Question | Answer |
Dizziness and vertigo differ in several ways. Describe dizziness. | faintness, a feeling of impending syncope
light-headedness, feeling of imbalance/unsteadiness. A vague spaced out or swimmy-headed feeling. |
Vertigo can be described as the following. | False sense of movement of self or environment. Usually rotary-a spinning or wheeling sensation, sometimes pulled to 1 side |
Symptoms that can accompany dizziness/vertigo include the following: | Nausea/vomiting or difficulty with balance
may be disturbing/incapacitating
can be a problem with dangerous tasks
dizziness accounts for 5-6% of o.p. visits
may be temporary or chronic |
What is the definition of chronic dizziness? | dizziness lasting more than 1 month and more common in elderly |
True or False: Dizziness may occur at any age but is more common in the 30-40 y/o group? | False. More common in elderly |
What percentage of dizziness is caused by a serious disorder? | 5% |
What are the most common causes of dizziness WITH vertigo? | Benign positional vertigo
Meniere's Disease
Vestibular neuronitis
labyinthitis |
What are the most common causes of dizziness WITHOUT vertigo? | Less clear cut but usually not otologic
drug effects
multifactoral or idiopathic |
Neurologic disorders with more global effect manifest as dizziness but rarely as vertigo. The elderly often multifactorial secondary to drug effects, decreased vision & auditory, and proprioception. | 1. hypotension 7. depression
2. hypoxemia 8. anemia
3. hypoglycemia
4. hormonal changes
5.CNS Active drugs
6. psychogeic-panic disorder |
The 2 most common specific causes are inner ear disorders. What are they called? | 1. Benign Paroxysmal Positional Vertigo
2. Meniere's Disease |
When taking the HPI, the information needed includes: | sensations felt, use open ended questions to have patient describe what THEY think dizziness is. Brief specific questioning that address whether the feeling is light-headedness, loss of balance or feeling, etc... |
What are some of the red flags regarding dizziness/vertigo? | head or neck pain
ataxia
loss of consciousness
focal neurologic deficit
severe, continuous symptoms for >1hr. |
When would MRI testing be appropriate? | 1. chronic symptoms to look for evidence of stroke, MS, or other CNS lesions
2. for acute symptoms who have headaches, neurologic abnormalities, or any other findings suggestive of a CNS etiology |
What is the treatment for dizziness/vertigo? | Treatment is directed at the cause, including stopping, reducing, or switching any causative drugs. |
Name some geriatric special considerations in regards to dizziness/vertigo. | 1. aging decreases balance function
2. older people more likely to have disorders that contribute to dizziness
3. more likely to be polypharmacy related
4. increased fall risk |
When would immediate neuroimaging be considered? | When symptoms are accompanied by headache, focal neurologic abnormalities, or both |