UMEM Educational Pearls

Category: Neurology

Title: What Do You Mean By Dizzy?

Keywords: dizzy, dizzinesss, acute vestibular syndrome, triggered episodic vestibular syndrome, spontaneous episodic vestibular syndrome, HINTS, Dix-Hallpike (PubMed Search)

Posted: 4/13/2016 by WanTsu Wendy Chang, MD
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What Do You Mean By Dizzy?

  • Patients with dizziness account for 3% of ED visits.
  • The traditional approach based on symptom quality (i.e. “What do you mean by dizzy”) is not reliable.
  • Drs. Edlow and Newman-Toker propose a new paradigm based on the timing and triggers of dizziness.
  • Acute vestibular syndrome begins abruptly or rapidly and continues for days.  Patients’ dizziness may be exacerbated by movement but is not triggered by movement.
  • Triggered episodic vestibular syndrome are repetitive episodes of dizziness triggered by some event.  Patients will be completed asymptomatic at rest and will develop dizziness that is reliably triggered by a specific event or postural shift.
  • Spontaneous episodic vestibular syndrome are multiple episodes of dizziness that occur without any clear identifiable trigger.  Patients are asymptomatic between episodes.


Table 1 shows common benign and serious causes of these vestibular syndromes.


Utilizing the HINTS battery or the Dix-Hallpike maneuver, a “safe to go” algorithm for acute vestibular syndrome and triggered episodic vestibular syndrome is outlined in Figure 2.



  1. Edlow JA, Newman-Toker D. Using the physical examination to diagnose patients with acute dizziness and vertigo. J Emerg Med. 2016;50(4):617-28.
  2. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504-10.


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20160413_Table_1.jpg (139 Kb)

20160413_Figure_2.jpg (89 Kb)