Dizziness

Question 1

What is vertigo?

Answer 1

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”

Question 2

What is the usual cause of vertigo?

Answer 2

Vestibular disorders

Question 3

What is peripheral vertigo?

Answer 3

labyrinth and vestibular nerve

Question 4

What is a central vertigo?

Answer 4

central nervous system
- Central vertigo is usually a result of an abnormal processing of the vestibular sensory input by the central nervous system

Question 5

What are some key differential diagnoses for vertigo?

Answer 5

• Labyrinthinecochlear disorders

* Central neurologic disorders

Question 6

What is presyncope?

Answer 6

• Patient’s complaint

• I might pass out
• I feel faint

Question 7

What is the usual cause of presyncope?

Answer 7

• Impaired cerebral perfusion

Question 8

What is a key differential diagnosis for pre-syncope?

Answer 8

• Cardiovascular disease

Question 9

What is disequilibrium?

Answer 9

• Patient’s complaint

• My balance is off
• I might fall

Question 10

What is the usual cause of disequilibrium?

Answer 10

• Sensory and/or neurologic dysfunction

Question 11

What are the key differential diagnoses for disequilibrium?

Answer 11

• Sensory deficits

* Neurologic disease

Question 12

What is lightheadedness?

Answer 12

• Patient’s complaint

* I’m just dizzy

Question 13

What is the usual cause of lightheadedness?

Answer 13

• Anxiety and/or depressive disorders

Question 14

What are the key differential diagnoses for lightheadedness?

Answer 14

• Anxiety disorder
• Depression
• Hyperventilation

Question 15

What types of dizziness are there? (4)

Answer 15

• Rotational sensation
• Impending fainting
• Loss of balance
• Light-headed

Question 16

What types of associated symptoms can occur with dizziness?

Answer 16

• Neurologic
• Cardiac
• Otologic
• Visual
• Psychiatric

Question 17

What should be in a physical exam of a patient with dizziness?

Answer 17

• Mental status
• Cranial and peripheral nerves
• Romberg testing
• Past pointing
• Cardiac examination
• Carotid arteries

Question 18

What are some dizziness simulation tests? (7)

Answer 18

• Orthostatic blood pressures
• Hyperventilation for 3 minutes
• Nylen-Barany maneuvers
• Observation of gait including turning
• Valsalva maneuver
• Carotid sinus stimulation
• Caloric testing

Question 19

What are some common causes of vertigo? (7)

Answer 19

• Benign paroxysmal positional vertigo
• Otitis media
• Meniere’s syndrome
• Labyrinthitis
• Acoustic neuroma
• Ototoxic and salt-retaining medications
• Brainstem dysfunction

Question 20

What are some common causes of syncope? (8)

Answer 20

• Vasovagal
• Cardiac
• Neurologic
• Orthostatic hypotension
• Situational
• Psychogenic (hyperventilation, hysteria)
• Metabolic and drug
• Unknown (approximately 25%)

Question 21

What are some common causes of disequilibrium? (9)

Answer 21

• Multiple sensory deficits
• Hyperventilation/anxiety disorders
• Vestibular disorders
• Senile gait
• Drug induced
• Parkinsonism
• Alcoholic
• Painful ambulation
• Fear of falling

Question 22

What are some common causes of lightheadedness? (9)

Answer 22

• Acute hyperventilation
• Panic disorders
• Hypoglycemia
• Pheochromocytoma
• Drug withdrawal
• Drug induced
• Epilepsy (temporal lobe)
• Mitral valve prolapse
• Cardiac arrhythmia