Am Fam Physician. 2010 Aug 15;82(4):361-8, 369.
Dizziness accounts for an estimated 5 percent of primary care clinic visits. The patient history can generally classify dizziness into one of four categories: vertigo, disequilibrium, presyncope, or lightheadedness. The main causes of vertigo are benign paroxysmal positional vertigo, Meniere disease, vestibular neuritis, and labyrinthitis. Many medications can cause presyncope, and regimens should be assessed in patients with this type of dizziness. Parkinson disease and diabetic neuropathy should be considered with the diagnosis of disequilibrium. Psychiatric disorders, such as depression, anxiety, and hyperventilation syndrome, can cause vague lightheadedness. The differential diagnosis of dizziness can be narrowed with easy-to-perform physical examination tests, including evaluation for nystagmus, the Dix-Hallpike maneuver, and orthostatic blood pressure testing. Laboratory testing and radiography play little role in diagnosis. A final diagnosis is not obtained in about 20 percent of cases. Treatment of vertigo includes the Epley maneuver (canalith repositioning) and vestibular rehabilitation for benign paroxysmal positional vertigo, intratympanic dexamethasone or gentamicin for Meniere disease, and steroids for vestibular neuritis. Orthostatic hypotension that causes presyncope can be treated with alpha agonists, mineralocorticoids, or lifestyle changes. Disequilibrium and lightheadedness can be alleviated by treating the underlying cause.
头晕约占初级保健诊所就诊的 5%。病史通常可将头晕分为以下四类：眩晕、失衡、晕厥前状态或头晕。眩晕的主要原因是良性阵发性位置性眩晕、梅尼埃病、前庭神经炎和迷路炎。许多药物可引起晕厥前状态，应评估此类头晕患者的治疗方案。帕金森病和糖尿病性神经病应与平衡障碍的诊断相关。精神障碍，如抑郁症、焦虑症和过度通气综合征，可引起模糊的头晕。通过易于进行的体格检查测试（包括评估眼球震颤、Dix-Hallpike 手法和直立位血压测试）可以缩小头晕的鉴别诊断范围。实验室检查和影像学检查在诊断中作用不大。大约 20%的病例无法获得明确诊断。眩晕的治疗包括 Epley 手法（耳石复位）和前庭康复治疗良性阵发性位置性眩晕、鼓室内地塞米松或庆大霉素治疗梅尼埃病以及类固醇治疗前庭神经炎。引起晕厥前状态的直立性低血压可通过使用α激动剂、盐皮质激素或生活方式改变进行治疗。通过治疗潜在病因，可以缓解失衡和头晕。
