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JJ竞技 2022 ; 378 doi: https://doi.org/10.1136/bmj-2021-069850 (Published 12 August 2022) Cite this as: JJ竞技 2022;378:e069850
- Kiran Agarwal , general practitioner 1 ,
- James Harnett , consultant in emergency medicine 2 ,
- Nishchay Mehta , consultant ENT surgeon 3 ,
- Fiona Humphries , consultant in stroke medicine 4 ,
- Diego Kaski , consultant neurologist 5
- 1 Ashlea Medical Practice, Surrey, UK
- 2 Emergency Department, University College London Hospitals NHS Foundation Trust, London, UK
- 3 University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
- 4 Comprehensive Stroke Service, University College London Hospitals NHS Foundation Trust, London, UK
- 5 Department of Clinical and Movement Neurosciences, University College London, UK
- Correspondence to: D Kaski d.kaski{at}ucl.ac.uk
What you need to know
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All patients presenting with brief episodic acute vertigo or unsteadiness should undergo a Dix-Hallpike manoeuvre
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Consider stroke in patients with new onset acute unilateral hearing loss and vertigo
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Urgent brain imaging is always indicated when acute vertigo is accompanied by other central neurological signs (such as dysphagia, dysarthria, diplopia)
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Severe acute gait ataxia (patient unable to stand without support) is most common with central causes of vertigo (such as cerebellar lesions) rather than inner ear causes
Dizziness is a common presentation to emergency departments and primary care. 1 2 It is defined as the sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion. 3 The estimated prevalence of dizziness in a general practice community sample varies across studies 4 but is approximately 20%. 5 6 Its prevalence increases with age.
While patients often use the word “dizziness” to describe their symptoms, this encapsulates a variety of distinct symptom clusters, including vertigo (box 1). Vertigo is a specific type of dizziness defined as the sensation of self motion when no self motion is occurring or the sensation of distorted self motion during an otherwise normal head movement. 3 Acute vertigo represents up to 5% of all admissions to the emergency department. 7
Specific definitions that are often included under the term “dizziness”
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Dizziness— The sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion
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Vertigo— The sensation of self motion when no self motion is occurring or the sensation of distorted self motion during an otherwise normal head movement
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Light-headedness— A feeling you are “going to faint”
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Imbalance— A state of being out of equilibrium, or with loss of balance
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Gait disorder— A problem or difficulty with walking
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Acute vestibular syndrome— Sudden onset of vertigo, nausea, postural instability, and nystagmus lasting for ≥24 hours
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Transient vestibular syndrome— Sudden onset of …
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