3. Differential diagnosis of vertigo and dizziness Flashcards
Types/grades of dizziness
- Vertigo (room-spinning)
- Lightheadedness
- Presyncope
- Dysequilibrium
The two types of vertigo
Peripheral and central
History taking of dizziness
- Type of dizziness
- Duration
- Exacerbations
- Associated symptoms
Exacerbations of dizziness and relations
Worse with head movement
- with eye closure (vestibular)
- no change (non-vestibular)
Worse with excercise (cardiac or pulm. cause)
Associated symptoms of dizziness and causes
- Neurological (central): transient diplopia, dysphagia, dysarthia, ataxia (TIA, VBI, migraine), headache, change in counciousness, sensory/motor deficit (CNS)
- Audiological (peripheral): hearing loss, tinnitus, otalgia
- Nausea, vomiting: peripheral vestibular disorders
- Shortness of breath, palpitations
Differential diagnosis of dizziness: vertigo, central
Central (brainstem or cerebellar)
- Tumor (astrocytoma)
- Cerebrovascular disorders (stroke, vertebrobasilar insufficiency, TIA)
- Migrainous vertigo
- Drugs/toxins
- MS (demyelination)
- Inflammation (meningitis, cerebellar, abscess)
- Trauma
- Syringobulbia
Differential diagnosis of dizziness: categorization
Vertigo
- Central (15%)
- Peipheral (75%)
Non-vertiginous
- Psychogenic
- Vascular
- Ocular
Differential diagnosis of dizziness: vertigo, peripheral
- Idiopathic
- Meniere
- BPPV
- Trauma
- Drugs (streptomycin, quinine, salicytes)
- Labyrinthitis
- Vestibular neuronitis
- Cerebellopontine angle tumors (acustic neuroma, meningima, epidermoid/dermoid)
Differential diagnosis of dizziness: non-vertinious
Psychogenic (diagnosis of exclusion)
- Depression, anxiety
Vascular
- Orthostatic hypotension
- Stokes-adams syndrome
- Arryhtmia
- CHF
- Aortic stenosis
- Vagovagal episodes
- Metabolic causes
Ocular:
- Decreased visual acuity
Vertigo definition
Illusion of rotational, linear or tilting of self or environment. Produced by peripheral (inner ear) or central (brainstem, cerebellum) stimulation
Symptoms and clinical difference of peripheral vs. central vertigo
Peripheral
- Imbalance: mod-severe
- Nausea/vomit: severe
- Auditory common
- Neurologic: rare
- Compensation: rapid
- Nystagmus: undirectional - horizontal or rotatory. Dissapears with fixing pupil.
Central
- Imbalance: mild-mod
- Nausea/vomit: variable
- Auditory rare
- Neurologic: common
- Compensation: slow
- Nystagmus: bidirectional - horizontal or rotatory. Does not dissapear with fixing the pupil.
Differential diagnosis vertigo, different diseases clinical picture
Onset:
- Sudden: BBPV, labyrinthitis
- Gradual: meniere
- Insidious: acoustic neuroma
Duration
- seconds: BBPV
- minute-hours: meniere
- days: labyrinthitis
- chronic: acoustic neuroma
Hearing loss
- none: BPPV
- unilateral: labyrinthitis, meniere
- Progressive: acousitc neuroma
Tinnitus:
- (-): BPPV
- (+) labyrinthitis, meniere, acousitc neuroma
Symptoms of vestibular neuronitis
sudden, severe vertigo, dizziness, balance problems, nausea and vomiting, nystagmus towards healthy side
Symptoms of cerebellar stroke
Acute vertigo, nystagmus towards healthy side, fall tendancy towards the affected side, loss of coordination, slurred speach
Peripheral vertigo locatation
Peripheral vertigo is due to a problem in the part of the inner ear that controls balance. These areas are called the vestibular labyrinth, or semicircular canals. The problem may also involve the vestibular nerve.
