What do you mean when you say Dizzy ? Part I

Alan Desmond
October 9, 2011

“Good morning Mrs. Butterworth, Tell me what you brings you here today.”

Mrs. Butterworth “I’m dizzy.”

What have I learned? Nothing.

The term “dizziness” encompasses so many different sensations that it is a poor  and ineffective descriptor.  “Dizziness” is often used to describe the sensations of vertigo, lightheadedness, faintness, disorientation, and/or gait instability.  These are varied complaints with many different possible causes.  To categorize all these symptoms under the broad heading of “dizziness” is counter-productive. Most specialists try to obtain a more detailed description of symptoms.

A recent study found that over 80% of Audiologists sought a more detailed description of the patient’s dizziness, however, only 33% of Geriatricians did the same {{1}}[[1]] Polensek, S., Sterk, C. & Tusa, R. (2008). Screening for vestibular disorders: A study of clinicians’ compliance with recommended practices. Med Sci Monit, 14(5), 238-242[[1]].  In many cases, patients with a  chronic history of vestibular symptoms report that a thorough history was never taken. Consequently, patients with chronic balance and/or vestibular disorders typically see several different physicians without diagnosis or resolution to their complaint. Many are treated symptomatically with vestibular suppressant medication such as Antivert (Meclizine) even though a diagnosis of vestibular dysfunction has not been made.

A directed case history and brief physical examination often allow a more direct, logical and cost effective route to diagnosis and treatment.  After giving patients an opportunity to describe the symptoms in their own words, a series of specific questions need to be asked to get a better idea what the patient is experiencing. To quote Dr. Joel Goebel from Washington University of St. Louis

The accuracy and quality of the history is directly related to the patience and skill of the examiner.

It is therefore important to spend sufficient time with individual patients to understand their history and complaints thoroughly before attempting to make a diagnosis. Next week, we will discuss the finer points of taking a history from a patient complaining of “dizziness.”

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