Journal List > J Korean Med Assoc > v.53(10) > 1042333

Lim and Chae: Evaluation and treatment of the patient with acute dizziness in primary care


Dizziness is a very common symptom encountered by primary care physicians. Dizziness can be divided into five subgroups according to symptoms. These subgroups can be determined by a patient's history and allow the physician to deduce the etiology. A careful and systematic approach to dizzy patients is the key to a correct diagnosis and finding the optimal treatment. Physicians should obtain a detailed history from the patient in an open-ended fashion. Brief and comprehensive bedside neuro-otologic examinations, such as cranial nerve examinations, the Dix-Hallpike test, and the head thrust test cannot be omitted for an accurate diagnosis. Knowledge about the numerous disease entities that may contribute to dizziness can be essential for differential diagnosis. In addition, this article provides information about frequently prescribed drugs, including vestibular suppressants and antiemetics.

Figures and Tables

Figure 1
Physiology of the head thrust test. Head movement towards a canal will cause activation of that canal. Reflex movement of the eyes in the opposite direction- that is, away from the canal (A). Head movement towards a defunct canal will result in the failure of activation of the vestibulo-ocular reflex and thus the visual target will be lost from fixation during sudden head movements (B).
Figure 2
Sit the patient upright. Turn the patient's head to the affected side at a 45 degree angle (A). The patient is brought into the supine position with the head extended below the level of the bed (Dix-Hallpike position) (B). Maintain up to 30 seconds after nystagmus disappears (C). Turn the patient's head 90 degrees to the other side (D). The patient's head is further rotated to the opposite side by rolling until the patient is face down (E). The patient is brought back to the upright position (F).
Table 1
Types of dizziness according to mechanism and etiology

BPPV, benign paroxysmal positional vertigo; VN, vestibular neuritis; MD, Meniere's disease; VBI, vertebrobasilar insufficiency

Table 2
Differential diagnosis of dizziness according to history-taking
Table 3
Differential diagnosis according to spontaneous nystagmus
Table 4
Considerations in obtaining imaging in acute vertigo
Table 5
Diagnostic criteria about migraine-associated vertigo
Table 6
Medical therapy of dizziness

p.o, by mouth; i.m, intramuscularly; i.v, intravenous

b.i.d, twice a day; t.i.d, three times a day; q.i.d, four times a day; q.d, every day

FDA, Food and Drug Administration; ADEC, Australian Drug Evaluation Committee


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