Dizziness is a common chief complaint in the emergency department (ED) that poses unique diagnostic challenges.1
The feeling of “dizziness” can be described in many ways, many of which fall into the subcategory of a vestibular syndrome (VS). The patient’s description of dizziness as light-headedness versus spinning offers minimal benefit in diagnosing the underlying disease.1
The differential diagnosis of dizziness in the ED is broad, with no single cause accounting for the majority of cases, so some rarely encountered diseases need to be considered in every dizzy patient. A systematic approach or direct feedback about every dizzy patient is critical to avoid misdiagnosis.2
Many of the most reliable diagnostic tools for dizziness, such as the Dix-Hallpike test for benign positional vertigo, are simple to perform bedside. By contrast, overreliance on advanced imaging without a systematic problem-based history and physical has been shown to increase length of stay, increase the cost of care, and falsely reassure providers that a life-threatening cause has been ruled out.