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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Tuesday, November 17, 2015


Taming the SRU - November 17, 2015 
"This month we have the pleasure of discussing the chief complaint of “dizziness” with Dr. William Knight. In the attached podcast much of our discussion regarding this symptom focuses on stroke as a cause of this complaint. Even so, it is important to remember that not all patients who present to the emergency department with dizziness are experiencing a stroke. Quite the opposite; the majority of patients seeking care for feeling “dizzy” or “lightheaded” or “imbalanced” will have a cause other than restriction of blood flow to, or bleeding into, the posterior fossa. One national survey found that of patients presenting to the ED for “dizziness”, half had a medical (i.e. non-vestibular and non-neurological) cause for their symptoms. The differential diagnosis for dizziness is wide in etiology as well as severity. It is important to consider that this chief complaint could represent anything from carbon monoxide poisoning to the combination of chewing tobacco and carnival rides. 
On review, of patients with an ABCD2 score of less than or equal to 3, only 5 of 512 patients had a cerebrovascular diagnosis as cause of their symptoms. Of those 5, all had at least 2 vascular risk factors. Among their findings they also report a positive likelihood ratio ranging from 1.3 for a score of 3 to the range of 7-8 for a score in the range of 6-7. Although this study does have its limitations and certainly doesn’t provide the evidence necessary to effectively rule out stroke through its application, it can be a useful tool for reinforcement of your assessment of a patient’s risk for stroke when presenting with dizziness."