Dizziness

Workup

Someone comes in and says they are dizzy:

• Presyncope, syncope: blacking out, pass out, loss of consciousness. Check syncope in intern and cardiovascular

• Vertigo: spinning room, unsteady

  • Central: neighborhood signs, no hearing loss, no tinnitus, brain stem lesions, FND

    • posteior fossa insults. Use MRI

  • Peripheral: no neighborhood signs, hearing loss, tinnitus, no brain stem lesions, no FND

Central Lesions

Posterior Fossa Insults

• path: MS, stroke, tumor, abscess, complex migraines, weird seizures

• symptoms: cerebellar FND, no ear symptoms

• diagnosis: MRI

• treatment: disease

Peripheral

BPPV

• Path: otolith

• symptoms: recurrent, reproducable vertigo lasting < 1 min

• diagnosis: Dix-Hallpike, look for rotary nyastagmus

• treatment: Epley

Vestibular Neuritis or labyrinthritis (+hearing loss)

• path: viral

• symptoms: 4 weeks after URI, vertigo 1-10 min, maybe hearing loss (labyrinthritis), maybe NV

• diagnosis: clinical

• treatment: steroids, anti-vertigo (meclizine)

Meniere

• path: unknown

• symptoms: hearing loss, tinnitus, vertigo; >30 min, < 1hr

• diagnosis: clinical

• treatment: salt restriction, thiazide, anti-vertigo