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Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care.

Abstract：

OBJECTIVE:To determine the causes of persistent dizziness in outpatients. DESIGN:Consecutive adult outpatients presenting with a chief complaint of dizziness. SETTING:Four clinics (internal medicine, walk-in, emergency room, and neurology) in a teaching hospital. PATIENTS:Of 185 patients presenting during the 10-month study period, 51 (28%) had minimal or no dizziness at 2-week follow-up. Of the remaining 134 patients, 100 completed the study protocol (mean age, 62 years; range, 20 to 85 years). MEASUREMENTS:Evaluation included a detailed study questionnaire, standardized physical examination, vestibular testing by a neuro-ophthalmologist, laboratory tests, audiometry, and a structured psychiatric interview. Data were abstracted onto a standard form and reviewed by three raters. Raters independently assigned diagnoses using explicit criteria, with the final cause determined by consensus. RESULTS:Primary causes of dizziness included vestibular disorders (54 patients), psychiatric disorders (16 patients), presyncope (6 patients), dysequilibrium (2 patients), and hyperventilation (1 patient); dizziness was multicausal in 13 patients and of unknown cause in 8 patients. Many of those with a single primary cause, however, had at least one other condition contributing to their dizziness; only 52% of patients had a single "pure" cause. Thirty patients had a potentially treatable primary cause, the most common being benign positional vertigo (BPV) (16%) and psychiatric disorders (6%). Central vestibulopathies detected in 10 patients were presumably vascular or idiopathic in origin. No brain tumors or cardiac arrhythmias were found. CONCLUSIONS:Vestibular disease and psychiatric disorders are the most common causes of persistent dizziness in outpatients. In about 50% of patients with dizziness, more than one factor causes or aggravates symptoms. Life-threatening causes were rare, even in our elderly population.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Kroenke K,Lucas CA,Rosenberg ML,Scherokman B,Herbers JE Jr,Wehrle PA,Boggi JO

doi

10.7326/0003-4819-117-11-898

subject

Has Abstract

pub_date

1992-12-01 00:00:00

pages

898-904

issue

eissn

0003-4819

issn

1539-3704

journal_volume

117

pub_type

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Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care.