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Why Are My Patients Dizzy? Review of Diagnosis

Am Fam Physician. 2003 Feb 15;67(4):845-846.

Vertigo, a subtype of dizziness characterized by a sense of rotation, is a common symptom in patients presenting to family physicians. In British general practice, vertigo accounts for about 11 visits per 1,000 person-years. Although little is known about vertigo in primary care, fewer than 15 percent of cases are referred for specialist care. Hanley and O'Dowd studied vertigo in general practice to determine the most common causes.

Thirteen Irish general practitioners collected data on all patients presenting with vertigo during a six-month period. Data were collected using standardized clinical assessments prepared after a review of the literature. True vertigo was identified by asking all patients complaining of dizziness about a sensation of the environment spinning as opposed to the sensation of being light-headed. The physicians attended a training session in the assessment of dizziness, and all followed a standardized procedure that included the Hallpike maneuver, Rinne's test, and Weber's test. Each physician was contacted by telephone one month after the initial consultation to see if there were any changes in diagnosis, as known to the physician, and then every two weeks to clarify queries, until the end of the study.

Complete data were available for 72 patients with true vertigo and 100 with nonvertiginous dizziness. The average age in both groups was 52, and nearly two thirds of the subjects were women. The physicians' initial diagnosis was confirmed in 63 of the 72 patients during initial follow-up. Most patients (30) were diagnosed with benign positional vertigo or acute vestibular neuronitis (28), as shown in the accompanying table.

One Month After Presenting with Vertigo

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Overall, 60 percent of patients had previous episodes of vertigo. All seven patients with Meniere's disease reported previous episodes of vertigo. Use of the Hallpike test showed that it was easy to incorporate into a busy clinical practice. Only six patients were referred for specialist opinion; the original diagnosis was confirmed in three of these patients. No medication was prescribed for 40 percent of the patients. In the remaining patients, vestibular sedatives were prescribed, especially for patients with acute vestibular neuronitis and Meniere's disease.

The authors conclude that most cases of vertigo can be assigned a clinical diagnosis at the initial visit. They also point out the differences in the most common causes of vertigo in general practices from patients seen in specialized or hospital clinics, where Meniere's disease can account for one third of diagnoses. They call for longer studies of dizziness and vertigo in primary care, and particularly studies to assess the outcomes of different treatments for this common problem.

Hanley K, O'Dowd T. Symptoms of vertigo in general practice: a prospective study of diagnosis. Br J Gen Pract. October 2002;52:809–12.


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