Context and Definition
Patients frequently present to the emergency department (ED) complaining of dizziness. This term is used by patients to refer to a range of different symptoms and also includes patients with vertigo.
Classification
| Vertigo | An illusion of motion of either the subject or the environment |
| Presyncope | A feeling of impending faint or loss of consciousness |
| Disequilibrium | Impaired balance and gait in the absence of abnormal head sensation (dizziness of the feet!) |
| Light-headedness | A non-specific description of symptoms that cannot be identified as one of the above types |
Detailed history is essential to differentiate vertigo from other non-rotatory dizziness. For example, lightheadedness triggered by postural change, but not head positional change, may have orthostatic hypotension.1,2
A 2018 systematic review suggested that around 44% of patients presenting with dizziness in primary care have peripheral vertigo,3 and another review suggested the lifetime incidence of vertigo may be as high as 10%.4
Whilst vertigo often has a benign or self-limiting cause, prospective studies reported dizziness as a presenting symptom in 47% to 75% of patients with posterior circulation strokes.5,6 Therefore, distinguishing between the benign and serious causes of vertigo is essential. This requires an understanding of the features of these aetiologies, careful clinical assessment and appropriate investigations.
Definition
Vertigo is a false perception of movement. This may be the feeling that the external world is moving around the individual (objective vertigo) or the feeling that the individual themselves is moving (subjective vertigo).