10/31/2023 0 Comments Dizziness handicap inventory excelPrevious research studies showed that Dutch PCPs scarcely reported adverse drug effect as a cause of dizziness in older patients (1–3%) ( 14, 15), whereas a diagnostic panel study among the same population found a much higher proportion (25%) ( 10). Although an adverse drug effect is a rare cause of vertigo/dizziness in younger patients, it is much more prevalent and regularly missed in older patients. An accurate diagnosis starts with thorough history taking, focusing on symptom characteristics, timing, and triggers according to the ICVD.ĭuring history taking, the importance of a medication review is apparent. Although this is not unusual for comparable reasons for encounter (like tiredness), we firmly believe it is possible and necessary to reduce the number of undiagnosed dizzy patients in primary care. Up to 40% of patients presenting with vestibular symptoms in primary care remain undiagnosed ( 14, 15). In short, the ICVD nomenclature provides an essential tool for the work-up and communication of vestibular symptoms in primary care (tool #1). ![]() Disorders presenting with CVS include poorly compensated vestibulopathy, bilateral vestibulopathy, and persistent postural perceptual dizziness ( 13). CVS is defined as chronic vertigo/dizziness lasting months to years, generally including symptoms that suggest persistent dysfunction of the vestibular system (like oscillopsia, nystagmus, and gait unsteadiness). Disorders presenting with EVS include vestibular migraine, benign paroxysmal positional vertigo, Menière's disease, and panic attacks. EVS is defined as transient vertigo/dizziness lasting seconds to hours, generally including symptoms that suggest temporary dysfunction of the vestibular system (like nausea, nystagmus, and sudden falls). Disorders presenting with AVS include vestibular neuritis, labyrinthitis, stroke affecting vestibular structures, and traumatic vestibulopathy. AVS is defined as acute-onset, continuous vertigo/dizziness, lasting days to weeks, generally including symptoms that suggest new dysfunction of the vestibular system (like vomiting, nystagmus, and severe postural instability). Combining the mentioned vestibular symptoms with timing and triggers results in three vestibular syndromes, i.e., acute vestibular syndrome (AVS), episodic vestibular syndrome (EVS), and chronic vestibular syndrome (CVS). When assessing a patient with vestibular symptoms, the Bárány society recommends to focus on timing (onset, duration, and evolution of symptom) and triggers (actions, movements, or situations that provoke onset of symptoms) ( 11, 12). These vestibular symptoms are not specific in terms of etiology, not overlapping, and not hierarchical (a single patient can experience multiple symptoms) ( 13). The ICVD identifies four main vestibular symptoms, i.e., dizziness (“the sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion”) vertigo (“the sensation of self-motion when no motion is present or the sensation of distorted self-motion during normal head movement”) vestibulovisual symptoms (“visual symptoms that result from vestibular pathology or visual-vestibular interaction”) postural symptoms (“balance symptoms related to maintenance of postural stability, occurring only while upright-seated, standing, or walking”) ( 13). The Bárány society, the leading international organization for clinicians and researchers involved in vestibular medicine, previously realized such a nomenclature: the International Classification of Vestibular Disorders (ICVD) ( 11, 12). Therefore, it is time to leave the Drachman-Hart typology and to adopt a more accurate and uniform way to describe vestibular symptoms. However, both doctors and patients use the term “vertigo” differently ( 6– 8), patients are inconsistent when describing their symptoms ( 7), the identified subtype does not reliably match the suggested etiology ( 5, 9), and regularly patients have more than one dizziness subtype ( 10). The Drachman-Hart typology is primarily based on how patients describe the nature of their symptoms, assuming that this will provide etiological insight, and therefore, diagnostic guidance ( 4, 5). This typology distinguishes four dizziness subtypes, i.e., vertigo (rotational dizziness), presyncope (lightheadedness), disequilibrium (unsteadiness when walking), and non-specific dizziness. ![]() To date, most primary care guidelines use the typology of Drachman and Hart ( 3). When approaching a potentially complex problem, the use of a uniform nomenclature is crucial.
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