Table 1.

Classification of Dizziness

Type	Features		Etiology
1. Vertigo	Rotary or tilting sensation		Labyrinthiasis (often viral)
	Episodic		BPPVa (canalithiasis, cupulolithiasis)
	Possible associations:	nystagmus	Labyrinthine ischemia (posterior circulation stroke)
		oscillopsia	Endolymphatic hydrops (e.g. Meniere disease)
	Vegetative symptoms:	nausea	Ototoxicity (if damage asymmetric)
		Vomiting	Trauma
		Pallor	Central vestibular connections (about 10% of cases)
		diaphoresis
2. Presyncope	Sensation of impending loss of consciousness		Dehydration
	Gradual onset (except if cardiac)		Orthostasis
	Resolution with recumbency (except if cardiac)		Vasovagal phenomena
	Associations:	generalized weakness	Sympatholytic drug therapy (alpha blockade)
		visual dimming	Primary autonomic insufficiency
	Vegetative symptoms (as with vertigo)
3. Dysequilibrium	Unsteadiness while standing or walking		Proprioceptive deficit (e.g. peripheral neuropathy)
	Exacerbated by poor lighting if sensory		Visuo-vestibular mismatch (e.g. use of optical devices)
			Compensated unilateral or balanced bilateral vestibulopathy
			Dementia
			Central motor disorders (stroke, Parkinson disease)
			Musculoskeletal disorders (e.g. DJDb, myopathies)
			Neuromuscular junction disorders (MGc, L-ESd)
4. Psychogenic	Vague sensation of giddiness or dissociation		Anxiety disorder
	Protracted or continuous with periodic flares Trigger often identifiable (crowds, confined spaces)		Mood disorder
	May be induced by hyperventilation
	Associations:	anxiety (acute or chronic)
		“light-headedness”
		“heavy-headedness”
		“wooziness”

^aBenign paroxysmal positional vertigo;

^bDegenerative joint disease;

^cmyasthenia gravis;

^dLambert-Eaton syndrome