Dizziness and vertigo: Clinical

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Dizziness and vertigo: Clinical

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A 45-year-old woman comes to the emergency room with a sudden onset of dizziness and gait instability that began two days earlier. Since it began, she has experienced constant dizziness, nausea, and vomiting, despite trying multiple over the counter medications. The patient also complains of hearing loss in her right ear. On further questioning, she notes that she had a runny nose and dry cough approximately 1 week ago that resolved on its own. Vital signs are within normal limits. Physical examination shows congested nasal mucosa, oropharyngeal erythema without exudate, and no tenderness to palpation of the sinuses. Which of the following is the most appropriate intervention?  

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The term “dizziness” can be used to refer to a number of related symptoms like presyncope, disequilibrium, what’s called “non-specific dizziness”, and vertigo.

Asking individuals specific questions about how they experience dizziness can help clarify the symptom. Let’s go through each of these.

Pre-syncope is the prodromal phase that occurs before syncope.

Individuals often complain of seconds to minutes of “nearly blacking out” or “nearly fainting”, and “feeling lightheaded when standing,” along with palpitations, sweating, a feeling of warmth, nausea or even blurry vision. Sometimes there’s a history of cardiac disease, such as congestive heart failure or coronary artery disease may be present.

Presyncope could be due to vasovagal syncope, orthostatic hypotension, or cardiac arrhythmias, so the workup usually includes an electrocardiogram, or ECG.

Disequilibrium refers to a sense of imbalance specifically while walking, and usually is due to neurologic disorders like Parkinson’s disease, cerebellar disorders, peripheral neuropathy, or cervical spine disease.

This is often described as “feeling the ground moving” or “feeling like you’re on a boat”.

Non-specific dizziness is a more vague term that has a variety of causes ranging from anxiety or panic attacks, to hypoglycemia, or side effects of medications like anticholinergics.

Finally, there’s vertigo which can be thought of as having an illusion of self-motion, or movement of the surrounding environment.

We’ve all experienced vertigo. It’s that spinny sensation you get after swinging a small child around or the woozy feeling of seasickness. Yeah, that’s vertigo.


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