All EMS presentations
NeurologicClinical presentation

Dizziness / vertigo

A streamlined, differential-led presentation for rapid clinical review.

Clinical snapshot

Twenty-second review

  • Dizziness may represent vertigo, disequilibrium, presyncope, or nonspecific light-headedness arising from vestibular, neurologic, cardiovascular, metabolic, or medication causes.
  • New focal deficit, inability to walk, severe headache, chest pain, dysrhythmia, syncope, or persistent vomiting raises concern.
  • Keep hypoglycemia or medication effect in the differential; overlapping or concurrent illness remains possible.
  • For dizziness / vertigo, trends and combinations of findings are more informative than one isolated vital sign.
Differentials

Compare the clinical patterns

The repeated material is grouped inside each possibility. Open only the condition you need.

Serious2 conditions
Posterior circulation strokeTime-sensitive high-risk possibility

HPI

Clarify clarify spinning vs lightheadedness vs imbalance; sudden/gradual; exact onset/last known well.

Signs & symptoms

New ataxia, focal findings, severe headache, or abnormal ECG.

Focused exam

Record GCS components, pupils, speech, gaze, motor symmetry, sensation, coordination, and gait when safe; Compare findings with baseline and collateral history.

Brief pathophysiology

Posterior circulation stroke may cause dizziness / vertigo through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Stroke is a clinical diagnosis supported by time course and neurologic findings. Blood pressure and glucose affect eligibility and mimics; normal vitals do not exclude stroke.

Blood pressure (mmHg)

Often elevated

Hypertension is common in acute stroke; hypotension suggests another cause or poor perfusion.

Blood glucose (mmol/L)

Check every patient

Hypoglycemia can mimic focal deficit; hyperglycemia may accompany stress or diabetes.

Heart rate (bpm)

Assess rate / rhythm

An irregular rhythm may suggest atrial fibrillation but is not required.

Oxygen saturation (SpO₂)

Usually preserved

Hypoxemia requires correction and may indicate aspiration or another process.

Front-load in the triage report

  • Posterior circulation stroke: New ataxia, focal findings, severe headache, or abnormal ECG.
  • Clarify spinning vs lightheadedness vs imbalance.
  • Sudden/gradual.
DysrhythmiaTime-sensitive high-risk possibility

HPI

Clarify sudden/gradual; exact onset/last known well; constant or episodic.

Signs & symptoms

New ataxia, focal findings, severe headache, or abnormal ECG.

Focused exam

Compare findings with baseline and collateral history; Clarify the sensation; assess eye movements, cerebellar function, gait when safe, hearing, neurologic findings, rhythm, and orthostatic context.

Brief pathophysiology

Dysrhythmia may cause dizziness / vertigo through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Rhythm, rate, symptoms, and perfusion determine urgency. A normal blood pressure does not exclude ischemia or a dangerous intermittent rhythm.

Heart rate (bpm)

Rate / rhythm abnormal

Characterize rate, regularity, onset, and ECG rhythm rather than assuming tachycardia.

Blood pressure (mmHg)

May be preserved or low

Falling pressure suggests reduced cardiac output or instability.

MAP (mmHg)

Trend perfusion

Interpret with mentation, skin signs, and symptom trajectory.

Oxygen saturation (SpO₂)

Usually preserved

Abnormal oxygenation suggests heart failure, ischemia, or another concurrent process.

Front-load in the triage report

  • Dysrhythmia: New ataxia, focal findings, severe headache, or abnormal ECG.
  • Sudden/gradual.
  • Exact onset/last known well.
Common2 conditions
Peripheral vertigoCommon presentation pattern

HPI

Clarify clarify spinning vs lightheadedness vs imbalance; sudden/gradual; exact onset/last known well.

Signs & symptoms

Positional trigger, auditory symptoms, volume loss, or medication change may support the mechanism.

Focused exam

Record GCS components, pupils, speech, gaze, motor symmetry, sensation, coordination, and gait when safe; Compare findings with baseline and collateral history.

Brief pathophysiology

Peripheral vertigo may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

Neurologic differentials often have nonspecific vital signs. Glucose, pressure, oxygenation, and cardiac rate/rhythm help identify mimics and prevent secondary injury.

Blood glucose (mmol/L)

Check early

Hypoglycemia can mimic or worsen neurologic dysfunction.

Blood pressure (mmHg)

Trend pressure

Both hypo- and hypertension can be clinically important in neurologic disease.

Oxygen saturation (SpO₂)

Prevent hypoxemia

Low saturation can worsen brain injury or suggest an alternate cause.

Heart rate (bpm)

Assess rate / rhythm

Rhythm disturbance can cause cerebral hypoperfusion or embolic events.

Front-load in the triage report

  • Positional trigger, auditory symptoms, volume loss, or medication change may support the mechanism.
  • Clarify spinning vs lightheadedness vs imbalance.
  • Sudden/gradual.
OrthostasisCommon presentation pattern

HPI

Clarify sudden/gradual; exact onset/last known well; constant or episodic.

Signs & symptoms

Positional trigger, auditory symptoms, volume loss, or medication change may support the mechanism.

Focused exam

Compare findings with baseline and collateral history; Clarify the sensation; assess eye movements, cerebellar function, gait when safe, hearing, neurologic findings, rhythm, and orthostatic context.

Brief pathophysiology

Orthostasis may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

Neurologic differentials often have nonspecific vital signs. Glucose, pressure, oxygenation, and cardiac rate/rhythm help identify mimics and prevent secondary injury.

Blood glucose (mmol/L)

Check early

Hypoglycemia can mimic or worsen neurologic dysfunction.

Blood pressure (mmHg)

Trend pressure

Both hypo- and hypertension can be clinically important in neurologic disease.

Oxygen saturation (SpO₂)

Prevent hypoxemia

Low saturation can worsen brain injury or suggest an alternate cause.

Heart rate (bpm)

Assess rate / rhythm

Rhythm disturbance can cause cerebral hypoperfusion or embolic events.

Front-load in the triage report

  • Positional trigger, auditory symptoms, volume loss, or medication change may support the mechanism.
  • Sudden/gradual.
  • Exact onset/last known well.
Mimics2 conditions
HypoglycemiaImportant alternative presentation

HPI

Clarify clarify spinning vs lightheadedness vs imbalance; sudden/gradual; exact onset/last known well.

Signs & symptoms

Check glucose and recent drug changes without stopping the neurologic assessment.

Focused exam

Record GCS components, pupils, speech, gaze, motor symmetry, sensation, coordination, and gait when safe; Compare findings with baseline and collateral history.

Brief pathophysiology

Hypoglycemia can resemble dizziness / vertigo through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Confirm low capillary glucose and reassess after treatment. Adrenergic signs may be absent in recurrent hypoglycemia or blunted by medications.

Blood glucose (mmol/L)

< 4.0 mmol/L

BCEHS defines hypoglycemia as blood glucose below 4.0 mmol/L.

Heart rate (bpm)

May rise

Adrenergic activation commonly produces tachycardia, but this is not universal.

Blood pressure (mmHg)

Often preserved

Blood pressure is not a reliable discriminator; hypotension suggests another or additional process.

Temperature (°C)

May fall

Hypothermia can accompany prolonged or severe hypoglycemia.

Front-load in the triage report

  • Check glucose and recent drug changes without stopping the neurologic assessment.
  • Clarify spinning vs lightheadedness vs imbalance.
  • Sudden/gradual.
Medication effectImportant alternative presentation

HPI

Clarify sudden/gradual; exact onset/last known well; constant or episodic.

Signs & symptoms

Check glucose and recent drug changes without stopping the neurologic assessment.

Focused exam

Compare findings with baseline and collateral history; Clarify the sensation; assess eye movements, cerebellar function, gait when safe, hearing, neurologic findings, rhythm, and orthostatic context.

Brief pathophysiology

Medication effect can resemble dizziness / vertigo through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Neurologic differentials often have nonspecific vital signs. Glucose, pressure, oxygenation, and cardiac rate/rhythm help identify mimics and prevent secondary injury.

Blood glucose (mmol/L)

Check early

Hypoglycemia can mimic or worsen neurologic dysfunction.

Blood pressure (mmHg)

Trend pressure

Both hypo- and hypertension can be clinically important in neurologic disease.

Oxygen saturation (SpO₂)

Prevent hypoxemia

Low saturation can worsen brain injury or suggest an alternate cause.

Heart rate (bpm)

Assess rate / rhythm

Rhythm disturbance can cause cerebral hypoperfusion or embolic events.

Front-load in the triage report

  • Check glucose and recent drug changes without stopping the neurologic assessment.
  • Sudden/gradual.
  • Exact onset/last known well.
Red flags

Findings that should escalate concern

  • New focal deficit, inability to walk, severe headache, chest pain, dysrhythmia, syncope, or persistent vomiting raises concern.
  • Posterior circulation stroke or dysrhythmia: New ataxia, focal findings, severe headache, or abnormal ECG.
Related EMS presentations

Continue the clinical pathway

CardiacSyncope / presyncopeGeneral MedicalNausea / vomitingNeurologicStroke / TIACardiacPalpitations / tachyarrhythmiaNeurologicAcute visual complaint
References

Clinical and academic sources

Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.

BCEHS Handbook — specific CPGs

  1. A02: Patient AssessmentBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for patient assessment.

  2. F01: Altered Levels of ConsciousnessBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for altered levels of consciousness.

Supporting clinical and academic evidence

  1. CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians

    Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.

  2. WHO Medical Emergency ChecklistWorld Health Organization

    A structured emergency assessment framework intended to reduce missed life-threatening conditions.

  3. GRACE-3: Acute dizziness and vertigo in the emergency departmentAcademic Emergency Medicine · 2023

    Evidence-based bedside assessment of acute dizziness and recognition of central causes including stroke.