Mj. Ruckenstein, A PRACTICAL APPROACH TO DIZZINESS - QUESTIONS TO BRING VERTIGO AND OTHER CAUSES INTO FOCUS, Postgraduate medicine, 97(3), 1995, pp. 70
Evaluation of a patient presenting with dizziness begins with and larg
ely depends on the patient's history. The diagnosis often can be accur
ately determined in a primary care setting when a stepwise algorithmic
approach is used. The first step is getting a detailed account of pre
cisely what the patient means by ''dizziness.'' This helps determine w
hether the cause is vertigo or another condition, such as orthostatic
hypotension. Establishing whether the vertigo is central or peripheral
in origin and, if peripheral, how long episodes last further focuses
the investigation. Certain clues on physical examination and appropria
te use of diagnostic tests help support the diagnosis. Referral should
be contemplated when significant central disease is suspected and whe
n vertigo of peripheral origin is persistent or atypical.