I am constantly looking for ways to make the path a little easier for the patient complaining of dizziness, and for the health care practitioners trying to help them. I have discussed on this blog in the past that it is imperative that the description go beyond simply describing the sensation as dizziness. The word “dizzy” can be used to describe so many different sensations that it is practically useless diagnostically.
Several years ago, I put together a symptom-based guide called the Dizziness Reference Guide to encourage practitioners to ask the all-important second question, “What do you mean by ‘dizzy’?”
I have been experimenting recently with a shorter version of that guide that includes classic complaints about several of the most common causes of dizziness. Of course, many people will not experience these conditions, or describe them, exactly as I have worded the options listed below. I do find, however, that those patients who will actually restrict themselves to choosing one “best” option, even though it might not fit perfectly, are pretty good at predicting the cause of their symptoms.
This would be a good time to point out that this is not a substitute for seeing a medical professional, and is intended for use by health care practitioners to make their examination more efficient.
Below, you will find seven typical complaints, and an option for “None of these fits.” There is a corresponding guide with a “most likely diagnosis” and management suggestion.
Please circle the number that BEST describes your symptoms.
Circle only one number please
1. The room spins for less than one minute when I lie down, roll over in bed, or tilt my head back.
2. I get temporarily dizzy, light-headed, or off-balance when I stand up, worse if I stand quickly.
3. I have had several episodes of severe vertigo with nausea, lasting for hours at a time, with fullness and noise in one ear that increases when I am dizzy.
4. I have had several episodes of severe vertigo, lasting hours at a time, sometimes accompanied by headache and/or sensitivity to light.
5. I had an episode of constant spinning vertigo and nausea for 1 to 3 days and I feel like I have not recovered back to normal yet.
6. I am unsteady whenever and as long as I am on my feet. I am fine while sitting or lying down.
7. I don’t really feel dizzy or off balance, but I am afraid of falling (or have already fallen).
8. None of these describes my symptoms.
If you have circled more than one number, please go back and correct!
On a scale of 1 to 10, with 1 being mildly annoying, and 10 being debilitating and life altering, how would you rate the severity of your dizziness or imbalance? ____________
Most Likely Diagnosis:
1 Benign Paroxysmal Positional Vertigo – perform Dix-Hallpike exam
2. Orthostatic Hypotension – record blood pressures, supine, then immediately after standing and at 1-minute intervals for 3-5 minutes
3. Meniere’s disease – refer for audiometric and vestibular function testing
4. Vestibular Migraine – inquire about history or family history of migraine, complaints of self motion or visual motion intolerance
5. Vestibular Neuritis –perform head impulse test or refer for vestibular function testing
6. Postural or Gait Instability – inquire about strength, sensation and stability of the lower extremities, assess nerve conduction.
7. Multi-factorial Dysequilibrium – have patient complete fall risk questionnaire, assess neurologic status and refer as indicated
8. Non-specific – Ask patient to describe symptoms
Please keep in mind that this has not been validated and is a work in progress. Feedback is appreciated
Photo courtesy of https://sportygifs.com/2011/02/funny-sports-pictures-tall-short/<a