Diagnosis and Management of Dizziness and Vertigo

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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

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