Diseases » Balance disorders » Causes

Causes of Balance disorders

List of causes of Balance disorders

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Balance disorders) that could possibly cause Balance disorders includes:

• Labrynthitis
• Meniere's disease
• Vestibular neuronitis

More causes: see full list of causes for Balance symptoms

Balance disorders Causes: Book Excerpts

• Differential Diagnosis - Syncope
• Differential Diagnosis - Dizziness/Lightheadedness & Vertigo
• Differential Diagnosis - Syncope
• Differential Diagnosis - Vertigo
• Medical causes - Syncope
• Medical causes - Vertigo
• Medical causes - Syncope
• Medical causes - Vertigo
• Differential Overview - Syncope
• Medical causes - Syncope
• Medical causes - Syncope
• Medical causes - Vertigo
• Principal Causes of Vertigo - Vertigo
• Principal Causes of Syncope and Dizziness - Syncope and Dizziness
• Medical causes - Syncope
• Medical causes - Vertigo

Balance disorders as a symptom:

Conditions listing Balance disorders as a symptom may also be potential underlying causes of Balance disorders. Our database lists the following as having Balance disorders as a symptom of that condition:

• Multiple Sclerosis
• Neurofibromatosis Type 1 (NF-1)
• Neurofibromatosis-1

Related information on causes of Balance disorders:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Balance disorders may be found in:

• Hidden causes of Balance disorders

Causes of Balance disorders: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Balance disorders.

Syncope: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Vasovagal episode
  –Most common cause of syncope
  –May be triggered by heat, fatigue, stress, hunger, alcohol, and severe pain
  –Associated with diaphoresis, weakness, blurry vision, lightheadedness
  –Almost always benign
• Orthostatic hypotension
  –Fall in blood pressure upon standing, due to failure of vasoconstrictor reflexes
  –Precipitated by sudden standing from recumbent position
  –Often associated with antihypertensive medications (diuretics, vasodilators, α - or β-blockers) and dehydration/hypovolemia
  –May occur with autonomic disorders (e.g., Shy-Drager syndrome)
  • Situational syncope
    –Increased intrathoracic pressure (e.g., cough, micturition, defecation) leads to decreased venous return and resulting diminished blood flow to the brain
  • Cardiac arrhythmias
    –Very slow (<30 bpm) or fast (>180 bpm) heart rates may result in decreased cardiac output and resulting diminished blood flow to the brain
• Valvular disease
  –Most commonly due to aortic stenosis
• Myocardial disease
• Cerebrovascular disease
  –Usually due to carotid or vertebrobasilar atherosclerosis
• Hypoglycemia
• Anemia
• Seizure
• Anxiety attack
• Migraine
• Medications (e.g., anticholinergics)
• CVA
• Hemorrhage
• Trauma

>

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Dizziness/Lightheadedness & Vertigo: Differential Diagnosis
(In a Page: Signs and Symptoms)

Dizziness/lightheadedness

• Transiently decreased cerebral blood flow
  –Hyperventilation
  –Vasovagal response
  –Congestive heart failure
  –Aortic stenosis
  –Hypertrophic cardiomyopathy
  –Hemorrhage
  –Dehydration or hypotension
  –Carotid sinus pressure
  –Cerebral artery thrombosis or embolism
  –Cardiac arrhythmia
  –Autonomic dysfunction (e.g., Shy-Drager syndrome)
  –TIA
  –Hypoxemia
  –Anemia

• Primary CNS dysfunction not associated with decreased blood flow
  –Migraine
  –Seizure
  –Severe electrolyte disturbance
  –Elevated intracranial pressure
• Panic attack
• Hyperventilation and/or anxiety
• Ictal aura
• Basilar migraine
• Drug intoxication (e.g., alcohol, sedatives, centrally-acting α-blockers)
• Allergic reactions
• Postconcussion syndrome
• Carbon monoxide poisoning
  Vertigo
• Peripheral vertigo (inner ear pathology)
  –Benign positional vertigo (>20% of cases)
  –Ménière's disease
  –Labyrinthine trauma
  –Labyrinthitis (viral)
  –Nonspecific or recurrent vestibulopathy
  –Bilateral vestibular loss
  –Acoustic neuroma
  –Autoimmune inner ear disease
• Central vertigo (CNS pathology)
  –Multiple sclerosis
  –Brainstem tumors
  –Labyrinthine trauma
  –Epileptic vertigo
  –Vertebrobasilar insufficiency
  –Tabes dorsalis
  –Friedreich's ataxia

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Syncope: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Vasovagal
  –Most common etiology (more than 50%)
  –Also known as neurocardiogenic or vasodepressor syncope
  –Typical in adolescents; greater in females
  –Occurs after prolonged standing in a warm place; with emotional upset, pain, hunger, the sight of blood; crowded places

• Postural/orthostatic hypotension
  –Occurs when standing up quickly
• Micturation syncope (a rare form)
• Breath-holding spells
  –Usually at ages 1–5 years
  –Two types: Cyanotic (80%) vs pale (20%)
  –Cyanotic spells start with crying
  –Provoked by anger, frustration, or pain, or used as an attention-getting behavior
  –May have generalized clonic jerks
  • Cardiac etiologies (less common)
    –Arrhythmias
    –Supraventricular tachycardia is the most common cause
    –Long QT syndrome (QTc >0.44 seconds): Causes ventricular arrhythmias, Romano-Ward (autosomal dominant), Jervell and Lange-Nielsen (autosomal recessive with deafness)
    –Medications (e.g., cisapride)
    –Sinus node dysfunction and atrioventricular block may lead to bradyarrhythmias
    –Post-op congenital lesions and dilated cardiomyopathy lead to arrhythmias
    –Structural cardiac disease
    –Severe obstructive lesions (e.g., hypertrophic obstructive cardiomyopathy, aortic stenosis, pulmonic stenosis, atrial myxomas, and pulmonary hypertension)
  • Hysterical fainting
  • Migraine
  • Hyperventilation
  • Pregnancy
  • Anemia or hypovolemia
  • Hypoglycemia
  • Carbon monoxide poisoning
  • Medications and drugs of abuse
  • Electrolyte abnormalities
  • Intracranial hypertension
  • Epilepsy may mimic syncope
  • Adrenal insufficiency

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Vertigo: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Benign paroxysmal positional vertigo (BPPV)
  –Each episode lasts seconds to minutes
• Vestibular neuritis
  –Viral infection of the vestibular nerve
• Otitis media
• Migraine
  –Vertigo may precede, follow, or present with the headache and aura
• Acute labyrinthitis
  –Acute onset with nausea and vomiting
  –Lasts for days and slowly resolves
  –45% cluster with viral infections
• Posttraumatic
  –Perilymphatic fistula
  –Labyrinthine concussion
  –Associated with postconcussive syndrome
  –Worsened by change in head position, cough, sneeze, swallow, straining, and airplane travel
• Cerebellar tumors
  –Tumors may be associated with tinnitus, facial weakness, and nystagmus
• Toxins/drugs: Antibiotics (aminoglycosides), salicylates, alcohol, phenytoin, quinine, arsenic, tricyclic antidepressants
• Autoimmune: Collagen vascular disease, Wegener granulomatosis
• Posterior circulation dissection
  –Often associated with a history of neck extension or rotational injury
• Cerebellar hemorrhage: Acute onset of vertigo, headache, nausea, and vomiting
• Multiple sclerosis
  –Vertigo is the presenting symptom in 5%
  –Hearing loss rare
  –Most common in young women
• Temporal lobe or complex partial seizures
• Ménière disease
• Familial periodic ataxia syndromes
  –Recurrent bouts of vertigo brought on by emotional stress or physical exertion
• CNS infection: Syphilis, Lyme disease
• Motion sickness
• Vertigo mimics: Presyncope, disequilibrium from decreased vision or proprioception
• Psychogenic
  –Panic or anxiety disorder

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Syncope: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Aortic arch syndrome

With aortic arch syndrome, the patient experiences syncope and may exhibit weak or abruptly absent carotid pulses and unequal or absent radial pulses. Early signs and symptoms include night sweats, pallor, nausea, anorexia, weight loss, arthralgia, and Raynaud’s phenomenon. He may also develop hypotension in the arms; neck, shoulder, and chest pain; paresthesia; intermittent claudication; bruits; vision disturbances; and dizziness.

Aortic stenosis

A cardinal late sign, syncope is accompanied by exertional dyspnea and angina. Related findings include marked fatigue, orthopnea, paroxysmal nocturnal dyspnea, palpitations, and diminished carotid pulses. Typically, auscultation reveals atrial and ventricular gallops as well as a harsh, crescendo-decrescendo systolic ejection murmur that’s loudest at the right sternal border of the second intercostal space.

Cardiac arrhythmias

Any arrhythmia that decreases cardiac output and impairs cerebral circulation may cause syncope. Other effects — such as palpitations, pallor, confusion, diaphoresis, dyspnea, and hypotension — usually develop first. However, with Adams-Stokes syndrome, syncope may occur without warning. During syncope, the patient develops asystole, which may precipitate spasm and myoclonic jerks if prolonged. He also displays an ashen pallor that progresses to cyanosis, incontinence, a bilateral Babinski’s reflex, and fixed pupils.

Hypoxemia

Regardless of its cause, severe hypoxemia may produce syncope. Common related effects include confusion, tachycardia, restlessness, and incoordination.

Orthostatic hypotension

Syncope occurs when the patient rises quickly from a recumbent position. Look for a drop of 10 to 20 mm Hg or more in systolic or diastolic blood pressure as well as tachycardia, pallor, dizziness, blurred vision, nausea, and diaphoresis.

Transient ischemic attack (TIA)

Marked by transient neurologic deficits, TIAs may produce syncope and a decreased level of consciousness. Other findings vary with the affected artery, but may include vision loss, nystagmus, aphasia, dysarthria, unilateral numbness, hemiparesis or hemiplegia, tinnitus, facial weakness, dysphagia, and a staggering or an uncoordinated gait.

Other causes

Drugs

Quinidine may cause syncope — and possibly sudden death — associated with ventricular fibrillation. Prazosin may cause severe orthostatic hypotension and syncope, usually after the first dose. Occasionally, griseofulvin, levodopa, and indomethacin can produce syncope.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Vertigo: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Acoustic neuroma

Acoustic neuroma is a tumor of the eighth cranial nerve that causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and — with cranial nerve compression — facial paralysis.

Benign positional vertigo

With benign positional vertigo, debris in a semicircular canal produces vertigo on head position change, which lasts a few minutes. It’s usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia

Brain stem ischemia produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma

Persistent vertigo, occurring soon after injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased (LOC). Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster

Infection of the eighth cranial nerve produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis

Severe vertigo begins abruptly with labyrinthitis, an inner ear infection. Vertigo may occur in a single episode or may recur over months or years. Associated findings include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière’s disease

With Ménière’s disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, any sudden motion of the head or eyes can precipitate nausea and vomiting.

Multiple sclerosis (MS)

Episodic vertigo may occur early and become persistent. Other early findings include diplopia, visual blurring, and paresthesia. MS may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Seizures

Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures.

Vestibular neuritis

With vestibular neuritis, severe vertigo usually begins abruptly and lasts several days, without tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests

Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol

High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures

Ear surgery may cause vertigo that lasts for several days. Also, administration of overly warm or cold eardrops or irrigating solutions can cause vertigo.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Syncope: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Aortic arch syndrome

With this syndrome, the patient experiences syncope and may exhibit weak or abruptly absent carotid pulses and unequal or absent radial pulses. Early signs and symptoms include night sweats, pallor, nausea, anorexia, weight loss, arthralgia, and Raynaud’s phenomenon. He may also develop hypotension in the arms; neck, shoulder, and chest pain; paresthesia; intermittent claudication; bruits; vision disturbances; and dizziness.

Aortic stenosis

A cardinal late sign, syncope is accompanied by exertional dyspnea and angina. Related findings include marked fatigue, orthopnea, paroxysmal nocturnal dyspnea, palpitations, and diminished carotid pulses. Typically, auscultation reveals atrial and ventricular gallops as well as a harsh, crescendo-decrescendo systolic ejection murmur that’s loudest at the right sternal border of the second intercostal space.

Cardiac arrhythmias

Any arrhythmia that decreases cardiac output and impairs cerebral circulation may cause syncope. Other effects—such as palpitations, pallor, confusion, diaphoresis, dyspnea, and hypotension—usually develop first. However, with Adams-Stokes syndrome, syncope may occur without warning. During syncope, the patient develops asystole, which may precipitate spasm and myoclonic jerks if prolonged. He also displays an ashen pallor that progresses to cyanosis, incontinence, bilateral Babinski’s reflex, and fixed pupils.

Carotid sinus hypersensitivity

Syncope is triggered by compression of the carotid sinus, which may be caused by turning the head to one side or by wearing a tight collar. The fainting episode is usually of short duration.

Hypoxemia

Regardless of its cause, severe hypoxemia may produce syncope. Common related effects include confusion, tachycardia, restlessness, and incoordination.

Orthostatic hypotension

Syncope occurs when the patient rises quickly from a recumbent position. Look for a drop of 10 to 20 mm Hg or more in systolic or diastolic blood pressure as well as tachycardia, pallor, dizziness, blurred vision, nausea, and diaphoresis.

Transient ischemic attacks

Marked by transient neurologic deficits, these attacks may produce syncope and decreased level of consciousness. Other findings vary with the affected artery but may include vision loss, nystagmus, aphasia, dysarthria, unilateral numbness, hemiparesis or hemiplegia, tinnitus, facial weakness, dysphagia, and staggering or uncoordinated gait.

Vagal glossopharyngeal neuralgia

With this disorder, localized pressure may trigger pain in the base of the tongue, pharynx, larynx, tonsils, and ear, resulting in syncope that lasts for several minutes.

Other causes

Drugs

Quinidine may cause syncope—and possibly sudden death—associated with ventricular fibrillation. Prazosin may cause severe orthostatic hypotension and syncope, usually after the first dose. Occasionally, griseofulvin, levodopa, and indomethacin can produce syncope.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Vertigo: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Acoustic neuroma

This tumor of the eighth cranial nerve causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and—with cranial nerve compression—facial paralysis.

Benign positional vertigo

In this disorder, debris in a semicircular canal produces vertigo lasting a few minutes when the patient changes head position. This type of vertigo is usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia

This condition produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma

Persistent vertigo, occurring soon after a head injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased level of consciousness. Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster

Infection of the eighth cranial nerve produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis

Severe vertigo begins abruptly in this inner ear infection. Vertigo may occur in a single episode or may recur over months or years. Associated findings include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière’s disease

In this disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, any sudden motion of the head or eyes can precipitate nausea and vomiting.

Motion sickness

This condition is characterized by vertigo, nausea, vomiting, and headache in response to rhythmic or erratic motions.

Multiple sclerosis (MS)

Episodic vertigo may occur early and become persistent in MS. Other early findings include diplopia, visual blurring, and paresthesia. MS may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Posterior fossa tumor

This type of tumor may produce positional vertigo that lasts for a few seconds as well as papilledema, headache, memory loss, nausea, vomiting, nystagmus, apneustic or ataxic respirations, and increased blood pressure. The patient may also fall sideways.

Seizures

Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures.

Vestibular neuritis

In this disorder, severe vertigo usually begins abruptly, lasts several days, and isn’t accompanied by tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests

Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol

High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures

Ear surgery may cause vertigo that lasts for several days. Administration of overly warm or cold eardrops or irrigating solutions can also cause vertigo.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Syncope: Differential Overview
(Field Guide to Bedside Diagnosis)

Orthostatic/Autonomic

❑ Neurally mediated hypotension

❑ Volume depletion

❑ Cough syncope

❑ Anemia

❑ Autonomic insufficiency

Cardiac/Obstructive

❑ Myocardial infarction

❑ Pulmonary embolism

❑ Aortic stenosis

❑ Hypertrophic obstructive cardiomyopathy

❑ Aortic dissection

❑ Cardiac tamponade

❑ Left atrial myxoma

Cardiac/Dysrhythmic

❑ Complete heart block

❑ Sick sinus syndrome

❑ Tachyarrhythmia

❑ Carotid sinus hypersensitivity

Neurologic

❑ Vertebrobasilar ischemia

❑ Hypoglycemia

❑ Unwitnessed seizure

❑ Subclavian steal syndrome

Psychologic

❑ Hyperventilation

❑ Hysterical faint

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Syncope: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Aortic arch syndrome

With aortic arch syndrome, the patient experiences syncope and may exhibit weak or abruptly absent carotid pulses and unequal or absent radial pulses. Early signs and symptoms include night sweats, pallor, nausea, anorexia, weight loss, arthralgia, and Raynaud’s phenomenon. He may also develop hypotension in the arms, paresthesia, intermittent claudication, bruits, vision disturbances, dizziness, and neck, shoulder, and chest pain.

Aortic stenosis

A cardinal late sign, syncope is accompanied by exertional dyspnea and angina. Related findings include marked fatigue, orthopnea, paroxysmal nocturnal dyspnea, palpitations, and diminished carotid pulses. Typically, auscultation reveals atrial and ventricular gallops as well as a harsh, crescendo-decrescendo systolic ejection murmur that’s loudest at the right sternal border of the second intercostal space.

Cardiac arrhythmias

Any arrhythmia that decreases cardiac output and impairs cerebral circulation may cause syncope. Other effects — palpitations, pallor, confusion, diaphoresis, dyspnea, and hypotension — usually develop first. However, with Adams-Stokes syndrome, syncope may occur without warning. During syncope, the patient develops asystole, which may precipitate spasm and myoclonic jerks if prolonged. He also displays an ashen pallor that progresses to cyanosis, incontinence, bilateral Babinski’s reflex, and fixed pupils.

Carotid sinus hypersensitivity

Syncope is triggered by compression of the carotid sinus, which may be caused by turning the head to one side or by wearing a tight collar. The fainting episode is usually short.

Hypoxemia

Regardless of its cause, severe hypoxemia may produce syncope. Common related effects include confusion, tachycardia, restlessness, and incoordination.

Orthostatic hypotension

Syncope occurs when the patient rises quickly from a recumbent position. Look for a drop of 10 mm Hg or more in systolic or diastolic blood pressure as well as tachycardia, pallor, dizziness, blurred vision, nausea, and diaphoresis.

Transient ischemic attacks

Marked by transient neurologic deficits, these attacks may produce syncope and a decreased level of consciousness. Other findings vary with the affected artery, but may include vision loss, nystagmus, aphasia, dysarthria, unilateral numbness, hemiparesis or hemiplegia, tinnitus, facial weakness, dysphagia, and a staggering or an uncoordinated gait.

Vagal glossopharyngeal neuralgia

With this disorder, localized pressure may trigger pain in the base of the tongue, pharynx, larynx, tonsils, and ear, resulting in syncope that lasts for several minutes.

Other causes

Drugs

Quinidine may cause syncope — and possibly sudden death — associated with ventricular fibrillation. Prazosin may cause severe orthostatic hypotension and syncope, usually after the first dose. Occasionally, griseofulvin, levodopa, and indomethacin can produce syncope.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Syncope: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Aortic arch syndrome

With aortic arch syndrome, the patient experiences syncope and may exhibit weak or abruptly absent carotid pulses and unequal or absent radial pulses. Early signs and symptoms include night sweats, pallor, nausea, anorexia, weight loss, arthralgia, and Raynaud’s phenomenon. He may also develop hypotension in the arms; neck, shoulder, and chest pain; paresthesia; intermittent claudication; bruits; vision disturbances; and dizziness.

Aortic stenosis

A cardinal late sign of aortic stenosis, syncope is accompanied by exertional dyspnea and angina. Related findings include marked fatigue, orthopnea, paroxysmal nocturnal dyspnea, palpitations, and diminished carotid pulses. Typically, auscultation reveals atrial and ventricular gallops as well as a harsh, crescendo-decrescendo systolic ejection murmur that’s loudest at the right sternal border of the second intercostal space.

Cardiac arrhythmias

Any arrhythmia that decreases cardiac output and impairs cerebral circulation may cause syncope. Other effects — such as palpitations, pallor, confusion, diaphoresis, dyspnea, and hypotension — usually develop first. However, with Adams-Stokes syndrome, syncope may occur without warning. During syncope, the patient develops asystole, which may precipitate spasm and myoclonic jerks if prolonged. He also displays an ashen pallor that progresses to cyanosis, incontinence, bilateral Babinski’s reflex, and fixed pupils.

Carotid sinus hypersensitivity

With carotid sinus hypersensitivity, syncope is triggered by compression of the carotid sinus, which may be caused by turning the head to one side or by wearing a tight collar. The fainting episode is usually of short duration.

Hypoxemia

Regardless of its cause, severe hypoxemia may produce syncope. Common related effects include confusion, tachycardia, restlessness, and incoordination. The patient may also have tachypnea, dyspnea, and cyanosis.

Orthostatic hypotension

With orthostatic hypotension, syncope occurs when the patient rises quickly from a recumbent position. Look for a drop of 10 to 20 mm Hg or more in systolic or diastolic blood pressure as well as tachycardia, pallor, dizziness, blurred vision, nausea, and diaphoresis.

Transient ischemic attacks

Marked by transient neurologic deficits, transient ischemic attacks (TIAs) may produce syncope and decreased level of consciousness. Other findings vary with the affected artery but may include vision loss, nystagmus, aphasia, dysarthria, unilateral numbness, hemiparesis or hemiplegia, tinnitus, facial weakness, dysphagia, and staggering or uncoordinated gait.

Vagal glossopharyngeal neuralgia

With vagal glossopharyngeal neuralgia, localized pressure may trigger pain in the base of the tongue, pharynx, larynx, tonsils, and ear, resulting in syncope that lasts for several minutes.

Other causes

Drugs

Quinidine may cause syncope — and possibly sudden death — associated with ventricular fibrillation. Prazosin may cause severe orthostatic hypotension and syncope, usually after the first dose. Occasionally, griseofulvin, levodopa, and indomethacin can produce syncope.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Vertigo: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Acoustic neuroma

Acoustic neuroma is a tumor of the eighth cranial nerve that causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and — with cranial nerve compression — facial paralysis.

Benign positional vertigo

With benign positional vertigo, debris in a semicircular canal produces vertigo on head position change, which lasts a few minutes. It’s usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia

Brain stem ischemia produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma

Persistent vertigo, occurring soon after injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased level of consciousness (LOC). Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster

Infection of the eighth cranial nerve with herpes zoster produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis

Severe vertigo begins abruptly with this inner ear infection. Vertigo may occur in a single episode or may recur over months or years. Associated findings of labyrinthitis include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière’s disease

With Ménière’s disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, any sudden motion of the head or eyes can precipitate nausea and vomiting.

Motion sickness

Motion sickness is characterized by vertigo, nausea, vomiting, and headache in response to rhythmic or erratic motions. Headache, dizziness, fatigue, diaphoresis, hypersalivation, and dyspnea may also occur.

Multiple sclerosis

Episodic vertigo may occur early in multiple sclerosis and become persistent. Other early findings include diplopia, visual blurring, and paresthesia. Multiple sclerosis may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Seizures

Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures. The seizures may be heralded by an aura and followed by several minutes of mental confusion.

Vestibular neuritis

With vestibular neuritis, severe vertigo usually begins abruptly and lasts several days, without tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests

Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol

High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures

Ear surgery may cause vertigo that lasts for several days. Also, administration of overly warm or cold eardrops or irrigating solutions can cause vertigo.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Vertigo: Principal Causes of Vertigo
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Peripheralvestibular dysfunction
   1. Labyrinthitis
   2. Motion sickness
   3. Head trauma
   4. Drugs
   5. Benign paroxysmal vertigo
   6. Vestibular neuronitis
   7. Middle ear and temporal bone masses
   8. Perilymphatic fistula
   9. Ménière disease
2. Central vestibular dysfunction
   1. Head trauma
   2. Intracranial infection
   3. Seizure disorder
   4. Basilar artery migraine
   5. Neoplasm
3. Psychologic disturbance

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Syncope and Dizziness: Principal Causes of Syncope and Dizziness
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Cardiovascularsyncope
   1. Neurocardiogenicsyncope
   2. Cardiac syncope
      1. Congenitaland acquired heart disease
      2. Hypercyanotic episodes
      3. Arrhythmias in structurally normalheart
      4. Arrhythmias in structurally abnormalheart
   3. Vascular syncope
      1. Orthostaticsyncope
      2. Cerebrovascular syncope
      3. Carotid sinus syncope
2. Noncardiovascular syncope
   1. Breath-holding
   2. Hyperventilation
   3. Migraine
   4. Metabolic
      1. Hypoxia including anemia
      2. Hypoglycemia
   5. Psychologic

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Syncope: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Aortic arch syndrome.With aortic arch syndrome, syncope, weak or abruptly absent carotid pulses, and unequal or absent radial pulses may occur. Early signs and symptoms include night sweats, pallor, nausea, anorexia, weight loss, arthralgia, and Raynaud's phenomenon. He may also develop hypotension in the arms; neck, shoulder, and chest pain; paresthesia; intermittent claudication; bruits; vision disturbances; and dizziness.

Aortic stenosis.A cardinal late sign of aortic stenosis, syncope is accompanied by exertional dyspnea and angina. Related findings include marked fatigue, orthopnea, paroxysmal nocturnal dyspnea, palpitations, and diminished carotid pulses. Typically, auscultation reveals atrial and ventricular gallops as well as a harsh, crescendo-decrescendo systolic ejection murmur that's loudest at the right sternal border of the second intercostal space.

Cardiac arrhythmias.Any arrhythmia that decreases cardiac output and impairs cerebral circulation may cause syncope. Other effects—such as palpitations, pallor, confusion, diaphoresis, dyspnea, and hypotension—usually develop first. However, with Adams-Stokes syndrome, syncope may occur without warning. During syncope, the patient develops asystole, which may precipitate spasm and myoclonic jerks if prolonged. He also displays an ashen pallor that progresses to cyanosis, incontinence, a bilateral Babinski's reflex, and fixed pupils.

Hypoxemia.Regardless of its cause, severe hypoxemia may produce syncope. Common related effects include confusion, tachycardia, restlessness, and incoordination.

Orthostatic hypotension.Syncope occurs when the patient rises quickly from a recumbent position. Look for a drop of 10 to 20 mm Hg or more in systolic or diastolic blood pressure as well as tachycardia, pallor, dizziness, blurred vision, nausea, and diaphoresis.

Transient ischemic attack (TIA).Marked by transient neurologic deficits, TIAs may produce syncope and decreased level of consciousness. Other findings vary with the affected artery, but may include vision loss, nystagmus, aphasia, dysarthria, unilateral numbness, hemiparesis or hemiplegia, tinnitus, facial weakness, dysphagia, and a staggering or an uncoordinated gait.

Other causes

Drugs.Quinidine may cause syncope—and possibly sudden death—associated with ventricular fibrillation. Prazosin may cause severe orthostatic hypotension and syncope, usually after the first dose. Occasionally, griseofulvin, levodopa, and indomethacin can produce syncope.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Vertigo: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Acoustic neuroma.Acoustic neuroma causes mild, intermittent vertigo and unilateral sensorineural hearing loss. Other findings include tinnitus, postauricular or suboccipital pain, and—with cranial nerve compression—facial paralysis.

Benign positional vertigo.With benign positional vertigo, debris in a semicircular canal produces vertigo with head position change, which lasts a few minutes. It's usually temporary and can be effectively treated with positional maneuvers.

Brain stem ischemia.Brain stem ischemia produces sudden, severe vertigo that may become episodic and later persistent. Associated findings include ataxia, nausea, vomiting, increased blood pressure, tachycardia, nystagmus, and lateral deviation of the eyes toward the side of the lesion. Hemiparesis and paresthesia may also occur.

Head trauma.Persistent vertigo, occurring soon after head injury, accompanies spontaneous or positional nystagmus and, if the temporal bone is fractured, hearing loss. Associated findings include headache, nausea, vomiting, and decreased (LOC). Behavioral changes, diplopia or visual blurring, seizures, motor or sensory deficits, and signs of increased intracranial pressure may also occur.

Herpes zoster.Herpes infection of the eighth cranial nerve produces sudden onset of vertigo accompanied by facial paralysis, hearing loss in the affected ear, and herpetic vesicular lesions in the auditory canal.

Labyrinthitis.Severe vertigo begins abruptly with labyrinthitis. Vertigo may occur in a single episode or may recur over months or years. Associated findings include nausea, vomiting, progressive sensorineural hearing loss, and nystagmus.

Ménière's disease.With Ménière's disease, labyrinthine dysfunction causes abrupt onset of vertigo, lasting minutes, hours, or days. Unpredictable episodes of severe vertigo and unsteady gait may cause the patient to fall. During an attack, a sudden motion of the head or eyes can precipitate nausea and vomiting.

Multiple sclerosis (MS).With MS, episodic vertigo may occur early and become persistent. Other early findings include diplopia, visual blurring, and paresthesia. MS may also produce nystagmus, constipation, muscle weakness, paralysis, spasticity, hyperreflexia, intention tremor, and ataxia.

Seizures.Temporal lobe seizures may produce vertigo, usually associated with other symptoms of partial complex seizures.

Vestibular neuritis.With vestibular neuritis, severe vertigo usually begins abruptly and lasts several days, without tinnitus or hearing loss. Other findings include nausea, vomiting, and nystagmus.

Other causes

Diagnostic tests.Caloric testing (irrigating the ears with warm or cold water) can induce vertigo.

Drugs and alcohol.High or toxic doses of certain drugs or alcohol may produce vertigo. These drugs include salicylates, aminoglycosides, antibiotics, quinine, and hormonal contraceptives.

Surgery and other procedures.Ear surgery may cause vertigo that lasts for several days. Administration of overly warm or cold eardrops or irrigating solutions can also cause vertigo.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

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