Fits, faints, funny turns, and falls in the differential diagnosis of the dizzy patient

Abstract

Sudden unexplained falls may provide a diagnostic challenge to the physician as a broad differential diagnosis needs to be considered while confronted with an incomplete and potentially inaccurate history provided by the patient and eyewitnesses. Falls may go along with transient loss of consciousness (TLOC) and may be preceded by vertigo / dizziness (“funny turns”), which, however, may present in isolation also. The diagnostic approach should focus on the most frequent (reflex syncope (‘faints’), psychogenic syncope / seizure and epileptic seizures (“fits”)) and the most dangerous (cardiogenic syncope, symptomatic seizures, vertebrobasilar TIA) causes of TLOC and falls. Mimics of seizure include reflex syncope, autonomic failure and psychogenic non-epileptic seizures and their identification is important for a targeted treatment. The duration, onset and frequency of transient dizziness /vertigo needs to be carefully evaluated and potential triggers desire special attention to narrow the differential diagnosis of dizziness /vertigo. Diagnostic testing should be ordered based on the clinical findings only. While prognosis is usually excellent for certain differential diagnoses (e.g. reflex syncope), one-year mortality may reach values of up to 30% in others (e.g. cardiac syncope), underling the importance to distinguish between different conditions.