Dizziness in the Emergency Room: Diagnoses and Misdiagnoses

Royl, Georg; Ploner, Christoph J.; Leithner, Christoph

doi:10.1159/000331046

Cited by 113 publications

(92 citation statements)

References 44 publications

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“…A study that looked at the prevalence of misdiagnoses among dizzy patients found that the main diagnostic challenge lay in distinguishing vestibular neuritis from stroke [2]. For this purpose among AVS patients, the HINTS+ algorithm, which was rarely used in our study, may be of help [12].…”

Section: Discussionmentioning

confidence: 99%

Dizziness and the Acute Vestibular Syndrome at the Emergency Department: A Population-Based Descriptive Study

Ljunggren¹,

Persson²,

Salzer³

2017

Eur Neurol

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Background: Dizziness is a common occurrence witnessed at emergency departments (EDs). This study aims to describe the epidemiology and management of dizzy patients with and without an acute vestibular syndrome (AVS) in the ED at Umeå University Hospital. Methods: A total of n = 2,126 ED dizziness visits during 3 years were identified. Data were obtained through retrospective review of medical records. Cases were stratified based on presentation, including AVS and neurological deficits. The outcomes analyzed included cerebrovascular causes of dizziness. A Poisson distribution was assumed when calculating incidence CIs. Results: Dizziness accounted for 2.1% of all ED visits, incidence 477/100,000 inhabitants (95% CI 457–498). Among dizzy patients, 19.2% had an AVS, incidence 92/100,000 inhabitants (95% CI 74–113). Top medical diagnostic groups were otovestibular (15.1%), cardiovascular (8.7%) and neurological diseases (7.7%), including stroke and transitory ischemic attack (4.8%). Cerebrovascular causes of dizziness were more common among those with an AVS (10.0%) vs. those without (3.6%), p < 0.01. Conclusion: The risk for cerebrovascular causes of dizziness, although low in an unselected cohort, increases with the presence of neurological signs and an AVS. These population-based data may be useful when planning and implementing dizziness and AVS management algorithms at EDs.

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Section: Discussionmentioning

confidence: 99%

Dizziness and the Acute Vestibular Syndrome at the Emergency Department: A Population-Based Descriptive Study

Ljunggren¹,

Persson²,

Salzer³

2017

Eur Neurol

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“…B. peripher vestibulären Ätiolo-gien neurologische Expertise beispielsweise durch Beurteilung eines Nystagmus erfordert [8]. Selbst in einer großen deutschen Notaufnahme musste in 6 % der Fälle die initiale benige Ätiologie-vermutung zugunsten einer gravierenden Diagnose revidiert werden, während umgekehrt in 23 % der Fälle der Verdacht einer gravierenden Diagnose nicht bestä-tigt werden konnte [9].…”

Section: Neurologische Expertise Bei Vieldeutigen Symptomenunclassified

Brennpunkt Notaufnahme

2016

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The number of patients treated in hospital emergency departments in Germany has risen in recent years to approximately 20 million. This escalation also applies to the increasing numbers of patients presenting with neurological symptoms and diseases, which occur in approximately 20 % of emergency patients. In addition to patients with stroke, inflammatory or degenerative central nervous system (CNS) and peripheral nervous system (PNS) disorders who need urgent treatment, more and more patients with nonspecific complaints or conditions attend emergency departments for elective treatment, not least because timely appointments with specialist neurologists in practices could not be obtained. Neurological expertise and presence in emergency departments at the level of specialist standard are therefore indispensable for providing a professional level of treatment, which also corresponds to current legal requirements. The implementation of a generalist emergency physician in Germany, as introduced in some European countries, would mean a retrograde step for neurological expertise in emergency admission management. The discipline of neurology must work together with other emergency disciplines to improve the financing of emergency departments and provide neurologists working there with a substantive curriculum of further and continuing education in emergency-related aspects of neurology. The discipline of neurology has a responsibility to emergency patients within its range of competencies and must, therefore, strengthen and improve its role in healthcare politics and concerning organizational and personnel aspects of neurological emergencies.

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“…Dizziness is among the most frequent symptoms in emergency room patients as demonstrated by Royl et al in 2011 [1]. The management must be fast and effective due to similarities to central causes and to the great discomfort it causes to the patients.…”

Section: Introductionmentioning

confidence: 99%

Association between Hearing Loss and Vestibular Disorders: A Review of the Interference of Hearing in the Balance

Santos¹,

Venosa²,

Sampaio³

2015

IJOHNS

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Introduction: Dizziness is very prevalent and makes a great impact on people's life. Because of anatomical and functional similarities of hearing and vestibular systems, it is noted that there is a big relation between hearing loss and vestibular disorders. Depending on the age onset of hearing loss, it can cause even delay on motor development. Objective: To find literature that demonstrates the relation between hearing and balance. Confirming that hearing loss or even intervention to improve quality of hearing can interfere on vestibular system. Methodology: Revision of literature was carried out, preferring recent research only in English. Conclusion: Cochlea and vestibular systems have a close relationship; changes in one of them can cause big damage in the other. So, a complete evaluation of vestibular system is recommended before ear surgeries. Video Head Impulse Test is a new procedure able to evaluate high frequency movements of the head. It was an additional exam of vestibular status and came to help detect problems that were not diagnosed before. Efforts must be directed in order to protect the balance.

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Dizziness in the Emergency Room: Diagnoses and Misdiagnoses

Cited by 113 publications

References 44 publications

Dizziness and the Acute Vestibular Syndrome at the Emergency Department: A Population-Based Descriptive Study

Dizziness and the Acute Vestibular Syndrome at the Emergency Department: A Population-Based Descriptive Study

Brennpunkt Notaufnahme

Association between Hearing Loss and Vestibular Disorders: A Review of the Interference of Hearing in the Balance

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