Diagnosis of geriatric patients with severe dizziness

OBJECTIVE: To identify the causes of dizziness in older patients presenting to the general practitioner and the clinical characteristics at presentati on that might guide the general practitioner to the likely cause of dizzine ss and the most appropriate specialty for subsequent referral if referral i s required. DESIGN: A prospective case control study of older patients presenting with dizziness. SETTING: The initial assessment was made in four general practices, three u rban practices and one inner city practice (Newcastle). Subsequent investig ations were conducted randomly in the Neurocardiovascular Investigation Uni t and the Otolaryngology (ENT) Unit at local University hospitals (Newcastl e). PARTICIPANTS: Fifty consecutive patients more than 60 years of age presente d with dizziness. Twenty-two age- and sex-matched case controls were recrui ted from the same general practices. MEASUREMENTS: Measurements were of diagnoses attributable to symptoms. RESULTS: Symptoms were of long duration (median 1 year). Forty-six percent of patients had syncope and/or falls in addition to dizziness. Twenty-eight percent had a cardiovascular diagnosis, 18% had a peripheral vestibular di sorder, 14% had a central neurological disorder, 18% had more than one diag nosis, and 22% had no attributable cause of symytoms identified. A cardiovascular diagnosis was predicted by the presence of syncope (P <.00 1), dizziness described as lightheadedness (P <.001), the need to sit or li e down during symptoms (P <.001), pallor with symptoms (P <.001), symptom p recipitation by prolonged standing (P <.05), and whether patients had coexi sting cardiovascular disease (P <.05). The description of dizziness as "ver tigo" predicted a peripheral vestibular disorder (P <.001). The predictive strength of these prognostic indicators was then validated on a separate sa mple of 50 additional older patients. CONCLUSIONS: Clinical characteristics can predict an attributable cause of dizziness in most older patients and thus guide general practitioners in tr eatment and appropriate specialist referral. The presence of syncope, falls , or cardiovascular comorbidity increases the likelihood of a cardiovascula r diagnosis. Otolaryngological investigations are rarely diagnostic, but ve rtiginous symptoms do predict peripheral vestibular disorders.