Archives of General Internal Medicine

Review Article - Archives of General Internal Medicine (2018) Volume 2, Issue 2

Dizziness Update: A New Approach and Treatment Based on Triage, Timing and Triggers.

Introduction: In 1972, following a classic study of 125 patients, Drachman and Hart proposed a classification of dizziness based on the patient’s response to “What do you mean, dizzy?” The patient’s response is used to classify the stated dizziness experience into 4 categories of dizziness patterns: vertigo, presyncope, imbalance and light-headedness. Over time, this model resulted in misdagnosis.

Methodology: Two research questions are posed in this update and answers sought through current literature review in PubMed. (1) What is the evidence the Drachman-Hart model of enquiry is the wrong paradigm? (2) What new dizziness classification should be put in its place?

Results: A study by Newman-Toker showed that in 1,342 consecutive dizziness cases seen in ED, 52% of patients were “unclear, inconsistent, and unreliable”, casting doubt on the validity of the Drachman-Hart approach. Furthermore, a cross-sectional study of 9,472 dizziness cases seen in ED showed that otologic/vestibular causes accounted for only 32.9% of cases. In 2015, Edlow&Newman-Toker published a new approach to dizziness based on timing and triggers of the dizziness experience in the patient. A battery of 3 tests, targetted examination, and additional tests when serious causes are suspected, allowed differentiation of dizziness into acute vestibular syndrome, triggered episodic syndrome, spontaneous episodic syndrome, and chronic vestibular syndrome. This approach uses current best evidence to differentiate between peripheral and central lesions and offers the potential to reduce misdiagnosis.

Conclusions: The triage, timing and triggers approach described by Edlow and Newman-Toker is valid and should be adopted widely.

Author(s): LG Goh

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