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Causes of Persistent Dizziness
A Prospective Study of 100 Patients in Ambulatory Care
- Kurt Kroenke, MD;
- Christine A. Lucas, MPH;
- Michael L. Rosenberg, MD;
- Barbara Scherokman, MD;
- Jerome E. Herbers, Jr., MD;
- Paul A. Wehrle, MD; and
- Joseph O. Boggi, DO
Abstract
▪ Objective: To determine the causes of persistent dizziness in outpatients.
▪ Design: Consecutive adult outpatients presenting with a chief complaint of dizziness.
▪ Setting: Four clinics (internal medicine, walk-in, emergency room, and neurology) in a teaching hospital.
▪ Patients: Of 185 patients presenting during the 10-month study period, 51 (28%) had minimal or no dizziness at 2-week follow-up. Of the remaining 134 patients, 100 completed the study protocol (mean age, 62 years; range, 20 to 85 years).
▪ Measurements: Evaluation included a detailed study questionnaire, standardized physical examination, vestibular testing by a neuro-ophthalmologist, laboratory tests, audiometry, and a structured psychiatric interview. Data were abstracted onto a standard form and reviewed by three raters. Raters independently assigned diagnoses using explicit criteria, with the final cause determined by consensus.
▪ Results: Primary causes of dizziness included vestibular disorders (54 patients), psychiatric disorders (16 patients), presyncope (6 patients), dysequilibrium (2 patients), and hyperventilation (1 patient); dizziness was multicausal in 13 patients and of unknown cause in 8 patients. Many of those with a single primary cause, however, had at least one other condition contributing to their dizziness; only 52% of patients had a single "pure" cause. Thirty patients had a potentially treatable primary cause, the most common being benign positional vertigo (BPV) (16%) and psychiatric disorders (6%). Central vestibulopathies detected in 10 patients were presumably vascular or idiopathic in origin. No brain tumors or cardiac arrhythmias were found.
▪ Conclusions: Vestibular disease and psychiatric disorders are the most common causes of persistent dizziness in outpatients. In about 50% of patients with dizziness, more than one factor causes or aggravates symptoms. Life-threatening causes were rare, even in our elderly population.
Article and Author Information
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From the Departments of Medicine and Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD; and the Walter Reed Army Medical Center, Washington, D.C.
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Grant Support: In part by grant G183DP-01 from the Henry M. Jackson Foundation for the Advancement of Military Medicine.
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Requests for Reprints: LTC Kurt Kroenke, MD, Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
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Current Author Addresses: Dr. Kroenke and Ms. Lucas: Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Drs. Rosenberg and Scherokman: Department of Neurology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Drs. Herbers and Wehrle: General Medicine Service, Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20037.
Dr. Boggi: Internal Medicine Clinic, USA MEDDAC, Fort Meade, MD 20755.
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