Dizziness resident survival guide: Difference between revisions
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{{familytree | | | | | F01 | | | | | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | | |,|-|-|^|-|-|.| | | | F02 | | |F01= Apply [[Dix-Hallpike]] maneuver |F02= [[Physical examination]] }} | {{familytree | | | | | F01 | | | | | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | | |,|-|-|^|-|-|.| | | | F02 | | |F01= Apply [[Dix-Hallpike]] maneuver |F02= [[Physical examination]] }} | ||
{{familytree | | | | | |!| | | | | | F01 | | | F02 | | | F03 | | | | | | | | F04 | | | | F05 | | | |!| |F01= Deafness |F02= Headache |F03= Psychiatric symptoms |F04= Barotrauma |F05= Drugs }} | {{familytree | | | | | |!| | | | | | F01 | | | F02 | | | F03 | | | | | | | | F04 | | | | F05 | | | |!| |F01= [[Deafness]] |F02= Headache |F03= [[Psychiatric]] symptoms |F04= Barotrauma |F05= Drugs }} | ||
{{familytree | | |,|-|-|^|-|-|.| | | |!| | | | |!| | | | |!| | | | | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| }} | {{familytree | | |,|-|-|^|-|-|.| | | |!| | | | |!| | | | |!| | | | | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| }} | ||
{{familytree | | F01 | | | | F02 | | F03 | | | F04 | | | F05 | | | | | | | | | | | | | | | F06 | | | | | | F07 | | | |F01= Positive |F02= Negative |F03= Meniere disease |F04= Vestibular migraine|F05= Panic attack |F06= Saccade present, unidirectional, horizontal nistagmus |F07= No saccade, nistagmus dominantly vertical, torsion or gaze evoked | {{familytree | | F01 | | | | F02 | | F03 | | | F04 | | | F05 | | | | | | | | | | | | | | | F06 | | | | | | F07 | | | |F01= Positive |F02= Negative |F03= [[Meniere disease]] |F04= Vestibular migraine|F05= [[Panic attack]], [[psychiatric]] condition |F06= [[Saccade]] present, unidirectional, [[horizontal nistagmus]] |F07= No [[saccade]], [[nistagmus]] dominantly vertical, torsion or [[gaze]] evoked bidirectionaly }} | ||
{{familytree | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | |!| }} | |||
{{familytree | | F01 | | | | F02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | F03 | | | | | | F04 | | | |F01= [[Benign paroxysmal positional vertigo]] |F02= [[Orthostatic hypotension]] |F03= [[Vestibular neuritis]] |F04= [[Stroke]], [[transient ischemic attack]] }} | |||
{{familytree/end}} | {{familytree/end}} | ||
==Do's== | ==Do's== | ||
* | *Always ask the patient what do they mean by dizziness. Dizziness may have a different meaning among patients; while vertigo may represent a vestibular condition vestibular problems if “vertigo,” cardiovascular disorders if “presyncope” or “near-syncope,” neurologic issues for “disequilibrium” and psychiatric, or metabolic causes if “other | ||
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==Don'ts== | ==Don'ts== | ||
Revision as of 03:33, 20 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D.
Overview
Dizziness is a complex and subjective complaint that encompasses a wide spectrum of symptomatology.[1] It is one of the most common presenting symptoms among patients seen by emergency medical physicians, primary care physicians, neurologists, and otolaryngologists.[1]
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Hypotension
- Dehydration
- Hypoglycemia
- Arrhythmias
- Stroke
- Labyrinthitis
- Meniere's disease
- BPV
- Medication effects
Diagnosis
Shown below is an algorithm summarizing the diagnosis of dizziness according to the American Academy of Neurology guidelines.
| Patient with dizzinesss | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Presentation periodical or sustained? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Periodical | Sustained | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Provoked or unprovoked? | History of intoxication or trauma, or unknown? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Provoked | Unprovoked | History of intoxication | Unknown | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Apply Dix-Hallpike maneuver | Physical examination | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Deafness | Headache | Psychiatric symptoms | Barotrauma | Drugs | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positive | Negative | Meniere disease | Vestibular migraine | Panic attack, psychiatric condition | Saccade present, unidirectional, horizontal nistagmus | No saccade, nistagmus dominantly vertical, torsion or gaze evoked bidirectionaly | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Benign paroxysmal positional vertigo | Orthostatic hypotension | Vestibular neuritis | Stroke, transient ischemic attack | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Always ask the patient what do they mean by dizziness. Dizziness may have a different meaning among patients; while vertigo may represent a vestibular condition vestibular problems if “vertigo,” cardiovascular disorders if “presyncope” or “near-syncope,” neurologic issues for “disequilibrium” and psychiatric, or metabolic causes if “other
Don'ts
- The content in this section is in bullet points.
References
- ↑ 1.0 1.1 Chan Y (2009). "Differential diagnosis of dizziness". Curr Opin Otolaryngol Head Neck Surg. 17 (3): 200–3. doi:10.1097/MOO.0b013e32832b2594. PMID 19365263.