What is the difference between vertigo and dizziness?

Difference Between Vertigo and Dizziness

Vertigo specifically refers to a false sensation of movement (typically rotation) due to vestibular system dysfunction, while dizziness is a broader term encompassing various sensations including vertigo, lightheadedness, imbalance, and presyncope. 1, 2

Clinical Differentiation

Types of Dizziness

Dizziness can be categorized into four distinct types:

1. Type I (Vertigo):

   • Rotational sensation
   • Caused by vestibular system disorders (peripheral or central)
   • Characterized by a feeling of movement relative to surroundings 1

2. Type II (Presyncope):

   • Sensation of impending faint
   • Often related to cardiovascular issues 1

3. Type III (Dysequilibrium):

   • Balance disturbance without sensation of movement
   • Often related to proprioceptive or cerebellar dysfunction 1

4. Type IV (Lightheadedness):

   • Vague sensation of disconnection
   • Often associated with psychiatric conditions 1

Vestibular Syndromes Classification

According to the American Academy of Otolaryngology-Head and Neck Surgery, vestibular disorders can be classified into four syndromes based on timing and triggers 3:

1. Acute Vestibular Syndrome:

   • Acute persistent continuous dizziness lasting days to weeks
   • Usually associated with nausea, vomiting, and head motion intolerance
   • Examples: vestibular neuritis, labyrinthitis, posterior circulation stroke

2. Triggered Episodic Vestibular Syndrome:

   • Episodic dizziness triggered by specific actions (usually position changes)
   • Episodes generally last <1 minute
   • Primary example: BPPV

3. Spontaneous Episodic Vestibular Syndrome:

   • Episodic dizziness without specific triggers
   • Episodes last minutes to hours
   • Examples: Ménière's disease, vestibular migraine, TIA

4. Chronic Vestibular Syndrome:

   • Dizziness lasting weeks to months or longer
   • Examples: anxiety disorders, medication side effects, posttraumatic vertigo 3, 4

Diagnostic Approach

History Taking Focus

When evaluating patients with dizziness complaints, focus on:

• Timing (acute vs. episodic vs. chronic)
• Triggers (positional, pressure changes, spontaneous)
• Associated symptoms (hearing loss, neurological symptoms)

This approach is more valuable than focusing solely on the specific descriptor the patient uses 3.

Key Differential Features

Condition	Clinical Presentation	Key Distinguishing Features
BPPV	Brief positional vertigo	Positive Dix-Hallpike test, no hearing loss
Vestibular neuritis	Sudden severe vertigo lasting days	Unidirectional horizontal nystagmus
Menière's disease	Episodes with vertigo, hearing loss, tinnitus	Fluctuating hearing loss, aural fullness
Vestibular migraine	Variable duration vertigo	History of migraine, photophobia
Stroke/TIA	Sudden onset, often with neurological deficits	Abnormal HINTS exam, vascular risk factors
Superior canal dehiscence	Pressure-induced vertigo	Vertigo induced by pressure, not position [3,4]

Common Pitfalls and Caveats

1. Misdiagnosis Risk: BPPV is often underdiagnosed despite being the most common cause of vertigo 4.

2. Stroke Misidentification: CT head is often inadequate for diagnosing acute stroke in vertigo patients. The HINTS examination has superior sensitivity (100%) compared to early MRI (46%) for detecting stroke in acute vestibular syndrome 4.

3. Medication Interference: Excessive use of vestibular suppressants may interfere with central compensation for vestibular disorders 4.

4. Red Flags requiring immediate evaluation:

   • Sudden severe headache with dizziness
   • New neurological symptoms
   • Inability to walk or stand
   • Persistent vomiting with dizziness
   • Altered mental status 4

5. Imaging Considerations: No imaging is necessary for typical BPPV with positive Dix-Hallpike test. MRI brain is preferred over CT for suspected central vertigo 4.

By understanding the fundamental differences between vertigo and dizziness and applying a systematic approach based on timing and triggers, clinicians can more effectively diagnose and manage these common complaints.