I can’t be 100% sure. But if anyone knows, it’s probably Martin A. Samuels MD, who is an expert on the subject and whose excellent publication, Stop the Spinning: A Simple Approach to Vertigo and Dizziness (2009) is available online free.
Basically, there are four kinds of dizzy (my interpretation):
- Syncope or near-syncope – “I felt as though I was about to pass out” or “I felt lightheaded”
- Disequilibrium – “I felt as though I was losing my balance.”
- Vertigo – “I felt as though the room was spinning” or “I felt as though I was spinning”
- Indeterminate or psychogenic – “There’s so much going on, doc, I’m not sure where to start,” or, “I don’t now, doc, just plain dizzy.”
The key is not to put words in the patient’s mouth, and to try to distinguish benign from malignant processes. Ask, “How did being dizzy feel to you?” or, “What do you mean by dizzy?”
Workup
- Syncope or near-syncope: syncope workup
- Disequilibrium: consider peripheral neuropathies (diabetes, ethanol, B12 deficiency, HIV, multiple myeloma) and muscle weakness
- Vertigo: approach here.
P.s. I am very interested in finding a video of Dr. Samuels’ lecture on the topic. Please let me know if you know where I might be able to locate one.
References
- Buttaravoli, Philip, MD. Minor Emergencies, 3e (2012)
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