Dizziness

Question 1

What should you ask about when someone presents with dizziness?

Answer 1

Loss of consciousness

Question 2

What are the four main types of dizziness?

Answer 2

Pre-syncope
Vertigo
Disequilibrium
Non-specific dizziness

Question 3

What is pre-syncope caused by?

Answer 3

Reduced blood flow to the brain

Question 4

What will a person with pre-syncope describe?

Answer 4

Feeling faint
Like passing out
Don’t lose consciousness

Question 5

What is pre-syncope the same as?

Answer 5

Prodromal phase of syncope

Question 6

What are the symptoms of pre-syncope the same as?

Answer 6

Those for syncope

Question 7

Do you have to have syncope after pre-syncope?

Answer 7

No

Question 8

What is vertigo?

Answer 8

Illusion of motion

Question 9

What does a person with vertigo feel like?

Answer 9

They/their environment spinning around

Question 10

What is physiological vertigo?

Answer 10

Vertigo after spinning around fast multiple times

No underlying disease process

Question 11

What is pathological vertigo usually due to?

Answer 11

Disturbance of vestibular system

Question 12

What are the parts of the vestibular system?

Answer 12

Labyrinth in inner ear
- 3 fluid-filled semicircular canals
- Otolith organs: utricle and saccule
Vestibular nerve
Central vestibular structures in brain

Question 13

What do the vestibular nuclei project to?

Answer 13

Ophthalmic nuclei in brainstem
Spinal cord
Cerebellum
Cortex

Question 14

What other sensory inputs are important for maintaining balance?

Answer 14

Eyes
Skin
Muscles
Joints

Question 15

How many people presenting with dizziness will have vertigo?

Answer 15

50%

Question 16

What do the causes of vertigo include?

Answer 16

Viral infection
Stroke
Benign paroxysmal positional vertigo (BPPV)

Question 17

What is the most common cause of vertigo?

Answer 17

BPPV

Question 18

What happens in BPPV?

Answer 18

Ca crystals from otolith organs become dislodged
Settle in posterior semicircular canal
Spinning sensation whenever head moves suddenly

Question 19

What is disequilibrium?

Answer 19

Dizziness due to gait disturbance

Question 20

What can cause disequilibrium?

Answer 20

Loss of balance because of diseases of

• Nerves
• Muscles
• Cerebellum

Question 21

How might a patient with disequilibrium describe it?

Answer 21

Wobbliness of feet
Feel like leaning to one side when they walk
Doesn’t happen when not walking

Question 22

How is non-specific dizziness described?

Answer 22

Light headedness
Woozy
Foggy in head

Question 23

What causes non-specific dizziness?

Answer 23

Not clear
Sometimes related to
- Hyperventilation
- Psychological problems
   - Anxiety
   - Depression

Question 24

Can more than one type of dizziness be present at once?

Answer 24

Yes, especially in older patients who have multiple medical problems

Question 25

What can you ask about the quality of dizziness?

Answer 25

Spinning
Loss of balance
Foggy

Question 26

What can you ask about the severity of dizziness?

Answer 26

Disruption of normal activity

Causing falls

Question 27

What can you ask about the time course of dizziness?

Answer 27

Acute/chronic
Periodicity
Change over time

Question 28

What can you ask about the context of dizziness?

Answer 28

Viral illness
New medication
Headache

Question 29

What can you ask about the relieving factors of dizziness?

Answer 29

Keeping still

Medication

Question 30

What can you ask about the aggravating factors of dizziness?

Answer 30

Movement

Changing position

Question 31

What are the associated features of dizziness?

Answer 31

Nausea
Vomiting
Headache
Hearing loss
Tinnitus
Visual changes
Other neurological symptoms