Sex differences in dizziness diagnoses across acute and chronic neurological settings

Dizziness is commoner in females and therefore clinical diagnostic frameworks are perhaps biased towards this gender. This study specifically aimed to analyse the distribution of diagnoses in neuro-otology clinics based on sex, and across age.

Retrospective cohort study based on a case note review of 474 adult patients (≥ 18 years) using electronic healthcare records from patients who were referred with a primary complaint of dizziness, vertigo, or unsteadiness in outpatient neurological clinics from January 2023 to September 2024 at University College London Hospitals, UK.

Among the 474 patients, the most common diagnosis for dizziness was persistent postural perceptual dizziness (PPPD) (24.3%), followed by vestibular migraine (VM) (22.4%). In women the most common diagnosis was VM (31.9%), while in men it was PPPD (21.7%). In the population under 65 years old the major cause was VM (28.9%), followed by PPPD (28.6%) and "other central causes" (12.19%), while in the population over 65 years old they were benign paroxysmal positional vertigo (BPPV) (18.4%) and "other central causes" (18.4%). PPPD (28.3%) and VM (21.4%) were the commonest causes of chronic vertigo, while in the acute phase the commonest causes were VM (26%), vascular (14%) and BPPV (14%).

Overall, PPPD is the most common cause of dizziness in males, and vascular vertigo was the most common cause of acute dizziness in males, regardless of age. The combination of age and sex may be helpful in constructing a priori diagnostic possibilities for Neurologists, Otorhinolaryngologists and other clinicians seeing dizzy patients.