Dizziness

Question 1

What key history would you obtain from a patient who complains of dizziness?

Answer 1

Lightheadedness vs Vertigo
Auditory symptoms (hearing loss, tinnitus)
Duration of episodes
Context (occurs with positioning, following head trauma)
Other associated symptoms (visual disturbances, URI, nausea)
Neck pain or injury
Medications
History atherosclerotic vascular disease

Question 2

What key physical exams would you perform on a patient who complains of dizziness?

Answer 2

Vital signs
Complete neurologic exam including Romberg test, nystagmus, tilt test (Dix-Hallpike maneuver)
Gait
Hearing
Weber and Rinne test
Head and neck exam
Cardiovascular exam

Question 3

35 yo F presents with intermittent episodes of vertigo, tinnitus, nausea and hearing loss over the past week. Differentials?

Answer 3

Meniere's disease
Vestibular neuronitis
Labryinthitis
Benign positional vertigo
Acoustic neuroma

Question 4

35 yo F presents with intermittent episodes of vertigo, tinnitus, nausea and hearing loss over the past week. Differentials: Meniere’s disease, vestibular neuronitis, labryinthitis, benign positional vertigo, acoustic neuroma. Workup?

Answer 4

CBC
VDRL/RPR (syphilis is a cause of Meniere’s disease)
MRI - brain
Audiometry

Question 5

55 yo F complains of dizziness for the past day. She feels faint and has severed diarrhea that started two days ago. She takes furosemide for her hypertension. Differentials?

Answer 5

Orthostatic hypotension due to dehydration (diarrhea, diuretic use)
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Vertebrobasilar insufficiency

Question 6

55 yo F complains of dizziness for the past day. She feels faint and has severed diarrhea that started two days ago. She takes furosemide for her hypertension. Differentials: orthostatic hypotension due to dehydration (diarrhea, diuretic use), vestibular neuronitis, labyrinthitis, benign positional vertigo, vertebrobasilar insufficiency. Workup?

Answer 6

Orthostatic vital signs
CBC, electrolytes
Stool exam (occult blood, fecal leukocytes)

Question 7

65 yo M presents with postural dizziness and unsteadiness. He has hypertension and was started on hydrochlorothiazide two days ago. Differentials?

Answer 7

Drug-induced orthostatic hypotension
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Brain stem or cerebellar tumor
Acute renal failure

Question 8

65 yo M presents with postural dizziness and unsteadiness. He has hypertension and was started on hydrochlorothiazide two days ago. Differentials: drug-induced orthostatic hypotension, vestibular neuonitis, labyrinthitis, benign positional vertigo, brain stem or cerebellar tumor, acute renal failure. Workup?

Answer 8

Orthostatic vital signs
CBC, electrolytes
BUN/Cr
MRI - brain

Question 9

44 yo F complains of dizziness on moving her head to the left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea. Differentials?

Answer 9

Benign positional vertigo
Vestibular neuronitis
Labyrinthitis
Meniere’s disease

Question 10

44 yo F complains of dizziness on moving her head to the left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea. Differentials: benign positional vertigo, vestibular neuronitis, labyrinthitis, Meniere’s disease. Workup?

Answer 10

MRI - brain

Audiogram