The dizzy patient. A practical approach to management

Dizziness can generally be divided into true vertigo and pseudovertigo (giddiness or light-headedness). The most common causes of pseudovertigo are hyperventilation, orthostatic hypotension, and multisensory deficits of older patients. Of the many types of true vertigo, only a few are caused by serious structural disorders of the brainstem, and these can usually be recognized by their temporal profile and concomitant symptoms and signs. Most cases of vertigo are caused by peripheral vestibular disorders that are self-limiting. Treatment is directed toward control of the acute autonomic symptoms and labyrinthine suppression until physiologic compensation takes place. Patients with vertigo that is prolonged, chronic, and recurrent may be helped by exercises designed to hasten or assist recovery of compensatory mechanisms.