Dizziness Flashcards
List red flags for dizziness
- Dysarthria, Diplopia, Dysphagia, FND, Anesthesia
- Headache, Trauma, whiplash, neck pain
- Gait disturbance
- Palpitations
- Chest Pain
Differential Diagnosis for Dizziness
Presyncope: • cardiogenic vs. non-cardiogenic vs. hypoglycemia • See Approach to loss of consciousness Vertigo: Peripheral • BPPV • Vestibular Neuritis • Labrinthitis • Menieres Vertigo: Central • Cerebellar Infarct
Measurements
- HR – tachycardia
- BP – hotn
- Orthostatics
Top three important things to do in an appointment for dizziness
Timing
Triggers
A torough exam
Whats your ddx for dizziness lasting seconds
BPPV
Orthostatic hypotension
Whats your ddx for dizziness lasting minutes
Meniere’s
Whats your ddx for dizziness lasting days
Migraine
Neuritis
Stroke
List three triggers to ask about
Medications
Barotrauma
Turing/movement
Standing
List three associated symptoms to ask about and what they may point to
Aura or headaches----Migraine Blister-----Ramsay Hunt Neck pain-----Vertebral artery dissection Chest pain------Aortic dissection Deafness------Meniere's
List four things to do on a vertigo exam
Orthostatin BP
Gait exam
HINTS
Dix hallpike
What are the four componenets of the HINTS plus exam
Nystagmus (unidirectional is pointing to peripheral, bidirectional is central) Test of Skew (ANY vertical skew is central) Head impulse (Catch up saccade is peripheral, normal is normal or central) Bedside hearing (AICA stroke will have unilateral hearing loss)
What onHINTS points to peripheral
ALL: Unidirectional nystagmus No vertical skew Catch up on head impulse Normal hearing
What on HINTS points to central
ANY: Bidirectional nystagmus virtical skew Normal head impulse (no catch up) Hearing loss
Who do you do HINTS on
Constant hours or days of vertigo with nystagmus at rest or with sideways gaze
Who do you do a dix halpike on
Short episodes of dizziness with head movements and no nystagmus
