Table 1.

Summary of common pitfalls in current approaches to diagnosing acute dizziness

Pitfalls	Additional Information
1. Overreliance on type of dizziness to guide diagnostic inquiry	Patients’ descriptions of symptom type are not reliable. Types of dizziness are not valid discriminators. The type of dizziness should be de-emphasized when making diagnostic and management decisions.
2. Underuse and misuse of timing and triggers to categorize patients for diagnosis	Patients’ report of timing and triggers are reliable. Major causes of dizziness have characteristic timing and triggers, so these attributes should be emphasized. Care should be taken to distinguish ‘triggers’ from ‘exacerbating’ features, which have very different implications for diagnosis.
3. Underuse, misuse, and misconceptions linked to hallmark eye exam findings	Major causes of dizziness have hallmark eye movement examination findings that are virtually pathognomonic. Frontline providers and neurologists should be better trained in the use of these hallmark examination findings.
4. Overweighting age, vascular risk factors, and neuro exam to screen for stroke	Although older patients with vascular risk factors are more likely to have stroke as a cause for dizziness or vertigo, young patients with stroke are far more likely to be missed, with potentially devastating consequences. Patients with central patterns of eye movements are still at a very high risk of acute stroke even when there are no vascular risk factors or general neurologic abnormalities.
5. Overuse and overreliance on head CT to ‘rule out’ neurologic causes	Head CT is commonly and increasingly used in acute presentations of dizziness. Head CT is a very insensitive test for acute ischemic stroke, which is the most common central cause of acute dizziness, so its use should be severely curtailed. If neuroimaging is required, MRI-DWI is the test of choice.