From the Research
For patients complaining of dizziness, laboratory testing and imaging are usually not required and are usually not helpful, as the focus should be on determining whether the etiology is peripheral or central through physical examination and history taking 1. The evaluation of dizziness should prioritize the timing and triggers of the symptoms, as patients often have difficulty describing the quality of their symptoms.
- The physical examination should include orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver.
- The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies.
- Treatment of dizziness is dependent on the etiology of the symptoms, and canalith repositioning procedures, vestibular rehabilitation, and specific treatment to address the cause may be necessary. Key points to consider in the evaluation of dizziness include:
- The distinction between peripheral and central etiologies, as central etiologies often require urgent treatment.
- The use of the physical examination to make a specific diagnosis, as it can help accurately discriminate between benign inner ear conditions and dangerous central ones 2.
- The limitations of brain imaging, as focused eye movement examinations may be more sensitive for detecting early stroke than brain imaging, including diffusion-weighted magnetic resonance imaging 2. In general, a comprehensive laboratory workup is not necessary for the evaluation of dizziness, and the focus should be on the physical examination and history taking to determine the underlying cause 1.