Evaluating dizziness

Richard M. Hoffman, Douglas Einstadter, Kurt Kroenke

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Purpose: To conduct a structured literature synthesis on the etiology, prognosis, and diagnostic evaluation of dizziness, and to suggest a primary- care approach to evaluating this symptom. Methods: Studies were identified from MEDLINE searches (1966 through 1996) and a manual search of bibliographies from retrieved articles. Two investigators independently abstracted study data. Results: The most common etiologies for dizziness were peripheral vestibulopathies (35% to 55% of patients) and psychiatric disorders (10% to 25% of patients). Cerebrovascular disease (5%) and brain tumors (< 1%) were infrequent. The history and physical examination led to a diagnosis in about 75% of patients. At least 10% of patients eluded diagnosis. Symptoms were usually self-limited and not associated with an increased risk of mortality. The diagnostic testing literature, which was often methodologically flawed, suggested that routine laboratory tests as well as cardiovascular and neurologic testing had a low yield in unselected patients. We could not derive evidence-based guidelines for using specialized vestibular function tests such as electronystagmography. Conclusions: Dizziness is usually a benign, self-limited complaint. When a diagnosis can be made, a careful history and physical examination will usually identify the probable cause. Cardiovascular, neurologic, and laboratory testing should be guided by the clinical evaluation. Rigorous studies are needed to determine the accuracy and utility of specialized vestibular testing.

Original languageEnglish
Pages (from-to)468-478
Number of pages11
JournalThe American Journal of Medicine
Volume107
Issue number5
DOIs
StatePublished - Nov 1999

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Dizziness
Nervous System
Physical Examination
Vestibular Function Tests
History
Electronystagmography
Cerebrovascular Disorders
Bibliography
MEDLINE
Brain Neoplasms
Psychiatry
Primary Health Care
Research Personnel
Guidelines
Mortality

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Evaluating dizziness. / Hoffman, Richard M.; Einstadter, Douglas; Kroenke, Kurt.

In: The American Journal of Medicine, Vol. 107, No. 5, 11.1999, p. 468-478.

Research output: Contribution to journalArticle

Hoffman, Richard M. ; Einstadter, Douglas ; Kroenke, Kurt. / Evaluating dizziness. In: The American Journal of Medicine. 1999 ; Vol. 107, No. 5. pp. 468-478.
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