Chapter 46

### Introduction

I got my giddiness in 1690 (at the age of 23) by eating 100 golden pippins at a time at Richmond. Four years later at a place 20 miles further on in Surrey I got my deafness; and these two ‘friends’ have visited me one or other year since, and being old acquaintances have often sought fit to come together.

Jonathan Swift (1667–1745), describing his Ménière syndrome

When patients complain of ‘dizziness’, they can be using this term to describe many different phenomena, and hence a careful history is required to unravel the problem. Other patients may use different terms to explain the same sensation, for example, ‘giddiness’, ‘swimming in the head’, ‘my brain spinning’, ‘whirling’ and ‘swinging’.

‘Dizzy’ comes from an old English word, dysig, meaning foolish or stupid. Strictly speaking, it means unsteadiness or lightheadedness—without movement or motion or spatial disorientation.

‘Vertigo’, on the other hand, comes from the Latin vertere (to turn) and -igo for a condition. It should describe a hallucination of rotation of self or the surroundings in a horizontal or vertical direction.1

The term ‘dizziness’, however, is generally used collectively to describe all types of equilibrium disorders and, for convenience, can be classified as shown in FIGURE 46.1.

###### FIGURE 46.1

Classification of dizziness

Key facts and checkpoints

• Approximately one-third of the population will have suffered from significant dizziness by age 65 and about a half by age 80.2

• The commonest causes in family practice are postural hypotension and hyperventilation.

• The ability to examine and interpret the sign of nystagmus accurately is important in the diagnostic process.

• A drug history is very important, including prescribed drugs and others such as alcohol, cocaine, marijuana and illicit drugs.

• Ménière syndrome is overdiagnosed. It has the classic triad: vertigo–tinnitus–deafness (sensorineural).

• Vertebrobasilar insufficiency is also overdiagnosed as a cause of vertigo. It is a rare cause but may result in dizziness and sometimes vertigo but rarely in isolation.

### Defined terminology

#### Vertigo

Vertigo is defined as an episodic sudden sensation of circular motion of the body or of its surroundings or an illusion of motion, usually a rotatory sensation. Other terms used by the patient to describe this symptom include ‘everything spins’, ‘my head spins’, ‘the room spins’, ‘whirling’, ‘reeling’, ‘swaying’, ‘pitching’ and ‘rocking’. It is frequently accompanied by autonomic symptoms such as nausea, retching, vomiting, pallor and sweating.

Vertigo is characteristically precipitated by standing or turning the head or by movement. Patients have to walk carefully and may become nervous about descending stairs or crossing the road and usually seek support. Therefore the vertiginous patient is usually very frightened and tends to remain immobile during an attack.

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