Bells mission is disaster preparedness through education you are invited to attend a 1. This handout is designed for therapists providing differential diagnosis information for patients experiencing dizziness. One of the most common complaints encountered in the practice of medicine is dizziness. Differential diagnosis of dizziness yvonne chan introduction dizziness is a nonspeci. Pppd is a functional vestibular disorder characterized by chronic and persistent nonspinning dizziness, visualmotion hypersensitivities, and. Common causes of syncope and their associated symptoms are detailed in the figure below. The patients description is critical for classifying the etiology of dizziness. Differential diagnosis of cervicogenic dizziness rayner. Dizziness, a feeling of motion that persists when the patient and his surroundings are really stationary, can be caused by disorders of the proprioceptive system, the eye, or the ear. Dizziness is a nonspecific term and may be used by patients to indicate true vertigo, lightheadedness, imbalance, or a form of syncope. Dix hallpike is used to confirm a diagnosis of bppv in either the anterior or posterior canals. Standing, a fourstep bedside algorithm for differential. A complete examination of the eighth nerve is mandatory. The differential diagnosis of dizziness can be nar rowed with easytoperform physical examination tests, including evaluation for nystagmus, the dixhallpike maneuver, and ortho.
The differential diagnosis may include cervicogenic dizziness, benign parox ysmal positional vertigo, perilyrnphatic fistula, labyrinthine concussion, migrainerelated vertigo, and central or peripheral vestibular dysfunc tion. Finally, in this section of the article, you will be able to get access to the abc of emergency differential diagnosis pdf free download file in. She also complained of mild coordination problems and intermittent numbness and tingling in both upper extremities. Dizziness, vertigo, and imbalance differential diagnoses. Feb 01, 2017 dizziness is a common yet imprecise symptom often encountered by family physicians.
These two common symptoms are common reasons for presentation to physicians offices, absence from work, and disability, and are responsible of % of presentations to the emergency department ed. System manifestations differential diagnosis general fever, malaise, prostration, body ache any cause for fever and sepsis. Dizziness is an impairment in spatial perception and stability. Mar, 2017 dizziness and vertigo are among the most common symptoms causing patients to visit a physician as common as back pain and headaches. A thorough history is frequently sufficient to classify a patients dizziness into one of the 4 major categories vertigo, disequilibrium, presyncope, and psychophysiologic dizziness and, perhaps, even to. This newer approach to the differential diagnosis of csd ensures that both medical and psychiatric conditions associated with chronic dizziness will be identified appropriately.
Expanding the differential diagnosis of chronic dizziness. A prospective validation study of the standing algorithm simone vanni 1, rudi pecci 2, jonathan a. Powered by create your own unique website with customizable templates. Vertigo is a common, distressing presentation in general practice and constitutes approximately 54% of cases of dizziness. A study from a national database national hospital ambulatory medical care survey, over a year period, of 9472 patients with dizziness reported general medical including nonstroke cardiovascular diagnoses. Presyncope the feeling that one is about to faint or lose consciousness, but actual loss of consciousness is averted. The diagnosis remains uncertain in approximately 10 percent. This symptom is nonspecific and includes a broad differential diagnosis. Diagnosing patients with acuteonset persistent dizziness. Each chapter begins with a table listing the differential diagnosis.
Common and important causes of vertigo for doctors and medical students this page is currently being written and will be available soon. The course will run from saturday 71815 through sunday 71915, with exclusive options to earn 2. Differential diagnosis of dizziness the various causes of dizziness are similar in different settings including the primary care setting, the emergency department, and the specialized dizzy clinic 1. The handout compares benign paroxysmal positional vertigo bppv to central nervous system nystagmus and includes a comprehensive list of differential diagnosis points, including time before symptoms start after position change, duration of symptoms, direction of nystagmus. Older adults have a higher incidence of central causes of vertigo approaching 20 percent, most often due to stroke. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the follow us buttons. Evaluation of dizziness differential diagnosis of symptoms. Normal head impulse, directionchanging nystagmus, or skew deviation suggests stroke. She also complained of mild coordination problems and intermittent numbness and tingling in bo. The most common causes of vertigo are benign paroxysmal positional vertigo, acute vestibular neuronitis, menieres disease, migraine, anxiety disorders. Ask about precipitating events, prodromal symptoms, postictal confusion.
Establishing a diagnosis of benign paroxysmal positional vertigo through the dixhallpike and sidelying maneuvers. Pdf expanding the differential diagnosis of chronic dizziness. Jan 02, 2014 however, although the most common causes of dizziness and vertigo are benign, differential diagnosis must include potentially lifethreatening central disease 5. Dizziness may occur from an abnormality involving the brain in particular the brainstem or cerebellum, inner ear, eyes, heart, vascular system, fluid or blood volume, spinal cord, peripheral nerves, or body electrolytes. Common causes of vertigo in the elderly include bppv, neurolabyrinthitis, trauma, toxins, migraine, and posterior circulation or labyrinthine ischemia, which is particularly associated with posterior inferior cerebellar artery or anterior inferior cerebellar artery ischemia. Abc of emergency differential diagnosis pdf free download section. A new diagnostic approach to the adult patient with acute. When the ear is involved, the etiology is either central or peripheral. It is a symptom or manifestation of some abnormality which has affected the patients equilibrium. Dixhallpike maneuver is performed to look for nystagmus and eye beating hornibrook, 2011. Dizziness and vertigo are among the most common symptoms causing patients to visit a physician as common as back pain and headaches. This post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Patients complaining of symptoms of acute vertigo present a diagnostic challenge for the clinician.
Once ves tibular disease is confirmed, emphasis is on differentiat ing peripheral from central causes of vertigo. History is very important for distinguishing syncope from other causes seizure, dizziness, vertigo, presyncope. The patient was a 54yearold woman with a 5month history of worsening dizziness with head movements. Differential diagnosis for vertigo oxford medical education. Posterior canal is ruled in if there is upbeating nystagmus, and the direction of torsion demonstrates which side is affected. Episodic triggered symptoms are consistent with a diagnosis of benign paroxysmal positional vertigo bppv. The differential diagnosis for dizziness is extensive, encompassing diseases of the inner ear, central and peripheral nervous system, cardiovascular system and psychiatric disease. However, although the most common causes of dizziness and vertigo are benign, differential diagnosis must include potentially lifethreatening central disease 5. The first question in approaching patients with dizziness is to. Churchills pocketbook of differential diagnosis pdf 4th. The prevalence of dizziness in the general population ranges from 15% to 30%. During the test, the patients eyes will exhibit nystagmus with a torsional component.
Recent findings the term dizziness encompasses a large spectrum of symptomatology. Common and important causes of dizziness for doctors and medical students this page is currently being written and will be available soon. Differential diagnosis of vertigo and meneiers disease. Differential diagnosis of vertigo in the emergency department. There are 3 additional chapters covering anatomy, examination of the patient with vertigo, and the treatment of the dizzy patient. The most important part of the workup is the history. Pdf differential diagnosis of vertigo researchgate. This sensation can be confused with dizziness, which is a nonspecific term. Fortunately, an organized approach greatly simplifies evaluating the dizzy patient. The initial approach to the patient who complains of dizziness is to localize the cause of the symptom into one of these broad categories.
Differential diagnosis of cervicogenic dizziness should establish a correlation between dizziness and the cervical spine, excluding a vestibular disorder and a neurovascular injury, using the subjects previous history, the clinical assessment of cervical musculoskeletal and relevant sensorimotor impairments and the. Pdf differential diagnosis of vertigo zlatko trkanjec. This can result in feelings of vertigo, nausea, and dizziness, and are normally brought on by changes in head or body position. The examination of the cochlear division should include audiometry.
Expanding the differential diagnosis of chronic dizziness article pdf available in archives of otolaryngology head and neck surgery 32. Assessment of dizziness differential diagnosis of symptoms bmj. Increases on gaze in direction of fast phase decreases or resolves opposite. Dizziness that is not vertigo, syncope, or dysequilibrium. Falling can be a direct consequence of dizziness in this population, and the risk is compounded in elderly persons with other neurologic deficits and chronic medical problems. The causes of the dizziness may prove to be neoplastic, traumatic, vascular, toxic, allergic, metabolic, or functional. Anterior canal can be ruled in if downbeating nystagmus is noted. Primary care physicians see at least onehalf of the patients who present with dizziness. Churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of the clinical approach to the field. In patients without nystagmus, the head impulse test may give misdleading results. Dizziness is one of the most common complaints among patients presenting to primary care physicians, neurologists, and otolaryngologists.
Bppv results from calcium carbonate debris that becomes dislodged from the otoconial membrane and enters into a semicircular canal kerber, 2009. Differential diagnosis of dizziness jama jama network. Diagnosis of patients with acuteonset persistent dizziness ask and answer 5 questions in the following sequence. Apr 03, 20 the differential diagnosis of vertigo varies by age table 2. The results of this investigation provide some insight into pathophysiologic mechanisms that may precipitate and perpetuate chronic dizziness. Pathophysiology, differential diagnosis, and management of. Abc of emergency differential diagnosis pdf free download. The main causes of vertigo are benign paroxysmal positional vertigo, meniere disease, vestibular neuritis, and labyrinthitis. Differential diagnosis in a patient with dizziness journal.
Posterior canal can be ruled in if upbeating nystagmus is noted with a rotational component kerber, 2009. Frontiers differential diagnosis of vertigo in the. Differential diagnosis for dizziness oxford medical. Causes of vertigo are most commonly otological, followed by central, somatosensory, and visual. Nov 26, 2018 halker rb, barrs dm, wellik ke, wingerchuk dm, demaerschalk bm.
Peripheral vestibular disease, vertigo, is the most common diagnosis in dizzy patients. This new title in the abc series covers the assessment, diagnosis, treatment, and management of the most common symptoms with. Mar 27, 2015 the table below outlines the differential diagnosis of cervical vertigo know known as cervicogenic dizziness, vertigo, unsteadiness and oscillopsia. Assessment of dizziness differential diagnosis of symptoms. Vertigo is the illusory sense of movement, while unsteadiness is the feeling of being unstable while seated, standing, or walking.
Halker rb, barrs dm, wellik ke, wingerchuk dm, demaerschalk bm. Edlow 3, peiman nazerian 1, rossana santimone 2, giuseppe pepe 1, marco moretti 4, andrea pavellini 1, cosimo caviglioli 1, claudia casula 1, sofia bigiarini 1, paolo. Differential diagnosis in a patient with dizziness. Dizziness is a heterogeneous constellation of clinical syndromes that require distinct diagnostic and management approaches. Pdf expanding the differential diagnosis of chronic.
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