Dizziness

1
Dizziness

• Samadhi Reid
• NPT VTS

2

• Common symptom, heart sink
• Can mean different things, vague
• Sense of lightheadedness
• without illusion of movement (vertigo)
• Exact cause remain unclear, multifactorial

3
History taking

• Establish patients definition
• Duration of symptoms
• Associated symptoms e.g. room spinning, N V,
  tinnitus, deafness, LOC
• Preceding symptoms e.g. palpitations, chest pain,
  severe pain
• Preceding events e.g. standing up, on exertion,
  neck movements, recent viral URTI

4
History taking cont.

• Any anxiety symptoms?
• Are they well in general?
• PMH
• DM, cervical OA,
• hx of OM/ recurrent ear pathology,
• high risk for CVD
• DH anti-hypertensives, TCA, MAOI
• SH alcohol intake

5
Examination

• BP, sitting standing
• Pulse ?slow ?irregular
• CV
• If vertigo,
• ENT
• CNS - ?Nystagmus ?Abnormal gait ?Rombergs

6
Differential diagnosis - common

• Viral illness
• Anxiety /- hyperventilation
• Hypoglycaemia
• Postural hypotension (elderly, in pregnancy)
• Vertebro-basilar insufficiency
• If vertigo,
• Vestibular neuronitis/ labyrinthitis (viral, no
  assoc deafness), BP vertigo, Vertebro-basilar
  TIA, ET dysfunction, Menieres disease
  (recurrent, assoc deafness)

7
Differential diagnosis - occasional

• Acute intoxication - drugs/ alcohol
• Effects of chronic alcohol use
• Iatrogenic - antihypertensives, antidepressants
• Cardiac arrhythmias
• Any severe systemic disease
• If vertigo,
• Chronic OM, Aspirin, alcohol intoxication,
  migraine, epilepsy

8
Differential diagnosis - rare

• Aortic stenosis
• Partial seizures
• Addisons disease
• Carbon monoxide poisoning (any other family
  members affected)
• If vertigo
• Wax, acoustic neuroma, cerebellar tumours, MS,
  post traumatic, nasopharyngeal carcinoma

9
Investigations

• Unlikely to need any
• FBC - anaemia, î MCV
• U/E, LFT - if systemic illness is suspected,
  alcohol abuse
• Blood sugar
• ECG/ 24 hours tape
• ECHO
• EEG/ CT head

10
Treatment

• Depends on cause, may only need reassurance
• Alter medication
• Refer if indicated
• Viral labyrinthitis - Prochlorperazine 5mg TDS
• Menieres disease - Cinnarizine 30 mg TDS
• BP vertigo - Epley Maneuver

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