Last week, I reviewed a recent study from the journal Frontiers in Neurology demonstrating that nearly all (about 90%) of patients with complaints of dizziness or vertigo seen at a specialty vestibular clinic receive a firm diagnosis. This is much higher than any other diagnostic approach.
This week, let’s take a look at some of the specific diagnosis, and some of the conclusions put forth by the study authors. They report that BPPV, Vestibular Migraine, and multi-sensory dizziness are grossly under-diagnosed at the primary care level. They also point out that these three conditions have effective treatments once the diagnosis is made.
Benign Paroxysmal Positional Vertigo (BPPV)
The most under-diagnosed condition was BPPV. They found that 25% of patients referred had BPPV, when only 12 to 13% had received a preliminary diagnosis of BPPV. In essence, confirmed BPPV was twice as common as the PCP suspected.
[Editor’s note: The criteria for establishing a diagnosis of BPPV in this study was a positive Dix-Hallpike exam. We know that many patients with BPPV will have a negative exam when, in fact, BPPV is the cause of the symptoms that brought them in to the office. I suspect, therefore, that the actual number of patients with BPPV may be higher. I personally believe BPPV is grossly under-diagnosed at both the primary care and specialty levels]Conclusions
Rather than risk misinterpreting or mischaracterizing the study author’s conclusions, I will simply print two sentences from their “discussion” section that say it all:
“Considering that nearly 45% of outpatients with dizziness are seen and treated by general practitioners or family physicians and that our study demonstrates a significant change in diagnoses of vertigo after referral to a specialized center, underlines the importance of increasing neuro-otological skills of primary care physicians.”
“ However, when diagnoses cannot be established with bedside tests alone, a referral to a specialized center should always be considered.”
Next week, some editorial ranting.
