Diagnosis and Management of Dizziness and Vertigo
Section snippets
History
Obtaining a good history is the most critical step in the assessment of the dizzy patient. Because the term dizzy is used by patients to describe a variety of experiences, it is important to clarify the patient's actual complaint. The sensation of movement or spinning is classic for true vertigo. These patients may complain of objects moving around them (objective vertigo) or that they are spinning relative to their surroundings (subjective vertigo). Other patients may describe light-headedness
Peripheral vertigo
Peripheral causes of vertigo arise from abnormalities in the vestibular end organs (semicircular canals and utricle), the vestibular nerve, and the vestibular nuclei. Most of these causes are benign and readily treatable.
Central vertigo
Central vertigo manifests as marked vertigo, nausea, and vertical nystagmus. Neurologic symptoms such as headache or gait ataxia may also be present. In severe cases, patients may have depressed levels of consciousness. The cerebellum is often involved, and etiologies include multiple sclerosis, tumor, hemorrhage, and ischemia. Vascular injuries and infarcts of the central neurologic system can cause permanent debilitating disease. Because central processes have more serious consequences,
Dizziness
In patients who complain of dizziness without clear vertiginous symptoms, the differential remains broad. Many patients complain of disequilibrium and imbalance, whereas others note light-headedness and other presyncope symptoms. Often, dizziness can be a multisensory disorder due to any combination of peripheral neuropathy, visual impairment, and musculoskeletal disease.
Summary
Dizziness and vertigo present in patients of all ages. Particularly in older patients, dizziness is associated with a variety of cardiovascular, neurosensory, and psychiatric conditions and with the use of multiple medications [25]. For the patient, the symptoms can be debilitating. In patients older than 60 years, 20% have experienced dizziness severe enough to affect their daily activities [26]. Appropriate diagnosis and treatment can significantly improve quality of life. Most causes of
References (26)
- et al.
Common symptoms in ambulatory care incidence, evaluation, therapy, and outcome
Am J Med
(1989) Dizziness in children
Otolaryngol Clin North Am
(1994)- et al.
Isolated dizziness in vertebrobasilar insufficiency: clinical features, angiography, and follow-ups
J Stroke Cerebrovasc Dis
(1994) - et al.
Benign paroxysmal positional vertigo: diagnosis and treatment in the emergency department—a review of the literature and discussion of canalith-repositioning maneuvers
Ann Emerg Med
(2001) - et al.
A directed approach to the dizzy patient
Ann Emerg Med
(1989) - et al.
Integrated clinical and laboratory vestibular evaluation
Curr Curr Opin Otolaryngol Head Neck Surg
(2000) American Academy of Neurology. Assessment: electronystagmography. Report of the Therapeutics and Technology Assessment Subcommittee
Neurology
(1996)- et al.
Clinical neurophysiology of the vestibular system
(1990) - et al.
The diagnostic value of imaging the patient with dizziness: a Bayesian approach
Arch Neurol
(1996) - et al.
Particle repositioning maneuver: effective treatment for benign paroxysmal positional vertigo
J Otolaryngol
(1996)
A randomized trial of the canalith repositioning procedure
Laryngoscope
Success of the modified Epley maneuver in treating benign paroxysmal vertigo
Laryngoscope
Inner ear pathology and otitis media: a review
Anal Otol Rhinyl Laryngol
Cited by (59)
Investigation of coronavirus anxiety, health anxiety, and anxiety symptom levels in vertigo patients during COVID-19 pandemic
2023, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :Vertigo is a major health problem that affects approximately 20%–30% of the general population,3–5 and is associated with severe loss of functionality and workforce.6 Pathologies with symptoms of vertigo are divided into the following two groups in general which those caused by the peripheral nervous system (peripheral vertigo) and those caused by the central nervous system (central vertigo).7,8 Vertigo associated with peripheral vestibular causes (benign paroxysmal positional vertigo, vestibular neuritis, Ménière’s disease, and others) accounts for the majority of vertigo cases in total.
Impact of osteopathic manipulative techniques on the management of dizziness caused by neuro-otologic disorders: Protocol for systematic review and meta-analysis
2021, International Journal of Osteopathic MedicineCitation Excerpt :To explain heterogeneity between studies, we will test the following a priori hypotheses: (1) trials with a higher ROB will have larger effects size than trials with lower ROB, (2) trials with longer follow-up will have smaller treatment effects, (3) trials enrolling participants with comorbid conditions will have smaller treatment effects, and (4) trials with co-interventions will have larger treatment effects. Heterogeneity between studies will be assessed using a χ [2] test and the I [2] statistic, which measures the percentage of variability from true differences between studies (heterogeneity) rather than sampling error (chance) [64,65]. To inform subgroup analyses based on ROB, we will perform these analyses on a component-by-component basis when we detect variability in individual ROB components.
The Efficient Dizziness History and Exam
2021, Otolaryngologic Clinics of North AmericaDizziness and the Otolaryngology Point of View
2018, Medical Clinics of North AmericaCitation Excerpt :It is further essential to perform an ear examination. The use of an otoscope can reveal impacted cerumen or any foreign object in the ear canal, removal of which might relieve vertiginous symptoms.8 Fluid behind the eardrum, perforation, prominent scarring, and other signs of middle ear disease should also be ruled out.
Cervicogenic Vertigo
2018, Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and RehabilitationImpact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness
2017, Journal of Bodywork and Movement TherapiesCitation Excerpt :Dizziness is the most common symptom in central nervous system and vestibular pathologies but it is also associated with musculoskeletal pain, headache and migraine, and psychological and psychiatric disorders. It can be classified into 4 primary groups: (1) vertigo, which is an illusion of movement, (2) disequilibrium without vertigo, (3) presyncope, and (4) psychophysiological dizziness, often associated with anxiety and panic (Karatas, 2008; Chawla and Olshaker, 2006). Dizziness can significantly interfere with a person's ability to function at home and work, reflecting badly upon the quality of life of these patients (Bronstein et al., 2010; Ten Voorde et al., 2012; Weidt et al., 2014).