Dizziness of Cervical Origin: Diagnosis [Clinical Review Discussion]

It is important for the physician to recognize vertigo/dizziness that may indicate a potentially life-threatening condition from a more benign condition. Although a discussion on vertigo in general is beyond the scope of this paper, an excellent review outlining proper steps to [link=../ExhibitHall/Diagnostics.aspx]diagnosis[/link] can be found in an article by Labuguen in the American Family Physician (1).

A key component to the diagnosis of dizziness of cervical origin (DCO) is taking a complete history. Clinical testing has limited value except to rule out other conditions which is often the basis upon which the diagnosis of DCO is made. Much can be learned from the patient’s history, occasionally reducing the need for time-consuming and possibly expensive clinical testing.

The characteristics of DCO are (2):

1. Often associated with whiplash injury, severe cervical arthritis, herniated cervical disc or head trauma.
2. Often with concurrent neck pain, increased symptomology on neck movement, limited range of motion or headache.
3. Gradual onset after injury.
4. Episodic in nature lasting from minutes to hours.
5. Usually described as “light-headedness or dizziness,” not “the world is spinning around me.”

The most common type of dizziness is benign paroxysmal positional vertigo which accounts for 19% of all cases of dizziness (3). It is often diagnosed by using the Dix-Hallpike maneuver, a relatively easy to perform procedure, which is illustrated and described in detail by Labuguen in his article on vertigo (1).