Although dizziness is a common complaint in the ED, an exact cause is often unclear.
Use a “timing-and-triggers” approach to the diagnosis of patients with dizziness; the classic “symptom-quality” approach (“What do you mean, ‘dizzy’?) should be avoided.
The timings-and-triggers approach to dizziness sorts patients into one of 3 groups (1) acute vestibular syndrome (AVS), (2) the spontaneous episodic vestibular syndrome (s-EVS), and (3) the triggered episodic vestibular syndrome (t-EVS), each of which is tightly associated with a specific differential diagnosis.
Brief episodes of dizziness that wake a patient up from sleep are nearly always BPPV.