symptom rather than a condition on its own. It is a complex and subjective complaint that encompasses a wide spectrum of symptomatology. It is a sensation of postural unsteadiness or deceptive motion. It is one of the most communal presenting complaints that accounts for 5% of primary care practice for individuals aged 65 or older. Dizziness is a nonspecific term mainly used by many people and is classified into different categories: vertigo, spinning, disequilibrium, giddiness, presyncope, faintness, lightheadedness, or feeling woozy. It is one of the most common presenting symptom among patients seen by emergency medical physicians, primary care physicians, neurologists, and otolaryngologists.
 
==Historical Perspective==
 
==Classification==
Dizziness may be classified based on the symptoms of the patient into 4 main subtypes including [[vertigo]], [[presyncope]], [[BPPV], and [[disequilibrium]].


==Overview==
==Pathophysiology==
Dizziness is a common but vague symptom.  A wide variety of symptoms are often referred to as dizziness.
It is understood that pathophysiology of dizziness depends on the etiological subtype including orthostatic hypotension, benign paroxysmal positional vertigo, Menier's disease, Parkinson's disease, hyperventilation syndrome, peripheral neuropathy, and vestibular migraine.


==Causes==
==Causes==
Dizziness is the most common nonpain symptom following fatigue in clinic and community populations<ref name="Kroenke-1990">{{Cite journal  | last1 = Kroenke | first1 = K. | last2 = Arrington | first2 = ME. | last3 = Mangelsdorff | first3 = AD. | title = The prevalence of symptoms in medical outpatients and the adequacy of therapy. | journal = Arch Intern Med | volume = 150 | issue = 8 | pages = 1685-9 | month = Aug | year = 1990 | doi = | PMID = 2383163 }}</ref>. It is also one of the most common complaints in ambulatory care, accounting for nearly 8 million outpatient visits annually in the United States<ref name="Sloane-">{{Cite journal  | last1 = Sloane | first1 = PD. | last2 = Dallara | first2 = J. | last3 = Roach | first3 = C. | last4 = Bailey | first4 = KE. | last5 = Mitchell | first5 = M. | last6 = McNutt | first6 = R. | title = Management of dizziness in primary care. | journal = J Am Board Fam Pract | volume = 7 | issue = 1 | pages = 1-8 | month = | year = | doi = | PMID = 8135132 }}</ref>. Being a vague term, it includes several causes from various sensations like [[vertigo]], [[presyncope]], [[disequilibrium]] and [[psychogenic dizziness]].
Dizziness may be caused by hypotension, dehydration, arrhythmia, labyrinthitis, Meniere's disease, stroke, or hypoglycemia. Other causes are based on the organ system such as cardiovascular, neurological, musculoskeletal, dermatological, endocrine, infectious, pulmonological or side effects of the medicine.
 
==Differentiating dizziness from other diseases==
Dizziness must be differentiated from other [[Disease|diseases]] that cause [[vertigo]], [[nystagmus]], and [[Hearing impairment|hearing problems]], such as [[Vestibular neuronitis|vestibular neuritis]], [[Herpes simplex virus|HSV]] oticus, [[Ménière's disease|Meniere disease]], labyrinrhine [[concussion]], [[Perilymph fistula|perilymphatic fistula]], [[semicircular canal]] dehiscence syndrome, [[Vestibular system|vestibular]] paroxysmia, [[Cogan syndrome]], [[vestibular schwannoma]], [[otitis media]], [[aminoglycoside]] toxicity, recurrent vestibulopathy, vestibular [[migraine]], [[epileptic]] [[vertigo]], [[multiple sclerosis]], [[Brain tumor|brain tumors]], [[cerebellar infarction]]/[[hemorrhage]], [[brain stem]] [[ischemia]], [[Arnold-Chiari malformation|chiari malformation], [[presyncope]] and [[disequilibrium]].
 
==Epidemiology and Demographics==
Dizziness is one of the most common complaints in ambulatory care, accounting for nearly 8 million outpatient visits annually in the United States. The incidence of dizziness is approximately 50–100 million worldwide, and around 4.3 million patients in the United States. The lifetime prevalence of dizziness is expected to be 30%. Idiopathic dizziness commonly affects individuals 25 years and older in an emergency department.
 
==Risk factors==
Common risk factors in the development of dizziness include family history of thromboembolic factors (diabetes, hypertension, high cholesterol, and rheumatic disease), cardiac arrhythmias, stroke, medication side effect (diuretics, antiepileptic drugs, opioid-based analgesics, antipsychotic drugs, antidepressants, antihypertensive, antifungal, lithium, benzodiazepines, antiarrhythmic, antimalarial and anti-HIV-drugs). Multiple sclerosis, seizures, brain tumors, benign positional vertigo, and labyrinthitis.
 
 
==Screening==
 
==Natural history, complications and prognosis==
If left untreated, patients may experience spontaneous recovery. Common complications of dizziness include nausea, vomiting, fainting, fall, imbalance and hearing loss, and neurological complications following Dix Hallpike or Epley maneuvers. Prognosis is generally good, and the 10-year mortality rate of patients with dizziness is low approximately (hazard ratio [HR] = 0.62; 95% CI, 0.40-0.96)
 
==Diagnosis==
===Diagnostic Study of Choice===
 
===History and Symptoms===
 
===Physical Examination===
 
===Laboratory Findings===
 
===Electrocardiogram===
 
===X-ray===
 
===Echocardiography and Ultrasound===


==Natural History, Complications and Prognosis==
===CT scan===
Most causes of dizziness are not serious and either quickly get better on their own or are easily treated.
 
===MRI===
 
===Other Imaging Findings===
 
===Other Diagnostic Studies===


==Treatment==
==Treatment==
===Medical Therapy===
=== Interventions ===
===Surgery===


===Primary Prevention===
===Primary Prevention===
Promptly treat [[ear infections]], [[colds]], [[flu]], [[sinus]] [[congestion]], and other [[respiratory infections]]. This may help prevent [[labyrinthitis]] and [[Meniere's disease]]. If you have a [[cold]], the [[flu]], or other [[viral]] [[illness]], drink plenty of fluids to prevent getting [[dehydrated]].
 
===Secondary Prevention===


== References ==
== References ==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Otolaryngology]]
[[Category:Otolaryngology]]
[[Category:Symptoms]]
[[Category:Signs and symptoms]]
[[Category:Primary care]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Needs overview]]
{{WH}}
{{WS}}

Latest revision as of 18:13, 24 April 2021

Dizziness Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Dizziness from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Debduti Mukhopadhyay, M.B.B.S[2]Fatimo Biobaku M.B.B.S [3]

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Norina Usman, M.B.B.S[4]

Overview

Dizziness is a symptom rather than a condition on its own. It is a complex and subjective complaint that encompasses a wide spectrum of symptomatology. It is a sensation of postural unsteadiness or deceptive motion. It is one of the most communal presenting complaints that accounts for 5% of primary care practice for individuals aged 65 or older. Dizziness is a nonspecific term mainly used by many people and is classified into different categories: vertigo, spinning, disequilibrium, giddiness, presyncope, faintness, lightheadedness, or feeling woozy. It is one of the most common presenting symptom among patients seen by emergency medical physicians, primary care physicians, neurologists, and otolaryngologists.

Historical Perspective

Classification

Dizziness may be classified based on the symptoms of the patient into 4 main subtypes including vertigo, presyncope, [[BPPV], and disequilibrium.

Pathophysiology

It is understood that pathophysiology of dizziness depends on the etiological subtype including orthostatic hypotension, benign paroxysmal positional vertigo, Menier's disease, Parkinson's disease, hyperventilation syndrome, peripheral neuropathy, and vestibular migraine.

Causes

Dizziness may be caused by hypotension, dehydration, arrhythmia, labyrinthitis, Meniere's disease, stroke, or hypoglycemia. Other causes are based on the organ system such as cardiovascular, neurological, musculoskeletal, dermatological, endocrine, infectious, pulmonological or side effects of the medicine.

Differentiating dizziness from other diseases

Dizziness must be differentiated from other diseases that cause vertigo, nystagmus, and hearing problems, such as vestibular neuritis, HSV oticus, Meniere disease, labyrinrhine concussion, perilymphatic fistula, semicircular canal dehiscence syndrome, vestibular paroxysmia, Cogan syndrome, vestibular schwannoma, otitis media, aminoglycoside toxicity, recurrent vestibulopathy, vestibular migraine, epileptic vertigo, multiple sclerosis, brain tumors, cerebellar infarction/hemorrhage, brain stem ischemia, [[Arnold-Chiari malformation|chiari malformation], presyncope and disequilibrium.

Epidemiology and Demographics

Dizziness is one of the most common complaints in ambulatory care, accounting for nearly 8 million outpatient visits annually in the United States. The incidence of dizziness is approximately 50–100 million worldwide, and around 4.3 million patients in the United States. The lifetime prevalence of dizziness is expected to be 30%. Idiopathic dizziness commonly affects individuals 25 years and older in an emergency department.

Risk factors

Common risk factors in the development of dizziness include family history of thromboembolic factors (diabetes, hypertension, high cholesterol, and rheumatic disease), cardiac arrhythmias, stroke, medication side effect (diuretics, antiepileptic drugs, opioid-based analgesics, antipsychotic drugs, antidepressants, antihypertensive, antifungal, lithium, benzodiazepines, antiarrhythmic, antimalarial and anti-HIV-drugs). Multiple sclerosis, seizures, brain tumors, benign positional vertigo, and labyrinthitis.


Screening

Natural history, complications and prognosis

If left untreated, patients may experience spontaneous recovery. Common complications of dizziness include nausea, vomiting, fainting, fall, imbalance and hearing loss, and neurological complications following Dix Hallpike or Epley maneuvers. Prognosis is generally good, and the 10-year mortality rate of patients with dizziness is low approximately (hazard ratio [HR] = 0.62; 95% CI, 0.40-0.96)

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

References

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