Abstract

Introduction: Dizziness is one of the most common reasons for consultation in emergency departments and is usually associated with neurological, cardiovascular, vestibular, or medication-related causes. However, it may occasionally represent the initial manifestation of a serious systemic disease, highlighting the importance of a thorough medical history and comprehensive clinical assessment. Clinical case: We present the case of a 59-year-old man, a heavy active smoker, with a history of arterial hypertension and methadone maintenance therapy, who presented with a six-week history of nonspecific dizziness associated with occipital headache, arthralgia, asthenia, somnolence, and unintentional weight loss. Physical examination revealed no significant findings. Laboratory tests showed leukocytosis, anemia, thrombocytosis, and elevated inflammatory markers. A chest radiograph, requested in the context of constitutional symptoms and active smoking, revealed findings suggestive of a pulmonary mass. Computed tomography confirmed a right upper lobe lung neoplasm associated with mediastinal involvement and multiple metastatic pulmonary lesions. Subsequent staging studies demonstrated numerous supra- and infratentorial brain metastases. Following histopathological confirmation and multidisciplinary evaluation, the patient was enrolled in a clinical trial for oncologic treatment. Despite therapy, the disease progressed unfavorably, ultimately requiring follow-up by the Palliative Care Unit. Conclusions: This case highlights that seemingly nonspecific symptoms such as dizziness may represent the initial presentation of advanced lung cancer. The identification of associated symptoms and risk factors during history taking was crucial in guiding the diagnostic process. Furthermore, it underscores the importance of rapid diagnostic pathways to ensure timely specialist assessment in patients with suspected malignancy.

Keywords

dizziness, lung cancer, emergency medicine, constitutional symptoms, early diagnosis, neoplastic syndromes