Dizziness overview
Norina Usman, M.B.B.S

# Overview
Dizziness is a symptom rather than a condition on its own. It is a complex and subjective complaint that encompasses a wide spectrum of symptomatology. It is a sensation of postural unsteadiness or deceptive motion. It is one of the most communal presenting complaints that accounts for 5% of primary care practice for individuals aged 65 or older. Dizziness is a nonspecific term mainly used by many people and is classified into different categories: vertigo, spinning, disequilibrium, giddiness, presyncope, faintness, lightheadedness, or feeling woozy. It is one of the most common presenting symptom among patients seen by emergency medical physicians, primary care physicians, neurologists, and otolaryngologists.

# Historical Perspective

# Classification
Dizziness may be classified based on the symptoms of the patient into 4 main subtypes including vertigo, presyncope, , and disequilibrium.

# Pathophysiology
It is understood that pathophysiology of dizziness depends on the etiological subtype including orthostatic hypotension, benign paroxysmal positional vertigo, Menier's disease, Parkinson's disease, hyperventilation syndrome, peripheral neuropathy, and vestibular migraine.

# Causes
Dizziness may be caused by hypotension, dehydration, arrhythmia, labyrinthitis, Meniere's disease, stroke, or hypoglycemia. Other causes are based on the organ system such as cardiovascular, neurological, musculoskeletal, dermatological, endocrine, infectious, pulmonological or side effects of the medicine.

# Differentiating dizziness from other diseases
Dizziness must be differentiated from other diseases that cause vertigo, nystagmus, and hearing problems, such as vestibular neuritis, HSV oticus, Meniere disease, labyrinrhine concussion, perilymphatic fistula, semicircular canal dehiscence syndrome, vestibular paroxysmia, Cogan syndrome, vestibular schwannoma, otitis media, aminoglycoside toxicity, recurrent vestibulopathy, vestibular migraine, epileptic vertigo, multiple sclerosis, brain tumors, cerebellar infarction/hemorrhage, brain stem ischemia, , presyncope and disequilibrium.

# Epidemiology and Demographics
Dizziness is one of the most common complaints in ambulatory care, accounting for nearly 8 million outpatient visits annually in the United States. The incidence of dizziness is approximately 50100 million worldwide, and around 4.3 million patients in the United States. The lifetime prevalence of dizziness is expected to be 30%. Idiopathic dizziness commonly affects individuals 25 years and older in an emergency department.

# Risk factors
Common risk factors in the development of dizziness include family history of thromboembolic factors (diabetes, hypertension, high cholesterol, and rheumatic disease), cardiac arrhythmias, stroke, medication side effect (diuretics, antiepileptic drugs, opioid-based analgesics, antipsychotic drugs, antidepressants, antihypertensive, antifungal, lithium, benzodiazepines, antiarrhythmic, antimalarial and anti-HIV-drugs). Multiple sclerosis, seizures, brain tumors, benign positional vertigo, and labyrinthitis.

# Screening

# Natural history, complications and prognosis
If left untreated, patients may experience spontaneous recovery. Common complications of dizziness include nausea, vomiting, fainting, fall, imbalance and hearing loss, and neurological complications following Dix Hallpike or Epley maneuvers. Prognosis is generally good, and the 10-year mortality rate of patients with dizziness is low approximately (hazard ratio  = 0.62; 95% CI, 0.40-0.96)

# Diagnosis

## Diagnostic Study of Choice

## History and Symptoms

## Physical Examination

## Laboratory Findings

## Electrocardiogram

## X-ray

## Echocardiography and Ultrasound

## CT scan

## MRI

## Other Imaging Findings

## Other Diagnostic Studies

# Treatment

## Medical Therapy

## Interventions

## Surgery

## Primary Prevention

## Secondary Prevention