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

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