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Parent (intermediate) annotation
Open it s – “unsteadiness while walking”
Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, etc
<span>Nonspecific Dizziness – “woozy”, “giddy”, “light-headed”
DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, alcohol/drugs, menstruation, previous head trauma
Ask about: onset, duration, nausea, vomiting, hearing loss, tinnitus, headache, imbalance, aural fullness, ear pain, rash, facial paralysis, medications
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Original toplevel document
Dizziness/Vertigo Dizziness/Vertigo
Approach to patient with Dizziness
Subjective
“Does it feel like either the room is spinning or that you are spinning?” and/or “Is it triggered or worsened by turning your head or rolling over in bed?”
Yes = vertigo
BENIGN PAROXYSMAL POSITIONAL VERTIGO (most common)
brief, recurrent episodes (seconds to minutes), +/- nausea and vomiting
Vestibular Neuritis
rapid onset, severe, persistent (days), N/V, imbalance
Ménière’s Disease
recurrent episodes (minutes to hours), fluctuating hearing loss, tinnitus, and sensation of aural fullness
Vestibular Toxicity
aminoglycosides (eg. gentamycin), loop diuretics, ASA, NSAIDs, amiodarone, quinine, cisplatin
No = other forms of dizziness
Presyncopal Dizziness – “feels like nearly fainting or blacking out”
ECG
Triggered by exertion? Chest pain/palpitations? Known structural heart dz? FmHx of sudden death? Abnormal ECG? (if pt stable, fax ECG for urgent advice)
If yes to any, suspect cardiac etiology. Refer to Emergency
If no, orthostatic hypotension?
Yes = investigate underlying cause. meds/alcohol? Consider CBC/lytes
No = likely vasovagal/situational etiology. If recurrent episodes or pt is at risk of injury, consider referral for tilt test (+/- carotid sinus massage if >40 yo)
Disequilibrium Dizziness – “unsteadiness while walking”
Often multifactorial, common in elderly, risk of falls. Complete neuro and MSK exams to rule out peripheral neuropathy, Parkinsonism, MSK d/o, CVA, etc
Nonspecific Dizziness – “woozy”, “giddy”, “light-headed”
DDx: hypoglycemic (glucose), thyroid disease (TSH), pregnancy (β-HCG), meds, psychiatric disorders, alcohol/drugs, menstruation, previous head trauma
Ask about: onset, duration, nausea, vomiting, hearing loss, tinnitus, headache, imbalance, aural fullness, ear pain, rash, facial paralysis, medications
Objective
Assessment
viral labyrinthitis
benign positional vertigo
Eustachian tube dysfunction (often with s
Summary
status
not learned
measured difficulty
37% [default]
last interval [days]
repetition number in this series
0
memorised on
scheduled repetition
scheduled repetition interval
last repetition or drill
Details
No repetitions
Discussion
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