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Neurological Sciences : Official... Mar 2004Dizziness and vertigo are frequent causes of presentation at the emergency room, with an incidence in the Vimercate district, Italy, close to 3.5%. The basic management... (Review)
Review
Dizziness and vertigo are frequent causes of presentation at the emergency room, with an incidence in the Vimercate district, Italy, close to 3.5%. The basic management of the "dizzy" patients in the emergency room includes a detailed history and an accurate physical/neurological examination, with the aim to identify "at risk" patients who require further diagnostic procedures and/or immediate admission to the hospital.
Topics: Clinical Protocols; Diagnosis, Differential; Dizziness; Emergency Service, Hospital; Humans; Italy; Neurologic Examination; Practice Guidelines as Topic; Retrospective Studies; Vertigo
PubMed: 15045616
DOI: 10.1007/s10072-004-0212-9 -
The Medical Clinics of North America Mar 2006Dizziness and vertigo present in patients of all ages. Particularly in older patients, dizziness is associated with a variety of cardiovascular, neurosensory, and... (Review)
Review
Dizziness and vertigo present in patients of all ages. Particularly in older patients, dizziness is associated with a variety of cardiovascular, neurosensory, and psychiatric conditions and with the use of multiple medications. For the patient, the symptoms can be debilitating. In patients older than 60 years, 20% have experienced dizziness severe enough to affect their daily activities. Appropriate diagnosis and treatment can significantly improve quality of life. Most causes of dizziness are benign, but early recognition of serious or life-threatening disease is important. Management of these patients includes referral for neuroimaging and further evaluation in an emergency department.
Topics: Diagnosis, Differential; Dizziness; Humans; Medical History Taking; Office Visits; Physical Examination; Primary Health Care; Referral and Consultation; Vertigo
PubMed: 16448876
DOI: 10.1016/j.mcna.2005.11.003 -
Laryngo- Rhino- Otologie Aug 2014Vertigo and dizziness are symptoms of interdisciplinary dimension. However, the differentiation and classification of vertigo syndromes also require experience and... (Review)
Review
Vertigo and dizziness are symptoms of interdisciplinary dimension. However, the differentiation and classification of vertigo syndromes also require experience and multidisciplinary knowledge. Since the clinical syndrome is subjective, a detailed analysis of the complaints underlying is required. International disease definitions are an indispensable tool in the differential diagnosis of vertigo syndromes today. With simple diagnostic tools eye movement disorders and nystagmus can be examined and assigned to specific vestibular disorders today. Screening tests (e.g. head impulse test) are now an important instrument in the investigation of patients with vertigo syndromes in case of emergency. With objective diagnostic methods (caloric irrigation, video head impulse test, vestibular evoked myogenic potentials) the degree of functional impairment of the five vestibular receptors can be assessed quantitatively. Furthermore, in vestibulopathies, a receptor and side-specific diagnostic assessment can be performed even with regard to dynamic aspects.
Topics: Adult; Age Factors; Aged; Child; Cholesteatoma, Middle Ear; Chronic Disease; Diagnosis, Differential; Dizziness; Fistula; Humans; Labyrinth Diseases; Medical History Taking; Meniere Disease; Vertigo
PubMed: 25073026
DOI: 10.1055/s-0034-1384540 -
Revue Medicale de Liege May 2023Symptoms of vertigo and dizziness may arise from a dysfunction of the vestibular system in the inner ear but many or even most of them don't. The medical interrogatory...
Symptoms of vertigo and dizziness may arise from a dysfunction of the vestibular system in the inner ear but many or even most of them don't. The medical interrogatory is a key step for the diagnosis, combined with functional tests. Around 10 % of patients with vertigo are referred to specialists. They are a lot of psychogenic dizzy symptoms. The importance of a reassuring dialogue with the patient is of prime importance to avoid the development of functional or psychological imbalance.
Topics: Humans; Dizziness; Vertigo
PubMed: 37350202
DOI: No ID Found -
Current Opinion in Otolaryngology &... Jun 2009Dizziness is one of the most common complaints among patients presenting to primary care physicians, neurologists, and otolaryngologists. This symptom is nonspecific and... (Review)
Review
PURPOSE OF REVIEW
Dizziness is one of the most common complaints among patients presenting to primary care physicians, neurologists, and otolaryngologists. This symptom is nonspecific and includes a broad differential diagnosis. The current review aims to present a general overview of the approach to dizziness as well as to discuss the more common causes in detail.
RECENT FINDINGS
The term dizziness encompasses a large spectrum of symptomatology. Understanding how to differentiate between vestibular disorders and other types of dizziness is the key to the evaluation and management of dizzy patients. The distinction between central and peripheral vertigo will be emphasized and the various causes of each type of vertigo will be presented.
SUMMARY
Dizziness is a common medical condition that impacts significantly on patients' activities of daily living. This review outlines the clinical approach to dizziness to facilitate timely diagnosis and management of this complex symptom.
Topics: Adult; Brain Diseases; Cerebrovascular Disorders; Child; Diagnosis, Differential; Dizziness; Humans; Meniere Disease; Migraine Disorders; Multiple Sclerosis; Somatoform Disorders; Vertigo; Vestibular Neuronitis
PubMed: 19365263
DOI: 10.1097/MOO.0b013e32832b2594 -
Brazilian Journal of Otorhinolaryngology 2022"Dizziness" is a common complaint in clinical practice that can occur with anyone. However, since the symptom is caused by a wide range of disorders, a general clinician...
INTRODUCTION
"Dizziness" is a common complaint in clinical practice that can occur with anyone. However, since the symptom is caused by a wide range of disorders, a general clinician usually faces some difficulty to detect the cause.
OBJECTIVE
This study aimed to formulate and validate a simple instrument that can be used to screen and predict the most likely cause of dizziness in Thai outpatients.
METHODS
This study was divided into two phases. Phase I included 41 patients diagnosed with common causes of dizziness to determine the algorithm and construct the "structural algorithm questionnaire version 1". In addition, to test and retest its content validity and reliability until the instrument had an acceptable level of both. Phase II of the study pertained to evaluating its accuracy in clinical trials, 150 patients with dizziness had a face-to-face interview while they were waiting for their medical appointment.
RESULTS
The degree of agreement between the algorithm results and clinical diagnoses was within an acceptable level (κ = 0.69). Therefore, this algorithm was used to construct the structural algorithm questionnaire version 1. The content validity of the structural algorithm questionnaire version 1 evaluated by seven experts. The content validity index values of the questionnaire ranged from 0.71 to 1.0. The Cohen's kappa coefficient (κ) of intra-rater reliability of the structural algorithm questionnaire version 1 was 0.71. In clinical trials, 150 patients with dizziness had a face-to-face interview while they were waiting for their appointment. The overall agreement between their questionnaire responses and final diagnoses by specialists showed a moderate degree of clinical accuracy (κ = 0.55).
CONCLUSIONS
The structural algorithm questionnaire version 1 had a well-developed design and acceptable quality pertaining to both validity and reliability. It might be used to differentiate the cause of dizziness between vestibular and non-vestibular disorders, especially of outpatients with dizziness symptoms.
Topics: Dizziness; Humans; Outpatients; Reproducibility of Results; Surveys and Questionnaires; Thailand; Vertigo
PubMed: 34092523
DOI: 10.1016/j.bjorl.2021.05.007 -
The Laryngoscope Dec 2017
Review
Topics: Adult; Dizziness; Female; Head Impulse Test; Humans; Male; Middle Aged; Practice Guidelines as Topic; Reflex, Vestibulo-Ocular; Vertigo; Video Recording
PubMed: 28699192
DOI: 10.1002/lary.26774 -
Academic Emergency Medicine : Official... May 2023Patients presenting to the emergency department (ED) with acute vertigo or dizziness represent a diagnostic challenge. Neuroimaging has variable indications and yield.... (Meta-Analysis)
Meta-Analysis Review
Diagnostic accuracy of neuroimaging in emergency department patients with acute vertigo or dizziness: A systematic review and meta-analysis for the guidelines for reasonable and appropriate care in the emergency department.
BACKGROUND
Patients presenting to the emergency department (ED) with acute vertigo or dizziness represent a diagnostic challenge. Neuroimaging has variable indications and yield. We aimed to conduct a systematic review and meta-analysis of the diagnostic test accuracy of neuroimaging for patients presenting with acute vertigo or dizziness.
METHODS
An electronic search was designed following patient-intervention-control-outcome (PICO) question-(P) adult patients with acute vertigo or dizziness presenting to the ED; (I) neuroimaging including computed tomography (CT), CT angiography (CTA), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and ultrasound (US); (C) MRI/clinical criterion standard; and (O) central causes (stroke, hemorrhage, tumor, others) versus peripheral causes of symptoms. Articles were assessed in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess certainty of evidence in pooled estimates.
RESULTS
We included studies that reported diagnostic test accuracy. From 6309 titles, 460 articles were retrieved, and 12 were included: noncontrast CT scan-six studies, 771 patients, pooled sensitivity 28.5% (95% confidence interval [CI] 14.4%-48.5%, moderate certainty) and specificity 98.9% (95% CI 93.4%-99.8%, moderate certainty); MRI-five studies, 943 patients, sensitivity 79.8% (95% CI 71.4%-86.2%, high certainty) and specificity 98.8% (95% CI 96.2%-100%, high certainty); CTA-one study, 153 patients, sensitivity 14.3% (95% CI 1.8%-42.8%) and specificity 97.7% (95% CI 93.8%-99.6%), CT had higher sensitivity than CTA (21.4% and 14.3%) for central etiology; MRA-one study, 24 patients, sensitivity 60.0% (95% CI 26.2%-87.8%) and specificity 92.9% (95% CI 66.1%-99.8%); US-three studies, 258 patients, sensitivity ranged from 30% to 53.6%, specificity from 94.9% to 100%.
CONCLUSIONS
Noncontrast CT has very low sensitivity and MRI will miss approximately one in five patients with stroke if imaging is obtained early after symptom onset. The evidence does not support neuroimaging as the only tool for ruling out stroke and other central causes in patients with acute dizziness or vertigo presenting to the ED.
Topics: Adult; Humans; Dizziness; Vertigo; Neuroimaging; Stroke; Emergency Service, Hospital; Sensitivity and Specificity
PubMed: 35876220
DOI: 10.1111/acem.14561 -
Physiotherapy Research International :... Oct 2021Associations between dizziness, health-related quality of life, and musculoskeletal pain have not been systematically explored in patients with vestibular disorders....
BACKGROUND AND PURPOSE
Associations between dizziness, health-related quality of life, and musculoskeletal pain have not been systematically explored in patients with vestibular disorders. Such knowledge may be important for choice of treatments. The study objectives were to examine the extent and localization of musculoskeletal pain and explore whether pain was associated with dizziness and health-related quality of life.
METHODS
The cross-sectional study investigated anonymized data from an earlier survey on patients with long-lasting dizziness (>3 months) examined in an oto-rhino-laryngological department. The sample includes patient between 18 and 70 years with Ménière's disease, vestibular schwannoma, benign positional paroxysmal vertigo, vestibular neuritis, non-otogenic dizziness, and cervicogenic dizziness. General musculoskeletal, that is, pain in muscles, tendons, and joints was registered by a yes/no question. A pain drawing registered localization of pain. Multiple binary logistic regression models were used to determine the association between pain and vertigo-balance and autonomic-anxiety related dizziness by the short Vertigo Symptom Scale (VSS) and sub-scales (VSS-V, VSS-A), and between pain and health-related quality of life by the SF-36, mental and physical component summary scale (SF-36 MCS, SF-36 PCS).
RESULTS
The sample consisted of 503 patients, 60.2% were women, the median age was 50 years. General musculoskeletal pain was reported by 72.8% of patients, neck pain by 59.2% and widespread pain by 21.9%. Multiple binary logistic regression models demonstrated that all the pain measures were significantly associated with VSS-V and VSS-A and SF-36 PCS, but not SF-36 MCS.
DISCUSSIONS
Musculoskeletal pain is prevalent in patients with long-lasting dizziness. The strong associations between pain, VSS, and SF-36 PCS could result in a self-sustaining complex condition. The findings imply that in addition to assessing and treating the vestibular symptoms, musculoskeletal symptoms and physical health should be addressed.
Topics: Cross-Sectional Studies; Dizziness; Female; Humans; Middle Aged; Neck Pain; Quality of Life; Vertigo
PubMed: 34585499
DOI: 10.1002/pri.1923 -
Journal of General Internal Medicine Dec 2008To assess how frequently cardiovascular dizziness is vertigo. Recent studies suggest providers do not consider cardiovascular causes when a patient reports true vertigo... (Review)
Review
OBJECTIVES
To assess how frequently cardiovascular dizziness is vertigo. Recent studies suggest providers do not consider cardiovascular causes when a patient reports true vertigo (spinning/motion) as opposed to presyncope (impending faint). It is known that cardiovascular disease causes dizziness, but unknown how often such dizziness is vertiginous, as opposed to presyncopal.
DATA SOURCES
Systematic review of observational studies was made: Search--electronic (MEDLINE, EMBASE) and manual (references of eligible articles) search for English-language studies (1972-2007).
REVIEW METHODS
Inclusions Studies of >or=5 patients with confirmed cardiovascular causes for dizziness and reporting a proportion with vertigo were included. Two independent reviewers selected studies for inclusion, with differences adjudicated by a third. Study characteristics and dizziness-type proportions were abstracted. Studies were rated on methodology and quality of dizziness definitions. Differences were resolved by consensus.
RESULTS
We identified 1,506 citations, examined 125 full manuscripts, and included 5 studies. Principal reasons for exclusion were: abstracts--lack of original data, no cardiovascular diagnosis, or confounding exposure/disease (74%); manuscripts--failure to distinguish vertigo from other dizziness types (78%). In the three studies not using vertigo as an entry criterion (representing 1,659 patients with myocardial infarction, orthostatic hypotension, or syncope), vertigo was present in 63% (95% CI 57-69%) of cardiovascular patients with dizziness and the only dizziness type in 37% (95% CI 31-43%). Limitations include modest study quality and non-uniform definitions for vertigo.
CONCLUSIONS
Published data suggest that dizziness from primary cardiovascular disease may often be vertigo. Future research should assess prospectively whether dizziness type is a meaningful predictor for or against a cardiovascular diagnosis.
Topics: Cardiovascular Diseases; Dizziness; Humans; Vertigo
PubMed: 18843523
DOI: 10.1007/s11606-008-0801-z