Introduction
“Dizziness” is an umbrella, not a diagnosis.
One word covers spinning vertigo, near-faint, unsteadiness, and a vague floating fog — each with a different mechanism and work-up. The first clinical task is to turn that subjective complaint into a category.
- ≈0%of all outpatient visits are for dizziness1
- up to 0%of neurology & ENT referrals2
- ≈ 9 : 1female-to-male predominance in MdDS3
- ≥ 0 modefines PPPD (Bárány criteria)4
“Dizziness” is one of the commonest reasons people see a doctor, but it means very different things to different patients. Some feel the room spinning; some feel about to faint; some feel wobbly on their feet; and some just feel woozy or “not right”.
Sorting which kind of dizziness a patient has is the whole game — because a spinning inner-ear problem, a blood-pressure faint, and an anxiety-driven fog need completely different tests and treatments. This chapter walks through the four classic kinds and the newer functional syndromes.
Dizziness causes roughly 5% of outpatient visits and up to 10% of neurology/ENT referrals, with a heavy toll on falls and quality of life in the elderly.1 The symptom is nonspecific — an umbrella for disparate perceptual phenomena — so the diagnostic task is to convert it into objective categories that direct the work-up.
The enduring framework is Drachman & Hart's (1972) four types: vertigo, presyncope, disequilibrium, and nonspecific dizziness.2 Open-ended questioning before medical terminology is key, as overlap and imprecise description are common.3
Successful management hinges on differentiating vestibular from non-vestibular, neurological from cardiovascular, and structural from functional causes. Whether the experience is vertigo, presyncope, disequilibrium, or nonspecific dizziness is decisive, because each subtype maps to a different pathophysiology and treatment pathway.4
Modern practice extends the Drachman–Hart scheme with motion-provoked and functional syndromes — mal de débarquement and PPPD — that resist neat categorisation but are increasingly well-defined. Classification is not an academic exercise; placed in the context of comorbidities and associated signs, it is the foundation of safe diagnostic formulation.