Key Points

• Dizziness is a risk factor for falls and functional decline in older adults.

• Characterizing the type of dizziness can narrow the differential diagnosis.

• Benign paroxysmal positional vertigo patients complain of episodic vertigo without aural symptoms.

Dizziness is a common problem encountered by the family physician. It is a typical complaint of elderly patients and has a broad differential diagnosis. Fortunately, dizziness is usually benign and self-limited. Nevertheless, it is a risk factor for falls and functional decline in the geriatric population and, in a small subset of patients, can signal a life-threatening condition.

mental status changes that progress to stupor or coma, seizures, and focal neurologic findings. Laboratory studies are not impressive. Caution should be exercised before performing LP because brain edema is often present. Once past the initial cerebritis stage, CT or MRI of the brain often identifies the abscess. A search for a secondary cause is important. A radionuclide-labeled leukocyte scan may be needed to differentiate a brain tumor from infection. Aspiration or biopsy of the area in question usually confers a definitive diagnosis.

Treatment is directed toward the cause and lasts for 4 to 6 weeks. Drainage of the abscess is achieved by CT-guided needle aspiration or craniotomy. Recurrence can be expected

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