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A prospective case-controlled study involving 50 patients over the age of 60 who presented with dizziness and 22 case controls matched in age and sex was conducted to identify the clinical characteristics that might indicate the most likely basis for dizziness. Patients were interviewed about their symptoms, and all received neurologic, cardiovascular, and otolaryngologic examinations.
Researchers found that symptoms were of long duration, a median of one year, and 46% of subjects reported syncope and/or falls in addition to dizziness.
3 sources of dizziness
They attributed dizziness to three sources:
• cardiovascular diagnosis in 14 patients (28%);
• peripheral vestibular disorder in nine patients (18%);
• and central neurological disorder in seven patients (14%).
In nine patients (18%), two or more diagnoses were found, and in 11 (22%), no attributable cause could be identified.
Researchers found dizziness significantly more likely to be of cardiovascular origin when accompanied by syncope, lightheadedness, pallor, a coexisting cardiovascular disease, or triggered by prolonged standing. Dizziness described as vertigo predicted a peripheral vestibular origin.
Study authors concluded that "clinical characteristics can predict an attributable cause of dizziness in most older patients and thus guide general practitioners in treatment and appropriate specialist referral." — JAU
Lawson J, Fitzgerald J, Birchall J, et al. Diagnosis of geriatric patients with severe dizziness. J Am Geriatr Soc 1999;47:113-114.