Dizziness Flashcards
What is vertigo?
1) Patient’s complaint
2) Patient experiences a sense of movement in most any direction, often spinning
• “My head is spinning”
• “The room is whirling”
What is the usual cause of vertigo?
Vestibular disorders
What is peripheral vertigo?
labyrinth and vestibular nerve
What is a central vertigo?
central nervous system
- Central vertigo is usually a result of an abnormal processing of the vestibular sensory input by the central nervous system
What are some key differential diagnoses for vertigo?
- Labyrinthinecochlear disorders
* Central neurologic disorders
What is presyncope?
• Patient’s complaint
- I might pass out
- I feel faint
What is the usual cause of presyncope?
• Impaired cerebral perfusion
What is a key differential diagnosis for pre-syncope?
• Cardiovascular disease
What is disequilibrium?
• Patient’s complaint
- My balance is off
- I might fall
What is the usual cause of disequilibrium?
• Sensory and/or neurologic dysfunction
What are the key differential diagnoses for disequilibrium?
- Sensory deficits
* Neurologic disease
What is lightheadedness?
- Patient’s complaint
* I’m just dizzy
What is the usual cause of lightheadedness?
• Anxiety and/or depressive disorders
What are the key differential diagnoses for lightheadedness?
- Anxiety disorder
- Depression
- Hyperventilation
What types of dizziness are there? (4)
- Rotational sensation
- Impending fainting
- Loss of balance
- Light-headed
What types of associated symptoms can occur with dizziness?
- Neurologic
- Cardiac
- Otologic
- Visual
- Psychiatric
What should be in a physical exam of a patient with dizziness?
- Mental status
- Cranial and peripheral nerves
- Romberg testing
- Past pointing
- Cardiac examination
- Carotid arteries
What are some dizziness simulation tests? (7)
- Orthostatic blood pressures
- Hyperventilation for 3 minutes
- Nylen-Barany maneuvers
- Observation of gait including turning
- Valsalva maneuver
- Carotid sinus stimulation
- Caloric testing
What are some common causes of vertigo? (7)
- Benign paroxysmal positional vertigo
- Otitis media
- Meniere’s syndrome
- Labyrinthitis
- Acoustic neuroma
- Ototoxic and salt-retaining medications
- Brainstem dysfunction
What are some common causes of syncope? (8)
- Vasovagal
- Cardiac
- Neurologic
- Orthostatic hypotension
- Situational
- Psychogenic (hyperventilation, hysteria)
- Metabolic and drug
- Unknown (approximately 25%)
What are some common causes of disequilibrium? (9)
- Multiple sensory deficits
- Hyperventilation/anxiety disorders
- Vestibular disorders
- Senile gait
- Drug induced
- Parkinsonism
- Alcoholic
- Painful ambulation
- Fear of falling
What are some common causes of lightheadedness? (9)
- Acute hyperventilation
- Panic disorders
- Hypoglycemia
- Pheochromocytoma
- Drug withdrawal
- Drug induced
- Epilepsy (temporal lobe)
- Mitral valve prolapse
- Cardiac arrhythmia
