Although you should always try to characterize dizziness, patients often have difficulty describing their dizziness. Utilizing a timing and triggers approach is more accurate in determining underlying etiology compared to the classic symptom-based approach to dizziness (“vertigo” vs “lightheadedness” vs “disequilibrium”). If constant dizziness, perform HINTS+. If positive, obtain MRI brain to rule out posterior fossa ischemia and MRA head/neck to rule out cerebral dissection.
Characterize Dizziness
NOTE: BPPV may have feelings of constant dizziness if moving or in motion, but it should resolve when the patient is completely motionless IF YES: Check orthostatic vitals and perform Dix-Hallpike
IF YES: do HINTS+ to differentiate between posterior circulation stroke and vestibular neuritis. Check if prior brain and/or vessel imaging