Rationale

Dizziness is a common, but imprecise complaint. Physicians need to determine whether it refers to vertigo, which may be a symptom of significant intracranial disease, or a non-specific symptom that could be related to non-vestibular causes.

Causal Conditions

(list not exhaustive)

1. Vertigo

   1. Peripheral vestibular dysfunction

      • Benign positional vertigo

      • Peripheral vestibulopathy

      • Ménière’s disease

      • Drugs (e.g., aminoglycosides)

      • Acoustic neuroma

2. Central vestibular dysfunction

   1. Cerebrovascular

   2. Multiple sclerosis

   3. Drugs (e.g., anticonvulsants, hypnotics, alcohol)

3. Other dizziness

   1. Hyperventilation

   2. Disequilibrium (e.g., poor mobility, peripheral neuropathy)

   3. Presyncope

   4. Anxiety or panic disorder

Key Objectives

Given a patient complaining of dizziness, the candidate will discriminate between vertigo and other causes.

Enabling Objectives

Given a patient with dizziness or vertigo, the candidate will

1. list and interpret critical clinical findings, including

   1. distinguish clinically between amongst vertigo, gait disturbances, orthostatic light-headedness, and other disorders;

   2. differentiate patients with central versus peripheral causes of vertigo on the basis of history and physical examination;

2. list and interpret critical investigations, including

   1. selection of patients requiring specialized testing;

3. construct an effective initial management plan, including

   1. determine which patients with central vertigo require more urgent management;

   2. describe the symptomatic management of patients with benign causes of vertigo;

   3. counsel and educate patients with benign causes of dizziness or vertigo;

   4. select patients in need of specialized care.