SHM's Clinical Quick Talks-Acute Inpatient Management of Dizziness

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The article "Acute Inpatient Management of Dizziness" by Zain Abidin and Dr. Nicole Terrigno outlines the approach to assessing and treating dizziness, a symptom encompassing vertigo (spinning), presyncope (near-fainting), disequilibrium (unsteadiness), and light-headedness. Causes range from common, benign issues like benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere disease, to rare but serious conditions such as posterior circulation stroke, cardiac arrhythmias, acoustic neuroma, and vestibular migraine.<br /><br />Effective history-taking is critical, focusing on dizziness onset, duration, triggers, associated symptoms, and relevant medical history. Red flag symptoms indicating potentially life-threatening causes include focal neurological deficits, severe headaches, chest pain, syncope, and persistent vomiting.<br /><br />Key diagnostic tools include orthostatic blood pressure measurement, laboratory testing (CBC, electrolytes), ECG, the Dix-Hallpike maneuver for BPPV, and the HINTS exam to differentiate peripheral from central vertigo causes. MRI of the brain is reserved to rule out central causes such as stroke or tumors. Audiometry assesses sensorineural hearing loss related to conditions like Meniere disease. <br /><br />Treatment targets the underlying cause: canalith repositioning maneuvers for BPPV, corticosteroids and vestibular rehabilitation for vestibular neuritis, salt restriction and diuretics for Meniere disease, and supportive measures like fluids and compression stockings for orthostatic hypotension. Symptom relief includes vestibular suppressants (meclizine, diazepam) and antiemetics.<br /><br />Clinical management emphasizes careful bedside examination, particularly the HINTS exam, as it outperforms early imaging for diagnosing central vertigo. Physicians should avoid cognitive biases and overly relying on imaging, focusing instead on timing and triggers to guide diagnosis. Neurology, cardiology, and ENT consultations are warranted when central, cardiac, or persistent vestibular causes are suspected.<br /><br />(Word count: 282)

Asset Subtitle

Zain Abidin, Nicole Terrigno

Keywords

acute dizziness management

vertigo assessment

benign paroxysmal positional vertigo

vestibular neuritis treatment

Meniere disease

posterior circulation stroke

HINTS exam

Dix-Hallpike maneuver

vestibular suppressants

orthostatic hypotension