DIZZINESS

Ask the following questions:

1. Is it true vertigo? True vertigo is characterized by the fact that the subject feels he or his environment is turning. One other form of true vertigo is lateral pulsion, in which the subject feels as if he is moving to the left or right or may be moving forward or backward. True vertigo is a sign of neurologic or otologic disease, whereas dizziness that is not true vertigo is more likely a sign of cardiovascular disease.
2. Is there associated tinnitus or deafness? The presence of tinnitus or deafness, especially if the ear examination is negative, is a sign of a more serious otologic or neurologic condition. Such disorders as cholesteatoma, acoustic neuroma, and Ménière's disease must be considered. On the other hand, vertigo without tinnitus or deafness should prompt consideration of benign positional vertigo and vestibular neuronitis.
3. Are there other neurologic findings? The finding of abnormalities of other cranial nerves or the long tracts, such as the pyramidal tracts, would suggest multiple sclerosis, an advanced brain stem tumor, acoustic neuroma, or basilar artery insufficiency.
4. Are there findings on otoscopic examination? A normal neurologic examination with an abnormal ear exam would suggest otitis media, cholesteatoma, or petrositis.
5. Is there tachypnea during the attack? If there is hyperventilation during the attack, then hyperventilation syndrome should be considered.
6. Is there a history of trauma? A history of trauma would suggest a postconcussion syndrome.
7. Are there abnormalities of the blood pressure? If the dizziness is really lightheadedness, hypertension may be present, but hypertension may also cause true vertigo. Hypotension is more likely to cause lightheadedness, which is not true vertigo. Be sure to take the blood pressures while the patient is lying down and again after rapidly arising to the standing position.
8. Are there abnormal cardiac findings? A thorough cardiovascular examination should be done. Irregularities of the heartbeat, heart murmurs, or cardiac enlargement will suggest cardiac arrhythmia, aortic stenosis and insufficiency, mitral stenosis, prolapse of the mitral valve, and congestive heart failure.
9. Is there pallor? Moderate to severe anemia will cause lightheadedness and dizziness, but usually not true vertigo.

DIAGNOSTIC WORKUP

If there is true vertigo, an audiogram and a caloric test or electronystagmography should be done. Hallpike's maneuver should be done also. If these are abnormal, an x-ray of the mastoids, petrous bones, and internal auditory canals should be done. At this point a neurologist should be consulted. If an acoustic neuroma is strongly suspected, an MRI of the brain stem and auditory canals should be done. If the MRI of the brain is negative, a spinal fluid examination can be done to exclude such disorders as central nervous system lues and multiple sclerosis. An MRI of the brain needs to be done to distinguish multiple sclerosis. BSEPs, VEPs, and SSEPs will also be helpful in making the diagnosis of multiple sclerosis, along with the spinal fluid analysis mentioned above. A wake-and-sleep EEG needs to be done to exclude temporal lobe epilepsy. If migraine or migraine equivalents are suspected, perhaps a trial of beta-blockers would help make this diagnosis. If vertebral basilar artery ischemia is suspected, magnetic resonance angiography may be indicated.

If the dizziness is not true vertigo, a CBC and chemistry panel should be done at the outset. Additional studies in the form of 24-hr blood pressure monitoring, Holter monitoring, and echocardiography all have a valuable place in the diagnostic workup of dizziness without true vertigo. However, a referral to a cardiologist is wise before undertaking these expensive studies. If all studies are negative, perhaps a psychiatrist should be consulted.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

Other Book Chapters Related to Dizziness

Read excerpts from these other book chapters related to Dizziness:

Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Dizziness

• Back to symptom: Dizziness: Introduction (review 1275 causes)
• Next Book Extract About Dizziness: Aura (In a Page: Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Dizziness

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

 » Next page: Aura (In a Page: Signs and Symptoms)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Aura (In a Page: Signs and Symptoms)
• Syncope (In a Page: Signs and Symptoms)
• Dizziness/Lightheadedness & Vertigo (In a Page: Signs and Symptoms)
• Syncope (In A Page: Pediatric Signs and Symptoms)
• Vertigo (In A Page: Pediatric Signs and Symptoms)

Tools & Services:

• Bookmark this page
• Take a survey relating to Dizziness
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City