Approach to dizziness in the emergency department

Acute dizziness/vertigo is among the most common causes for visiting the emergency department. The traditional approach to dizziness starts with categorizing dizziness into four types: vertigo, presyncope, disequilibrium, and nonspecific dizziness. However, a recently proposed approach begins with classifying dizziness/vertigo as acute prolonged spontaneous dizziness/vertigo, recurrent spontaneous dizziness/vertigo, recurrent positional vertigo, or chronic persistent dizziness and imbalance. Vestibular neuritis and stroke are key disorders causing acute prolonged spontaneous dizziness/vertigo, but the diagnosis of isolated vascular vertigo has increased by virtue of developments in clinical neurotology and neuroimaging. However, a well-organized bedside examination appears more sensitive than brain imaging in diagnosing strokes presenting with acute dizziness/vertigo. A detailed history is vital to diagnose recurrent spontaneous dizziness/vertigo since confirmatory diagnostic tests are usually unavailable. Isolated positional vertigo is usually caused by benign paroxysmal positional vertigo, which can be treated at the bedside. In recent years, marked progress has occurred in the evaluation/management of acute dizziness/vertigo. However, even with developments in imaging technology, the diagnosis of acute dizziness/vertigo largely relies on bedside examination.