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Causes of Benign Paroxysmal Positional Vertigo

Contents
  1. Benign Paroxysmal Positional Vertigo: Introduction
  2. List of Causes
  3. Hidden causes
  4. Excerpts from book chapters
  5. Related cause information

List of causes of Benign Paroxysmal Positional Vertigo

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Benign Paroxysmal Positional Vertigo) that could possibly cause Benign Paroxysmal Positional Vertigo includes:

Benign Paroxysmal Positional Vertigo Causes: Book Excerpts

Related information on causes of Benign Paroxysmal Positional Vertigo:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Benign Paroxysmal Positional Vertigo may be found in:

Causes of Benign Paroxysmal Positional Vertigo: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Benign Paroxysmal Positional Vertigo.

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

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

Fever – Recurrent: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

    • Repeated viral infections
      –Most common cause of recurrent febrile episodes in childhood
      –Start of day care or change of geographic location may be related
    • Urinary tract infection (UTI)
      –May be self-limited but recur especially if underlying anomaly exists
    • Epstein-Barr virus (EBV)
      –May present with recurrent febrile episodes due to one initial infection
  • Other specific viral syndromes
    –Parvovirus B19
    –CMV
    • Immunodeficiency
      –Repeated bacterial infections should lead to investigation of immune status
  • Dental abscess (non-dental abscesses typically present with prolonged daily fever)
  • Chronic meningococcemia
  • Acute rheumatic fever
  • Inflammatory bowel disease (IBD)
  • Juvenile rheumatoid arthritis (JRA)
  • Behçet disease
    • Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) or Hibernian Fever
      –Autosomal dominant disease with fever, myalgias with migratory pattern, conjunctivitis and rash
    • Familial cold autoinflammatory syndrome or familial cold urticaria
      –Rash, fever, arthralgia, and conjunctivitis
      –Precipitated by exposure to cold
  • Muckle-Wells syndrome
    –Similar presentation to familial cold urticaria
    –Symptoms not triggered by cold
    • Brucellosis
      –Most prevalent around the Mediterranean and Arabic countries, also present in South America and India
  • Yersiniosis
  • Typhoid fever
  • Rat-bite fever
  • Malaria
  • Factitious fever

» READ BOOK EXCERPT ONLINE »

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

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

Anemia.

Typically, anemia causes dizziness that's aggravated by postural changes or exertion. Other signs and symptoms include pallor, dyspnea, fatigue, tachycardia, and a bounding pulse. The capillary refill time is increased.

Cardiac arrhythmias.

Dizziness lasts for several seconds or longer and may precede fainting in arrhythmias. The patient may experience palpitations; irregular, rapid, or thready pulse; and, possibly, hypotension. He may also experience weakness, blurred vision, paresthesia, and confusion.

Emphysema.

Dizziness may follow exertion or the chronic productive cough in patients with emphysema. Associated signs and symptoms include dyspnea, anorexia, weight loss, malaise, use of accessory muscles, pursed-lip breathing, tachypnea, peripheral cyanosis, and diminished breath sounds. Barrel chest and clubbing may be seen.

Generalized anxiety disorder

Generalized anxiety disorder produces continuous dizziness that may intensify as the disorder worsens. Associated signs and symptoms are persistent anxiety (for at least 1 month), insomnia, difficulty concentrating, and irritability. The patient may show signs of motor tension — for example, twitching or fidgeting, muscle aches, a furrowed brow, and a tendency to be startled. He may also display signs of autonomic hyperactivity, such as diaphoresis, palpitations, cold and clammy hands, dry mouth, paresthesia, indigestion, hot or cold flashes, frequent urination, diarrhea, a lump in the throat, pallor, and increased pulse and respiratory rates.

Hypertension.

With hypertension, dizziness may precede fainting, but it may also be relieved by rest. Other common signs and symptoms include a headache and blurred vision. Retinal changes include hemorrhage, sclerosis of retinal blood vessels, exudate, and papilledema.

Hyperventilation syndrome.

Episodes of hyperventilation cause dizziness that usually lasts a few minutes; however, if these episodes occur frequently, dizziness may persist between them. Other effects include apprehension, diaphoresis, pallor, dyspnea, chest tightness, palpitations, trembling, fatigue, and peripheral and circumoral paresthesia.

Hypovolemia.

Dizziness is caused by a lack of circulating volume and may be accompanied by other signs of fluid volume deficit (dry mucous membranes, decreased blood pressure, increased heart rate).

Orthostatic hypotension.

Orthostatic hypotension produces dizziness that may terminate in fainting or disappear with rest. Related findings include dim vision, spots before the eyes, pallor, diaphoresis, hypotension, tachycardia and, possibly, signs of dehydration.

Postconcussion syndrome.

Occurring 1 to 3 weeks after a head injury, postconcussionsyndrome is marked by dizziness, a headache (throbbing, aching, bandlike, or stabbing), emotional lability, alcohol intolerance, fatigue, anxiety and, possibly, vertigo. Dizziness and other symptoms are intensified by mental or physical stress. The syndrome may persist for years, but symptoms eventually abate.

Rift Valley fever

Typical signs and symptoms of Rift Valley fever include dizziness, a fever, myalgia, weakness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss.

Transient ischemic attack (TIA)

Lasting from a few seconds to 24 hours, a TIA commonly signals an impending stroke and may be triggered by turning the head to the side. Besides dizziness of varying severity, TIAs are accompanied by unilateral or bilateral diplopia, blindness or visual field deficits, ptosis, tinnitus, hearing loss, paresis, and numbness. Other findings include dysarthria, dysphagia, vomiting, hiccups, confusion, a decreased LOC, and pallor.

Other causes

Drugs

Anxiolytics, central nervous system depressants, opioids, decongestants, antihistamines, antihypertensives, and vasodilators commonly cause dizziness.

Herb alert  

Herbal remedies, such as St. John's wort, can produce dizziness.

» 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

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

Brain abscess

Decorticate posture may occur with brain abscess. Accompanying findings vary depending on the size and location of the abscess, but may include aphasia, hemiparesis, a headache, dizziness, seizures, nausea, and vomiting. The patient may also experience behavioral changes, altered vital signs, and a decreased LOC.

Brain tumor

A brain tumor may produce decorticate posture that's usually bilateral — the result of increased intracranial pressure (ICP) associated with tumor growth. Related signs and symptoms include a headache, behavioral changes, memory loss, diplopia, blurred vision or vision loss, seizures, ataxia, dizziness, apraxia, aphasia, paresis, sensory loss, paresthesia, vomiting, papilledema, and signs of hormonal imbalance.

Head injury

Decorticate posture may be among the variable features of a head injury, depending on the site and severity of the injury. Associated signs and symptoms include a headache, nausea and vomiting, dizziness, irritability, a decreased LOC, aphasia, hemiparesis, unilateral numbness, seizures, and pupillary dilation.

Stroke.

Typically, a stroke involving the cerebral cortex produces unilateral decorticate posture, also called spastic hemiplegia. Other signs and symptoms include hemiplegia (contralateral to the lesion), dysarthria, dysphagia, unilateral sensory loss, apraxia, agnosia, aphasia, memory loss, a decreased LOC, urine retention, urinary incontinence, and constipation. Ocular effects include homonymous hemianopsia, diplopia, and blurred vision.

» READ BOOK EXCERPT ONLINE »

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

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

Anemia

Anemia typically causes dizziness that’s aggravated by postural changes or exertion. Other signs and symptoms include pallor, dyspnea, fatigue, tachycardia, bounding pulse, and increased capillary refill time.

Cardiac arrhythmias

Dizziness lasts for several seconds or longer and may precede fainting in arrhythmias. The patient may experience palpitations; irregular, rapid, or thready pulse and, possibly, hypotension. He may also experience weakness, blurred vision, paresthesia, and confusion.

Carotid sinus hypersensitivity

This disorder is characterized by brief episodes of dizziness that usually terminate in fainting. These episodes are precipitated by stimulation of one or both carotid arteries by seemingly minor sensations or actions, such as wearing a tight collar or moving the head. Associated signs and symptoms include sweating, nausea, and pallor.

Emphysema

Dizziness may follow exertion or the chronic productive cough that’s characteristic of this disorder. Associated signs and symptoms include dyspnea, anorexia, weight loss, malaise, use of accessory muscles, pursed-lip breathing, tachypnea, peripheral cyanosis, and diminished breath sounds. Barrel chest and clubbing may occur.

Generalized anxiety disorder

This disorder produces persistent anxiety (for at least 1 month), insomnia, difficulty concentrating, irritability and, possibly, continuous dizziness that may intensify as the anxiety worsens. The patient may show signs of motor tension—for example, twitching or fidgeting, muscle aches, a furrowed brow, and a tendency to be startled. He may also display signs of autonomic hyperactivity, such as diaphoresis, palpitations, cold and clammy hands, dry mouth, paresthesia, indigestion, hot or cold flashes, frequent urination, diarrhea, a lump in the throat, pallor, and increased pulse and respiratory rates.

Hypertension

In patients with hypertension, dizziness may precede fainting, but it may also be relieved by rest. Other common signs and symptoms include headache and blurred vision. Retinal changes include hemorrhage, sclerosis of retinal blood vessels, exudate, and papilledema.

Hyperventilation syndrome

Episodes of hyperventilation cause dizziness that usually lasts a few minutes; however, if these episodes occur frequently, dizziness may persist between them. Other effects include apprehension, diaphoresis, pallor, dyspnea, chest tightness, palpitations, trembling, fatigue, and peripheral and circumoral paresthesia.

Hypoglycemia

Dizziness is a central nervous system (CNS) disturbance that can result from fasting hypoglycemia. It’s generally accompanied by headache, clouding of vision, restlessness, and mental status changes.

Hypovolemia

Dizziness may be accompanied by other signs of fluid volume deficit, such as dry mucous membranes, decreased blood pressure, and increased heart rate.

Orthostatic hypotension

This condition produces dizziness that may terminate in fainting or disappear with rest. Related findings include dim vision, spots before the eyes, pallor, diaphoresis, hypotension, tachycardia and, possibly, signs of dehydration.

Panic disorder

Dizziness may accompany acute attacks of panic in patients with this disorder. Other findings include anxiety, dyspnea, palpitations, chest pain, a choking or smothering sensation, vertigo, paresthesia, hot and cold flashes, diaphoresis, and trembling or shaking. The patient may feel like he’s dying or losing his mind.

Postconcussion syndrome

Occurring 1 to 3 weeks after a head injury, this syndrome is marked by dizziness, headache (throbbing, aching, bandlike, or stabbing), emotional lability, alcohol intolerance, fatigue, anxiety and, possibly, vertigo. Dizziness and other symptoms are intensified by mental or physical stress. The syndrome may persist for years, but symptoms eventually abate.

Rift Valley fever

Typical signs and symptoms of this disorder include dizziness, fever, myalgia, weakness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever, which can lead to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss.

Transient ischemic attack (TIA)

Lasting from a few seconds to 24 hours, a TIA commonly signals an impending stroke and may be triggered by turning the head to the side. Besides dizziness of varying severity, TIAs are marked by unilateral or bilateral diplopia, blindness or visual field deficits, ptosis, tinnitus, hearing loss, paresis, and numbness. Other findings may include dysarthria, dysphagia, vomiting, hiccups, confusion, decreased LOC, and pallor.

Other causes

Drugs

Anxiolytics, CNS depressants, opioids, decongestants, antihistamines, antihypertensives, and vasodilators commonly cause dizziness.

Herb Alert

Herbal remedies, such as St. John’s wort, can produce dizziness.

» 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

Decorticate posture [Decorticate rigidity, abnormal flexor response]: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Brain abscess

Decorticate posture may occur in a brain abscess. Accompanying findings vary depending on the size and location of the abscess but may include aphasia, hemiparesis, headache, dizziness, seizures, nausea, and vomiting. The patient may also experience behavioral changes, altered vital signs, and decreased LOC.

Brain tumor

A brain tumor may produce decorticate posture that’s usually bilateral—the result of increased intracranial pressure (ICP) associated with tumor growth. Related signs and symptoms include headache, behavioral changes, memory loss, diplopia, blurred vision or vision loss, seizures, ataxia, dizziness, apraxia, aphasia, paresis, sensory loss, paresthesia, vomiting, papilledema, and signs of hormonal imbalance.

Head injury

Decorticate posture may result from a head injury, depending on the site and severity of the injury. Associated signs and symptoms include headache, nausea and vomiting, dizziness, irritability, decreased LOC, aphasia, hemiparesis, unilateral numbness, seizures, and pupillary dilation.

Stroke

Typically, a stroke involving the cerebral cortex produces unilateral decorticate posture, also called spastic hemiplegia. Other signs and symptoms include hemiplegia (contralateral to the lesion), dysarthria, dysphagia, unilateral sensory loss, apraxia, agnosia, aphasia, memory loss, decreased LOC, urine retention, urinary incontinence, and constipation. Ocular effects include homonymous hemianopsia, diplopia, and blurred vision.

» READ BOOK EXCERPT ONLINE »

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

Dizziness: Differential Overview
(Field Guide to Bedside Diagnosis)

Vertigo

❑ Benign paroxysmal positional vertigo

❑ Vestibular neuronitis

❑ Toxic labyrinthitis

❑ Vertebrobasilar insufficiency

❑ Ménière disease

❑ Migraine

❑ Multiple sclerosis

❑ Acoustic neuroma

❑ Herpes zoster oticus (Ramsey–Hunt)

Disequilibrium

❑ Multifactorial disequilibrium

❑ Stroke

❑ Cerebellar disease

❑ Frontal lobe apraxia

Lightheadedness

❑ Orthostatic hypotension

❑ Common fainting (presyncope)

❑ Hyperventilation

❑ Panic attack

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Chronic/Recurrent Abdominal Pain: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Irritable bowel syndrome

❑ Peptic ulcer disease

❑ Cholecystitis

❑ Chronic pancreatitis

❑ Inflammatory bowel disease

❑ Intermittent mesenteric ischemia

❑ Pancreatic cancer

❑ Gastric cancer

❑ Endometriosis

❑ Recurrent intestinal obstruction

❑ Sickle cell anemia

❑ Radiculopathy

❑ Adrenal insufficiency

❑ Lead poisoning

❑ Porphyria

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

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

Anemia

Typically, anemia causes dizziness that’s aggravated by postural changes or exertion. Other signs and symptoms include pallor, dyspnea, fatigue, tachycardia, and bounding pulse. Capillary refill time is increased.

Cardiac arrhythmias

Dizziness lasts for several seconds or longer and may precede fainting in arrhythmias. The patient may experience palpitations; irregular, rapid, or thready pulse; and possibly hypotension. He may also experience weakness, blurred vision, paresthesia, and confusion.

Carotid sinus hypersensitivity.

Carotid sinus hypersensitivity is characterized by brief episodes of dizziness that usually terminate in fainting. These episodes are precipitated by stimulation of one or both carotid arteries by seemingly minor sensations or actions, such as wearing a tight collar or moving the head. Associated signs and symptoms include sweating, nausea, and pallor.

Emphysema

Dizziness may follow exertion or the chronic productive cough in patients with emphysema. Associated signs and symptoms include dyspnea, anorexia, weight loss, malaise, use of accessory muscles, pursed-lip breathing, tachypnea, peripheral cyanosis, and diminished breath sounds. Barrel chest and clubbing may be seen.

Generalized anxiety disorder

Generalized anxiety disorder produces continuous dizziness that may intensify as the disorder worsens. Associated signs and symptoms are persistent anxiety (for at least 1 month), insomnia, difficulty concentrating, and irritability. The patient may show signs of motor tension — for example, twitching or fidgeting, muscle aches, furrowed brow, and a tendency to be startled. He may also display signs of autonomic hyperactivity, such as diaphoresis, palpitations, cold and clammy hands, dry mouth, paresthesia, indigestion, hot or cold flashes, frequent urination, diarrhea, a lump in the throat, pallor, and increased pulse and respiratory rates.

Hypertension

With hypertension, dizziness may precede fainting, but it may also be relieved by rest. Other common signs and symptoms include headache and blurred vision. Retinal changes include hemorrhage, sclerosis of retinal blood vessels, exudate, and papilledema.

Hyperventilation syndrome

Episodes of hyperventilation cause dizziness that usually lasts a few minutes; however, if these episodes occur frequently, dizziness may persist between them. Other effects include apprehension, diaphoresis, pallor, dyspnea, chest tightness, palpitations, trembling, fatigue, and peripheral and circumoral paresthesia.

Hypoglycemia.

Dizziness is a central nervous system (CNS) disturbance that can occur due to fasting hypoglycemia. It’s generally accompanied by headache, clouding of vision, restlessness, and mental status changes.

Hypovolemia

Dizziness is caused by a lack of circulating volume and may be accompanied by other signs of fluid volume deficit (dry mucous membranes, decreased blood pressure, increased heart rate).

Orthostatic hypotension

Orthostatic hypotension produces dizziness that may terminate in fainting or disappear with rest. Related findings include dim vision, spots before the eyes, pallor, diaphoresis, hypotension, tachycardia and, possibly, signs of dehydration.

Panic disorder

Dizziness may accompany acute attacks of panic in patients with panic disorder. Other findings include anxiety, dyspnea, palpitations, chest pain, a choking or smothering sensation, vertigo, paresthesia, hot and cold flashes, diaphoresis, and trembling or shaking. The patient may have the sensation of dying or losing his mind.

Postconcussion syndrome

Occurring from the time of injury to 3 weeks after a head injury, postconcussion syndrome is marked by dizziness, headache (throbbing, aching, bandlike, or stabbing), emotional lability, alcohol intolerance, fatigue, anxiety and, possibly, vertigo. Dizziness and other symptoms are intensified by mental or physical stress. The syndrome may persist for years, but symptoms eventually abate.

Rift Valley fever

Typical signs and symptoms of Rift Valley fever include dizziness, fever, myalgia, weakness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss.

Transient ischemic attack (TIA)

Lasting from a few seconds to 24 hours, a TIA commonly signals impending stroke. Besides dizziness of varying severity, TIAs are accompanied by unilateral or bilateral diplopia, blindness or visual field deficits, ptosis, tinnitus, hearing loss, paresis, and numbness. Other findings include dysarthria, dysphagia, vomiting, hiccups, confusion, decreased LOC, and pallor.

Other causes

Drugs

Anxiolytics, CNS depressants, opioids, decongestants, antihistamines, antihypertensives, and vasodilators commonly cause dizziness.

Herbal remedies

St. John’s wort can produce dizziness.

» READ BOOK EXCERPT ONLINE »

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

Decorticate posture [Decorticate rigidity, abnormal flexor response]: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Brain abscess.

Decorticate posture may occur with brain abscess. Accompanying findings vary on the size and location of the abscess but may include aphasia, hemiparesis, headache, dizziness, seizures, nausea, and vomiting. The patient may also experience behavioral changes, altered vital signs, and decreased LOC.

Brain tumor

Brain tumor may produce decorticate posture that’s usually bilateral — the result of increased intracranial pressure (ICP) associated with tumor growth. Related signs and symptoms include headache, behavioral changes, memory loss, diplopia, blurred vision or vision loss, seizures, ataxia, dizziness, apraxia, aphasia, paresis, sensory loss, paresthesia, vomiting, papilledema, and signs of hormonal imbalance.

Head injury

Decorticate posture may be among the variable features of a head injury, depending on the site and severity of head injury. Associated signs and symptoms include headache, nausea and vomiting, dizziness, irritability, decreased LOC, aphasia, hemiparesis, unilateral numbness, seizures, and pupillary dilation.

Stroke.

Typically, a stroke involving the cerebral cortex produces unilateral decorticate posture, also called spastic hemiplegia. Other signs and symptoms include hemiplegia (contralateral to the lesion), dysarthria, dysphagia, unilateral sensory loss, apraxia, agnosia, aphasia, memory loss, decreased LOC, urine retention, urinary incontinence, and constipation. Ocular effects include homonymous hemianopsia, diplopia, and blurred vision.

» READ BOOK EXCERPT ONLINE »

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

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

Anemia

Typically, anemia causes dizziness that’s aggravated by postural changes or exertion. Other signs and symptoms include pallor, dyspnea, fatigue, tachycardia, and bounding pulse. Capillary refill time is increased.

Cardiac arrhythmias

Dizziness lasts for several seconds or longer and may precede fainting in arrhythmias. The patient may experience palpitations; irregular, rapid, or thready pulse; and possibly hypotension. He may also experience weakness, blurred vision, paresthesia, and confusion.

Carotid sinus hypersensitivity

Carotid sinus hypersensitivity is characterized by brief episodes of dizziness that usually terminate in fainting. These episodes are precipitated by stimulation of one or both carotid arteries by seemingly minor sensations or actions, such as wearing a tight collar or moving the head. Associated signs and symptoms include sweating, nausea, and pallor.

Generalized anxiety disorder

Generalized anxiety disorder produces continuous dizziness that may intensify as the disorder worsens. Associated signs and symptoms are persistent anxiety (for at least 1 month), insomnia, difficulty concentrating, and irritability. The patient may show signs of motor tension — for example, twitching or fidgeting, muscle aches, furrowed brow, and a tendency to be startled. He may also display signs of autonomic hyperactivity, such as diaphoresis, palpitations, cold and clammy hands, dry mouth, paresthesia, indigestion, hot or cold flashes, frequent urination, diarrhea, a lump in the throat, pallor, and increased pulse and respiratory rates.

Hypertension

With hypertension, dizziness may precede fainting, but it may also be relieved by rest. Other common signs and symptoms include headache and blurred vision. Retinal changes include hemorrhage, sclerosis of retinal blood vessels, exudate, and papilledema.

Hyperventilation syndrome

Episodes of hyperventilation cause dizziness that usually lasts a few minutes; however, if these episodes occur frequently, dizziness may persist between them. Other effects include apprehension, diaphoresis, pallor, dyspnea, chest tightness, palpitations, trembling, fatigue, and peripheral and circumoral paresthesia.

Hypoglycemia

Dizziness is a central nervous system (CNS) disturbance that can occur due to fasting hypoglycemia. It’s generally accompanied by headache, clouding of vision, restlessness, and mental status changes. Other signs and symptoms include irritability, trembling, hunger, cold sweats, and tachycardia.

Hypovolemia

Dizziness is caused by a lack of circulating volume and may be accompanied by other signs of fluid volume deficit (dry mucous membranes, decreased blood pressure, increased heart rate). Other signs and symptoms include orthostatic hypotension, thirst, poor skin turgor, and flattened neck veins.

Orthostatic hypotension

Orthostatic hypotension produces dizziness that may terminate in fainting or disappear with rest. Related findings include dim vision, spots before the eyes, pallor, diaphoresis, hypotension, tachycardia and, possibly, signs of dehydration.

Panic disorder

Dizziness may accompany acute attacks of panic in patients with panic disorder. Other findings include anxiety, dyspnea, palpitations, chest pain, a choking or smothering sensation, vertigo, paresthesia, hot and cold flashes, diaphoresis, and trembling or shaking. The patient may have the sensation of dying or losing his mind.

Postconcussion syndrome

Occurring 1 to 3 weeks after a head injury, postconcussion syndrome is marked by dizziness, headache (throbbing, aching, bandlike, or stabbing), emotional lability, alcohol intolerance, fatigue, anxiety and, possibly, vertigo. Dizziness and other symptoms are intensified by mental or physical stress. The syndrome may persist for years, but symptoms eventually abate.

Transient ischemic attack

Lasting from a few seconds to 24 hours, a transient ischemic attack (TIA) commonly signals impending stroke and may be triggered by turning the head to the side. Besides dizziness of varying severity, TIAs are accompanied by unilateral or bilateral diplopia, blindness or visual field deficits, ptosis, tinnitus, hearing loss, paresis, and numbness. Other findings include dysarthria, dysphagia, vomiting, hiccups, confusion, decreased LOC, and pallor.

Other causes

Drugs

Anxiolytics, CNS depressants, opioids, decongestants, antihistamines, antihypertensives, and vasodilators commonly cause dizziness. Herbal remedies such as St. John’s wort can also produce dizziness.

» 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

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

Brain abscess

Decorticate posture may occur with a brain abscess. Accompanying findings vary depending on the size and location of the abscess but may include aphasia, hemiparesis, headache, dizziness, seizures, nausea, and vomiting. The patient may also experience behavioral changes, altered vital signs, and decreased LOC.

Brain tumor

A brain tumor may produce decorticate posture that’s usually bilateral — the result of increased intracranial pressure (ICP) associated with tumor growth. Related signs and symptoms include headache, behavioral changes, memory loss, diplopia, blurred vision or vision loss, seizures, ataxia, dizziness, apraxia, aphasia, paresis, sensory loss, paresthesia, vomiting, papilledema, and signs of hormonal imbalance.

Head injury

Decorticate posture may be among the variable features of a head injury, depending on its site and severity. Associated signs and symptoms include headache, nausea and vomiting, dizziness, irritability, decreased LOC, aphasia, hemiparesis, unilateral numbness, seizures, and pupillary dilation.

Stroke

Typically, a stroke involving the cerebral cortex produces unilateral decorticate posture, also called spastic hemiplegia. Other signs and symptoms include hemiplegia (contralateral to the lesion), dysarthria, dysphagia, unilateral sensory loss, apraxia, agnosia, aphasia, memory loss, decreased LOC, urine retention, urinary incontinence, and constipation. Ocular effects include homonymous hemianopsia, diplopia, and blurred vision.

» 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

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

  1. Normalhost
    1. Upperrespiratory tract infections
    2. Otitis media
    3. Skin infections
    4. Urinary tract infections
    5. Pneumonia
    6. Meningitis
    7. Foreign body
  2. Immunologically compromised host
    1. Primaryimmunodeficiency
      1. Primary B-Cell disorders
        1. Transienthypogammaglobulinemia of infancy
        2. X-linked (Bruton) agammaglobulinemia
        3. Common variable immunodeficiency
        4. Selective IgA deficiency
        5. IgG subclass deficiencies
      2. Primary T-cell disorders
        1. Thymichypoplasia (DiGeorge syndrome)
      3. Combined B- and T-cell disorders
        1. Combinedimmunodeficiency
        2. Purine nucleoside phosphorylase deficiency
        3. Severe combined immunodeficiency
        4. Immunodeficiency with thrombocytopeniaand eczema (Wiskott-Aldrich syndrome)
        5. X-linked CD-40 ligand deficiency
        6. X-linked lymphoproliferative disease
        7. Ataxia-telangiectasia
        8. Hyper-IgE syndrome
        9. Cartilage-hair hypoplasia
      4. Disorders of phagocytic function
        1. Congenitalneutropenia
        2. Cyclic neutropenia
        3. Chronic granulomatous disease of childhood
        4. Chediak-Higashi syndrome
      5. Disorders of the complement system
    2. Secondary immunodeficiency
      1. Immunosuppressiveagents
      2. Sickle cell disease
      3. Nephrotic syndrome
      4. Burns
      5. Uremia
      6. Asplenia including splenectomy
      7. Neutropenia
      8. Lymphoid malignancy
      9. Protein-calorie malnutrition
      10. Human immunodeficiency virus infection

» READ BOOK EXCERPT ONLINE »

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

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

Anemia.Typically, anemia causes dizziness that's aggravated by postural changes or exertion. Other signs and symptoms include pallor, dyspnea, fatigue, tachycardia, and a bounding pulse. The capillary refill time is increased.

Cardiac arrhythmias.Dizziness may occur for several seconds or longer and may precede fainting in arrhythmias. The patient may experience palpitations; irregular, rapid, or thready pulse; and, possibly, hypotension. He may also experience weakness, blurred vision, paresthesia, and confusion.

Emphysema.Dizziness may follow exertion or the chronic productive cough in patients with emphysema. Associated signs and symptoms include dyspnea, anorexia, weight loss, malaise, use of accessory muscles, pursed-lip breathing, tachypnea, peripheral cyanosis, and diminished breath sounds. Barrel chest and clubbing may be seen.

Generalized anxiety disorder.Generalized anxiety disorder produces continuous dizziness that may intensify as the disorder worsens. Associated signs and symptoms are persistent anxiety (for at least 1 month), insomnia, difficulty concentrating, and irritability. The patient may show signs of motor tension—for example, twitching or fidgeting, muscle aches, a furrowed brow, and a tendency to be startled. He may also display signs of autonomic hyperactivity, such as diaphoresis, palpitations, cold and clammy hands, dry mouth, paresthesia, indigestion, hot or cold flashes, frequent urination, diarrhea, a lump in the throat, pallor, and increased pulse and respiratory rates.

Hypertension.With hypertension, dizziness may precede fainting, but it may also be relieved by rest. Other common signs and symptoms include a headache and blurred vision. Retinal changes include hemorrhage, sclerosis of retinal blood vessels, exudate, and papilledema.

Hyperventilation syndrome.Episodes of hyperventilation cause dizziness that usually lasts a few minutes; however, if these episodes occur frequently, dizziness may persist between them. Other effects include apprehension, diaphoresis, pallor, dyspnea, chest tightness, palpitations, trembling, fatigue, and peripheral and circumoral paresthesia.

Hypovolemia.A lack of circulating blood volume may cause dizziness and may be accompanied by other signs of fluid volume deficit (dry mucous membranes, decreased blood pressure, increased heart rate).

Orthostatic hypotension.Orthostatic hypotension produces dizziness that may terminate in fainting or disappear with rest. Related findings include dim vision, spots before the eyes, pallor, diaphoresis, hypotension, tachycardia and, possibly, signs of dehydration.

Postconcussion syndrome.Occurring 1 to 3 weeks after a head injury, postconcussion syndrome is marked by dizziness, a headache (throbbing, aching, bandlike, or stabbing), emotional lability, alcohol intolerance, fatigue, anxiety and, possibly, vertigo. Dizziness and other symptoms are intensified by mental or physical stress. The syndrome may persist for years, but symptoms eventually abate.

Rift Valley fever.Typical signs and symptoms of Rift Valley fever include dizziness, a fever, myalgia, weakness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss.

Transient ischemic attack (TIA).Lasting from a few seconds to 24 hours, a TIA commonly signals an impending stroke and may be triggered by turning the head to the side. Besides dizziness of varying severity, TIAs are accompanied by unilateral or bilateral diplopia, blindness or visual field deficits, ptosis, tinnitus, hearing loss, paresis, and numbness. Other findings include dysarthria, dysphagia, vomiting, hiccups, confusion, a decreased LOC, and pallor.

Other causes

Drugs.Anxiolytics, central nervous system depressants, opioids, decongestants, antihistamines, antihypertensives, and vasodilators commonly cause dizziness.

» 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

Decorticate posture [Decorticate rigidity, abnormal flexor response]: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Brain abscess.Decorticate posture may occur with brain abscess. Accompanying findings vary depending on the size and location of the abscess, but may include aphasia, hemiparesis, a headache, dizziness, seizures, nausea, and vomiting. The patient may also experience behavioral changes, altered vital signs, and a decreased LOC.

Brain tumor.A brain tumor may produce decorticate posture that's usually bilateral—the result of increased intracranial pressure (ICP) associated with tumor growth. Related signs and symptoms include a headache, behavioral changes, memory loss, diplopia, blurred vision or vision loss, seizures, ataxia, dizziness, apraxia, aphasia, paresis, sensory loss, paresthesia, vomiting, papilledema, and signs of hormonal imbalance.

Head injury.Decorticate posture may be among the variable features of a head injury, depending on the site and severity of the injury. Associated signs and symptoms include a headache, nausea and vomiting, dizziness, irritability, a decreased LOC, aphasia, hemiparesis, unilateral numbness, seizures, and pupillary dilation.

Stroke.Typically, a stroke involving the cerebral cortex produces unilateral decorticate posture, also called spastic hemiplegia. Other signs and symptoms include hemiplegia (contralateral to the lesion), dysarthria, dysphagia, unilateral sensory loss, apraxia, agnosia, aphasia, memory loss, a decreased LOC, urine retention, urinary incontinence, and constipation. Ocular effects include homonymous hemianopsia, diplopia, and blurred vision.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007


 » Next page: Symptoms of Benign Paroxysmal Positional Vertigo

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