Dizziness in the emergency department: an update on diagnosis
Open accessAbstract
This review aims to assist emergency physicians in finding the underlying aetiology when a patient presents with dizziness to the emergency department. After reading this review, the emergency physician will be able to consider the most relevant differential diagnoses and have an idea about dangerous aetiologies that require immediate action. The emergency physician will also know what diagnostic steps need to be taken at what time, such as the three-component HINTS Test (Head Impulse, Nystagmus, and Test-of-Skew), which helps with distinguishing central from peripheral causes of the acute vestibular syndrome. Furthermore, episodic vestibular syndromes and chronic vestibular syndromes are discussed in detail. The five most frequent categories of dizziness are vasovagal syncope / orthostatic hypotension (22.3%), vestibular causes (19.9%), fluid and electrolyte disorders (17.5%), circulatory/pulmonary causes (14.8%) and central vascular causes (6.4%).Given that it would neither be economical nor practical to send all patients to specialists from the start, we present general guidelines for the diagnostic workup of patients presenting with dizziness to the emergency department. This review will focus on epidemiology, aetiologies, differential diagnoses and diagnostics. Treatment is described in a separate article.
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The differential diagnosis of patients presenting with unspecific, neurovegetative and autonomic symptoms is complex and involves a variety of diseases, including psychosomatic, neurologic, cardiologic, and endocrine disorders.
“The differential diagnosis of patients presenting with unspecific, neurovegetative and autonomic symptoms is complex and involves a variety of diseases, including psychosomatic, neurologic, cardiologic, and endocrine disorders [1,2].”
From An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS) (2023) · cites this paper as [2]
The Aetiology section describes a diverse differential diagnosis for dizziness, including psychosomatic, central vascular, circulatory and hypoglycaemic causes. The paper addresses patients presenting with dizziness, however, not patients presenting with unspecific neurovegetative or autonomic symptoms generally; it also does not identify endocrine disorders as a broad diagnostic category. (LLM, conf=0.84)
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Dieterle, M. P., Husari, A., Prozmann, S. N., Wiethoff, H., Stenzinger, A., Röhrich, M., Pfeiffer, U., Kießling, W. R., Engel, H., Sourij, H., et al. (2023) · Biomedicines · doi:10.3390/biomedicines11061741 · Cited by 5 · see citing works
“The differential diagnosis of patients presenting with unspecific, neurovegetative and autonomic symptoms is complex and involves a variety of diseases, including psychosomatic, neurologic, cardiologic, and endocrine disorders [1,2].”
Background
- Authors
- Spiegel, R., Kirsch, M., Rosin, C., Rust, H., Baumann, T., Sutter, R., Hergen, F., Göldin, M., Müri, R., Kalla, R., Bingisser, R., & Mantokoudis, G.
- Affiliations
- University of Basel (CH)
- University of Bern (CH)
- Venue
- Swiss Medical Weekly
- Publisher
- SMW Supporting Association
- Published
- 2017-12-27
- Volume
- 147
- Issue
- 4950
- Pages
- w14565
- ISSN
- 0036-7672 (ISSN-L)
- 1424-3997
- OpenAlex
- W2615048781
- Cited by
- 43
- References
- 48
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 8 · 2020: 11 · 2019: 2 · 2018: 3
- FWCI
- 0.42
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Swiss Medical Weekly (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- edoc (University of Basel) (submittedVersion)
- Open Access CRIS of the University of Bern
- Topics
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Surgery › Nausea and vomiting management
- Keywords
- dizziness, emergency department, differential diagnosis, central vestibular disorders, peripheral vestibular disorders, vasovagal syncope, orthostatic hypotension, fluid and electrolyte disorders, diagnostic workup
- MeSH terms
- Diagnosis, Differential, Dizziness, Emergency Service, Hospital, Humans, Nystagmus, Pathologic, Vertigo, Vestibular Diseases, Stroke
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