Transcript Dizziness - Frasercoasted

Dizziness
David Johnson
Staff Specialist, Emergency Medicine
Dizziness
• Need to decide is this
– Vertigo
• Central
• Peripheral
– Lightheadedness/presyncope
• Sepsis
• Drugs
• Cardiac
– Anxiety
Vertigo
• History
– Sensation of motion
• Room spinning
• Patient spinning
• “swimming” or “floating”
– 1/3 of cases unable to determine
Peripheral vs central
Peripheral
• Sudden onset
• Nystagmus – horizontal or
rotatory, fixed direction
• Fast towards affected ear
• Hearing loss
• Nausea, diaphoresis
• Positive head impulse
• Negative skew
Central
• Slower onset – mostly
• Less nystagmus.
– May be vertical
– Does not fatigue
– Persists with fixation
• Usually other neuro signs or
headache
• Often impaired balance
• Negative head impulse
• Positive skew
BPPV
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Most common cause of vertigo
Very sudden onset, often after being supine
Vertigo on head turning, not when head is still
Duration of vertigo <1 min for each episode
If this is not the story, do not make the
diagnosis
Other peripheral causes
• Viral labyrinthitis
– Constant +/- viral infection +/- hearing loss
• Meniere’s
– Tinnitus/aural fullness
• Acoustic neuroma
• Suppurative labyrinthitis
Central causes
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Cerebellar stroke
Brainstem stroke
Drug toxicity
Lateral Medullary Syndrome
Physical exam
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Full neurological exam
Cerebellar signs
Ears, Weber/Rinne
HINTS exam
– Head impulse
– Nystagmus
– Test of skew
HINTS Exam
Investigations
• MRI
• CT has sensitivity approx 16% for posterior
fossa disease
• If you are worried get an MRI. If you are not
worried do no imaging.