From the Guidelines
The workup for fatigue and dizziness should begin with a comprehensive history and physical examination, followed by targeted laboratory tests, as this approach allows for the identification of underlying causes and guides further management, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life. The initial evaluation should include a focused history to assess the patient's current disease status, treatment, and response to treatment, as well as an in-depth fatigue assessment to evaluate aspects of fatigue onset, pattern, duration, and associated factors 1. A review of systems should be completed to determine the various organ systems affected and to direct the physical evaluation and diagnostic workup. Initial blood work should include a complete blood count, comprehensive metabolic panel, thyroid function tests, and inflammatory markers, with additional tests such as vitamin levels, iron studies, and cortisol levels considered based on the patient's symptoms and medical history 1. For dizziness specifically, orthostatic vital signs should be measured, and an electrocardiogram may be performed to rule out cardiac arrhythmias, with specialized tests like the Dix-Hallpike maneuver considered if vertigo is present 1. Neuroimaging, vestibular function testing, or referral to specialists may be warranted for persistent or severe symptoms, with the workup tailored to the patient's age, medical history, medication use, and specific symptom characteristics 1. Key considerations in the workup include:
- Comprehensive history and physical examination
- Targeted laboratory tests
- Assessment of underlying causes, such as anemia, electrolyte imbalances, and thyroid dysfunction
- Evaluation of dizziness and vertigo using specialized tests and neuroimaging as needed
- Referral to specialists for further management and treatment. Given the most recent and highest quality study available 1, a comprehensive and tailored approach to the workup of fatigue and dizziness is essential for improving patient outcomes.
From the Research
Diagnostic Workups for Fatigue and Dizziness
- A thorough history and physical examination are the most useful diagnostic approaches in distinguishing different types of dizziness and fatigue 2, 3, 4, 5, 6
- Additional tests are rarely necessary for diagnosing dizziness, but may be helpful in certain cases 2, 6
- Screening laboratory tests can help rule out most medical causes of fatigue 3
- A systematic patient history and physical exam are crucial to accurately diagnosing conditions related to dizziness and fatigue 4, 5, 6
Specific Diagnostic Tests and Techniques
- Orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, the Dix-Hallpike maneuver, and the HINTS examination may be included in the physical examination for dizziness 6
- Laboratory testing and imaging are usually not required but can be helpful in certain cases 6
- Canalith repositioning procedures (e.g., Epley maneuver) and vestibular rehabilitation may be used to treat benign paroxysmal positional vertigo and other etiologies of dizziness 6
Approach to Diagnosis
- Clinicians should focus on the timing of the events and triggers of dizziness to develop a differential diagnosis 6
- Distinguishing between central and peripheral causes of vertigo can be accomplished reliably through history and examination, but imaging techniques have further added to accuracy 5
- A broad view of disease, psychosocial sensitivity, and a good ongoing relationship with the patient are essential for evaluating the fatigued patient 3