Approach to dizziness in internal medicine: a systematic review

Resumo

Background and objectives: One of the most common complaints physicians face is dizziness. Patients with dizziness may have an array of conditions, from benign vertigo to potentially fatal cardiac arrhythmias, and including diverse conditions such as Parkinson`s disease and hyponatremia. This is a systematic review of the classification of dizziness, aiming at a more efficient and comprehensive clinical management of the condition, prompted from the presentation of an actual clinical case. Methods: a 63-year-old man, with a 1-year-history of dizziness predominantly on walking, was presented. The complaint prompted a search of the Pubmed and Scielo databases, for flow-charts and systematizations of the approach to the condition. Results: some approaches were identified that were useful in primary care, chiefly Drachman`s 4-type classification, which minimizes diagnostic biases. The clinical case was then discussed according to the information found, and a sequence of physical examination maneuvers, to be implemented whenever a patient with dizziness is seen, was presented. Conclusion: Approaching a patient complaining of dizziness and making its differential diagnosis is a huge intellectual challenge to any physician. There are tools that allow for correct classification of the patients, reduce diagnostic biases, discourage incorrect treatments and reduce expenses.