Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care

K. Kroenke, C. A. Lucas, M. L. Rosenberg, B. Scherokman, J. E. Herbers, P. A. Wehrle, J. O. Boggi

Research output: Contribution to journalArticle

215 Scopus citations

Abstract

Objective: To determine the causes of persistent dizziness in outpatients. Design: Consecutive adult outpatients presenting with a chief complaint of dizziness. Setting: Four clinics (internal medicine, walk-in, emergency room, and neurology) in a teaching hospital. Patients: Of 185 patients presenting during the 10-month study period, 51 (28%) had minimal or no dizziness at 2- week follow-up. Of the remaining 134 patients, 100 completed the study protocol (mean age, 62 years; range, 20 to 85 years). Measurements: Evaluation included a detailed study questionnaire, standardized physical examination, vestibular testing by a neuro-ophthalmologist, laboratory tests, audiometry, and a structured psychiatric interview. Data were abstracted onto a standard form and reviewed by three raters. Raters independently assigned diagnoses using explicit criteria, with the final cause determined by consensus. Results: Primary causes of dizziness included vestibular disorders (54 patients), psychiatric disorders (16 patients), presyncope (6 patients), dysequilibrium (2 patients), and hyperventilation (1 patient); dizziness was multicausal in 13 patients and of unknown cause in 8 patients. Many of those with a single primary cause, however, had at least one other condition contributing to their dizziness; only 52% of patients had a single 'pure' cause. Thirty patients had a potentially treatable primary cause, the most common being benign positional vertigo (BPV) (16%) and psychiatric disorders (6%). Central vestibulopathies detected in 10 patients were presumably vascular or idiopathic in origin. No brain tumors or cardiac arrhythmias were found. Conclusions: Vestibular disease and psychiatric disorders are the most common causes of persistent dizziness in outpatients. In about 50% of patients with dizziness, more than one factor causes or aggravates symptoms. Life-threatening causes were rare, even in our elderly population.

Original languageEnglish (US)
Pages (from-to)898-904
Number of pages7
JournalAnnals of internal medicine
Volume117
Issue number11
DOIs
StatePublished - Jan 1 1992
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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    Kroenke, K., Lucas, C. A., Rosenberg, M. L., Scherokman, B., Herbers, J. E., Wehrle, P. A., & Boggi, J. O. (1992). Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care. Annals of internal medicine, 117(11), 898-904. https://doi.org/10.7326/0003-4819-117-11-898