ABSTRACT
Dizziness, or vertigo, figures substantially as a pre-eminent complaint in the workload of both general practitioners and neurologists. In Fry’s experience, the symptoms accounted for 30 consultations per 2000 patients per annum.2 In an outpatient neurology series, vertigo, dizziness or giddiness was a primary part of the patient’s symptoms in 11 per cent of consultations.9 A survey of patients in four general practices in London revealed that one in five responders had experienced dizziness within the previous month.10 A more recent practice analysis concluded that 2.2 per cent of patients per year consulted regarding dizziness, amounting to 0.7 per cent of all consultations,11 (i.e. about half the figure in Fry’s series). Data on the underlying mechanism of dizziness, as seen by the general practitioner, is difficult to come by. Analysis by questionnaire is unable to provide diagnostic data, although one such analysis established that half of the patients with dizziness reported anxiety or agorophobic behaviour.12 In a neurological outpatient setting, a breakdown of diagnosis in patients in whom vertigo, dizziness or giddiness was a primary complaint (though not necessarily
the sole complaint) indicated that approximately half of the patients either had a psychiatric disorder or were not specifically diagnosed (Table 4). When a patient presents to a general practitioner (or a neurologist) with vertigo or dizziness as the sole complaint, the likely diagnosis lies between:
a psychiatric condition;
an acute vestibular upset;
benign positional vertigo;
a condition of unknown origin.
