Examination of patients with acute dizziness in a neurological department.

Abstract

Acute dizziness may have a number of causes, including cerebrovascular stroke which can present as isolated acute vestibular syndrome. It is recommended that acute episodic dizziness be assessed using positioning tests, and acute persistent dizziness with a focus on the HINTS (Head Impulse, Nystagmus, Test of Skew) battery of tests, which can distinguish cerebrovascular stroke from vestibular neuritis. We wished to identify the prevalence, diagnostic spectrum and approach to acute dizziness in a neurological department. We undertook a retrospective review of the medical records of all patients with acute dizziness as the primary symptom who where admitted to the department of neurology at Sørlandet Hospital, Kristiansand in 2015. Of 2 231 patients admitted to the department of neurology in 2015, altogether 243 (11%) had dizziness as the primary symptom. A total of 106 patients (44%) were examined using HINTS in its entirety. A cranial CT was performed in 213 (88%) and MRI in 91 (37%), and these showed relevant pathology in 1 and 4 patients, respectively. Upon discharge, 122 patients (50%) were given a non-specific symptom diagnosis, 59 (24%) received the diagnosis vestibular neuritis, 41 (17%) benign paroxysmal positional vertigo, and 5 (2%) were diagnosed with cerebrovascular stroke. Four out of five cases of cerebrovascular stroke could be classified retrospectively as acute vestibular syndrome, whereof three had typical findings determined by the HINTS test. Acute dizziness is a frequent symptom in patients admitted to the department of neurology. Evidence-based diagnostic recommendations for the assessment of acute dizziness were not satisfactorily implemented in practice.