DIZZINESS - 09/09/11

Doi : 10.1016/S0733-8627(05)70036-5

James S. Walker, DO ^{^{*
Section of Emergency Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma}}, FACEP ^{^{*
Section of Emergency Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma}}, S. Brent Barnes, MD ^{^{*
Section of Emergency Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma}}

Resumen

Dizziness is a commonly encountered complaint in the emergency department (ED) and accounts for approximately 1.5% of all hospital admissions.^{13 Davis E.A. Emergency department approach to vertigo Emerg Med Clin North Am 1987 ; 5 : 211-226

Haga clic aquí para ir a la sección de Referencias, 35 Olsky M., Murray J. Dizziness and fainting in the elderly Emerg Med Clin North Am 1990 ; 8 : 295-307

Haga clic aquí para ir a la sección de Referencias, 40 Sloane P.D. Dizziness in primary care: Results from the National Ambulatory Medical Care survey J Fam Pract 1989 ; 29 : 33-38

Haga clic aquí para ir a la sección de Referencias} In one survey, 26% of all ED patients stated that they had experienced dizziness.^{28 Koziol-McLain J., Lowenstein S.R., Fuller B. Orthostatic vital signs in emergency department patients Ann Emerg Med 1991 ; 20 : 606-610 [cross-ref]

Haga clic aquí para ir a la sección de Referencias} Dizziness may be the most common non–pain-related physical complaint seen in the ED. In primary care practices, it is reported that dizziness accounts for 8 million outpatient visits per year in the United States.^{40 Sloane P.D. Dizziness in primary care: Results from the National Ambulatory Medical Care survey J Fam Pract 1989 ; 29 : 33-38

Haga clic aquí para ir a la sección de Referencias} In fact, all people experience dizziness at some point during their lives. If dizziness is so frequently encountered, what precipitates a patient with dizziness to present to the ED? There are two primary reasons why people experiencing dizziness present to the ED: (1) it interferes with their normal daily activities, and (2) the patient is concerned that they might have a serious underlying disease process.^{41 Sloane P.D. Evaluation and management of dizziness in the older patient Clin Geriatr Med 1996 ; 12 : 785-801

Haga clic aquí para ir a la sección de Referencias, 51 Warner E.A., Wallach P.M., Adelman H.M. , y al. Dizziness in primary care patients J Gen Intern Med 1992 ; 7 : 454-463 [cross-ref]

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Dizziness is uncommon in children, but becomes more common in adults as a function of age. In fact, dizziness affects more than 50% of elderly patients and is the commonest complaint of patients over 75 years of age.^{26 Jacobson G.P., Newman C.W. The development of the dizziness handicap inventory Arch Otolaryngol Head Neck Surg 1990 ; 116 : 424-427

Haga clic aquí para ir a la sección de Referencias} In the elderly, dizziness can lead to falls and significant injuries. When troubled by dizziness, older patients often refrain from physically strenuous activities, social events, and travel. Accordingly, a fear of dizziness can cause these senior citizens to withdraw socially and facilitate their functional decline.^{8 Boult C., Murphy J., Sloane P. , y al. The relation of dizziness to functional decline J Am Geriatr Soc 1991 ; 39 : 858-861

Haga clic aquí para ir a la sección de Referencias, 25 Honrubia V., Bell T.S., Harris M.R. , y al. Quantitative evaluation of dizziness characteristics and impact on quality of life Am J Otol 1996 ; 17 : 595-602

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For many emergency physicians, the clinical evaluation of dizziness is a difficult and perplexing task. The primary reason for this frustration is because dizziness is a nonspecific symptom that describes a subjective sensation that is virtually impossible to objectively measure. Patients use the term dizziness to describe a perception of altered variation in spatial awareness.^{3 Baloh R.W. Approach to the dizzy patient Bailliere's Clin Neurol 1994 ; 3 : 453-465

Haga clic aquí para ir a la sección de Referencias} This perception ranges from a general sense of illness, to fatigue, weakness, lightheadedness, fainting, disequilibrium, or an illusion of motion (vertigo). The cause of these perceptions can range from labyrinthitis to cerebral hemorrhage to cardiac arrhythmias to orthostatic hypotension to volume depletion. It is readily apparent to the clinician that the ability to rapidly focus on one organ system dysfunction to explain or account for the patient's presentation is not possible—especially in the aged. Multiple systems maintain the proper perception of the relationship between the person and the environment. These systems include the vestibular, visual, and proprioceptive systems. Accordingly, the differential diagnosis can be quite lengthy. Regretfully, there is no quick and simple method to identify patients, especially older patients, at risk for “serious” causes of dizziness.

The purpose of this article is to present a systematic approach to the evaluation and management of the dizzy patient from the perspective of the emergency physician, with an emphasis on a management strategy that is timely and cost effective. Subsequently, obtaining a precise and accurate history and physical examination cannot be stressed enough, because in the evaluation of this complaint, laboratory tests and imaging studies are of little, if any, diagnostic value. The first portion of the article focuses on adults, particularly the geriatric patient, and the second portion of the article concentrates on pediatric patients.

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