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Symptoms and Syndromes in the Patient with Dizziness or Unsteadiness 

Symptoms and Syndromes in the Patient with Dizziness or Unsteadiness
Symptoms and Syndromes in the Patient with Dizziness or Unsteadiness

Adolfo M. Bronstein

and Thomas Lempert

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date: 28 October 2021

The more important part of the assessment of any patient with dizziness or unsteadiness is the clinical history. Symptoms of vertigo, dizziness or unsteadiness can be present in diseases from many organs and systems so the doctor should not automatically equate dizziness with the inner ear. “True” or rotational vertigo implies involvement of the semicircular canals or their central connections, usually the brainstem or cerebellum. However, patients with fainting or syncope syndromes can describe transient rotational feelings as well. It is often the accompanying symptoms and presentation pattern that leads to a diagnosis. Some of the questions doctors should try to answer are: Is this a single, prolonged attack of vertigo, as in vestibular neuritis or brainstem stroke? Is this a recurrent vertiginous syndrome, as in vestibular migraine or Meniere’s disease? Are there any associated migraneous features like in the former or aural symptoms like in the latter? Are the symptoms provoked by lying down/turning over in bed, as in BPPV, or only occur whilst standing up as in postural hypotension? Are there any associated brainstem symptoms as in TIAs or demyelination? Is the patient chronic “dizziness” a progressive gait disorder? Carefully enquiring about the nature of the symptom (vertigo, dizziness, fainting sensation, unsteadiness), presentation (acute, recurrent, chronic, progressive), duration and triggers is vital in reaching a diagnosis.

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