Vertigo And Dizziness

Brian Goldman

Pathophysiology

Clinical.Features

Disorders., causing..Peripheral..vertigp Benign., Paroxysmal ā€˛Peripheral Vertigo

Meniere'sDisease

Perilymph. Fistula

Vestibular., Neuronitis

Labyrinthitis Ototoxicity

Benign. Paroxysmal ..Vertigo!. .of . .Childhood Eighth-Ne.rye.. . Lesions Ce.re.b.e.llopo.nt.i.n.e. Angle ..Tumors

PosttraumaticVertigo

Disorders. Causing..Central,..Vertigo Cerebellar Hemorrhage and ..Infarction

Wallenberg Syndrome Vertebrobasilar .Insufficiency

M,igrain,e:Re,lated,..DiZZiness.andn Vertigo Ph,ysiologic..Vertigo OtherConditions iDisleglMilibriMlm..ofL Aging NearSyncope Conyulsiye, .Disorders

Hyperventilation .Syndrome

Psychiatric., .Dizziness

Diagnosis History

Physical ..Examination

AnciNaryTests

Treatment Drug.Jherapy

Vestibular, .Rehabilitation ...Exercises

Pa^rticle..Eepositjoning., Maneuyer

Disposition Chapter., References

As many as 0.5 percent of the population consult their physician each year regarding vertigo, and 1 percent report dizziness. 1 The evaluation of dizziness can test the diagnostic skill of most emergency physicians. The difficulties begin with the patient's chief complaint. The term dizziness is nonstandardized and ambiguous. Dizziness may mean vertigo, syncope, presyncope, weakness, giddiness or anxiety, or a disturbance in mentation. The patient's symptoms should therefore be clarified as much as possible.

Vertigo is the perception of movement where no movement exists. Patients may describe themselves as moving or may describe the environment as moving in relation to themselves. The type of movement may be described as rotatory or vertical; alternatively, the patient may describe a sense of staggering, swaying, or being pulled or hurled to the side or onto the ground.

Syncope is a transient loss of consciousness that is accompanied by loss of postural tone with spontaneous recovery. It is associated with a transient reduction of cerebral blood flow, oxygen, and glucose to the reticular activating system. To meet the definition of syncope, no exogenous electrical or chemical cardioversion should be required to regain consciousness. Syncope accounts for 3 percent of emergency department (ED) visits and 1 to 6 percent of hospital admissions. Near-syncope is defined as light-headedness signifying an impending loss of consciousness without loss of consciousness actually occurring.

Psychiatric dizziness has recently been defined as a sensation of dizziness not related to vestibular dysfunction that occurs exclusively in combination with other symptoms as part of a recognized psychiatric symptom cluster.2 In dizziness clinics, the frequency of this category can range between 20 and 50 percent of patients.

Disequilibrium is another term that is sometimes used to describe a feeling of unsteadiness or imbalance while walking. Some patients describe a sensation of feeling as if they were "floating." It is often due to decreases in visual acuity or proprioception.

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