Dizziness is a common complaint and has a very broad list of possible underlying causes. Dizziness is a nonspecific term which can mean true Vertigo, light-headedness, weakness (neurological impairment), unsteadiness, feeling faint (presyncope), funny turns, visual disturbance, or a psychological problem.

Dizziness is often dismissed as a trivial symptom. However, patients often experience significant social and occupational morbidity, and establishing the diagnosis is essential in view of the wide variety of possible causes and also to enable effective management. It is essential that patients who present with dizziness should be given the correct diagnosis, both to avoid missing serious neurological causes and to ensure that the right treatment is given.

Expensive investigations are rarely helpful in dizzy elderly people. The cause of the dizziness can be diagnosed in most cases on the basis of a thorough clinical history and examination and often does not require hospital referral.

Causes of dizziness
The most common causes of true vertigo encountered in primary care are labyrinthitis or vestibular neuronitis, benign paroxysmal positional vertigo (BPPV), vestibular migraine and Ménière's Disease. Even in the elderly, an underlying cause for dizziness can usually be established.

Management
Management depends on the underlying cause but, in general terms, management includes:
-- Thorough discussion with the patient and explanation of the problem and any underlying cause.
-- Evaluation and correction or amelioration of any associated medical problem.
-- Drug treatment for symptoms of vertigo and any associated nausea, vomiting, sweating or diarrhoea. Great care should be given in prescribing drugs, especially to the elderly, in view of potential sedative effects and possible increase in risk of falls. Drugs should not be prescribed without a thorough assessment of the underlying cause of the dizziness.