Dizziness is a common complaint and often has resolved by the time the patient arrives to see a health care practitioner. Usually there is no rush to seek care. However, while the complaint of dizziness is not often an emergency, care should be sought immediately if it is accompanied by any of the following:
Chest pain, shortness of breath, or palpitations. These symptoms should not be ignored as they suggest the heart may be the source of the dizziness.
Dehydration. Often there may be an associated illness including fever, vomiting, or diarrhea.
People with diabetes may have dizziness due to low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia), and may need emergent care to stabilize their insulin and medication requirements.
Bleeding from any source.
Altered mental status or thinking. This may include symptoms such as confusion, change in vision, change in speech, facial droop, weakness of one side of the body, or headache. These may be signs of stroke, bleeding in the brain, or tumor.
Vertigo may cause significant problems with vomiting and may be debilitating. Often, medical care is needed to control symptoms even though the underlying problem is not serious.
The diagnosis of dizziness begins with the health care practitioner evaluating whether the complaint of dizziness refers to lightheadedness or vertigo. Further direction continues once this distinction is made.
The key to the diagnosis of dizziness is a thorough history and physical examination. Often the diagnosis is made by listening to the patient's story. The health care practitioner may ask about triggers that cause and relieve the symptoms of dizziness, such as:
- "Is it related to changing positions quickly?" and
- "Does it resolve on its own or does the patient have to do something, like lie down to make it better?"
A review of systems is a series of questions that review the patient's body functions. Questions may be asked about associated symptoms including fever, vomiting, diarrhea, chest pain, shortness of breath, palpitations, or abnormal bleeding. The past medical history may be reviewed, and this includes reviewing medications the patient is currently taking.
A thorough physical examination will likely be done, this may include:
Vital signs: Taking the patient's blood pressure and pulse rate lying down and standing (called orthostatic or postural vital signs) often will indicate the fluid status of the body. In patients who are dehydrated or bleeding, the vital signs may rise on changing position. However, patients taking medications such as beta blockers will not generate in increased pulse rate.
Tailored physical examination: Often, the physical examination is tailored to the patient based upon the information provided in the patient's medical history. For example, a woman with a heavy menstrual period may need a pelvic examination, or a patient with cough and shortness of breath may need a closer examination of the heart and lungs.
Imaging studies and blood tests: The need for imaging studies and/or and blood tests will depend on the concerns the health care practitioner and patient have in regard to the cause of the dizziness. Common tests that may be ordered include:
- complete blood count (CBC) to screen for anemia or infection
- evaluation of electrolytes
- blood sugar tests
- kidney function tests
- thyroid tests
X-rays, CT scans, and MRI may be indicated depending upon the patient's needs.
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