taking a history from a patient with dizziness
Last edited 09/2020 and last reviewed 10/2020
- the following points are important when taking a history from a patient with dizziness
- dizziness is a highly subjective symptom
- different patients may describe dizziness in different ways
- objective questions must attempt to differentiate vertigo from other froms of dizziness
- clues as to the different types of dizzines should be looked for in the
history (1)
- vertigo
- do you get the feeling of rotation?
- does the surroundings spin around?
- is there a tendency to fall to one side?
- dysequilibrium
- are you having a feeling of unsteadiness?
- presyncope
- do you feel faintish?
- lightheadedness
- do you feel lightheaded?
- vertigo
- onset and duration of the symptoms: (2)
- provide information
concerning the likely pathological processes
- causes of episode lasting
only a few seconds include:
- peripheral cause like
- unilateral loss of vestibular function, acute vestibular neuronitis, Meniere's disease
- peripheral cause like
- causes of episodes lasting for several seconds
to a few minutes include:
- benign paroxysmal positional vertigo, perilymphatic fistula
- causes of episodes lasting for several minutes to one
hour include:
- transient ischemic attack, perilymphatic fistula
- causes
of episodes lasting for several hours include
- Meniere's disease, perilymphatic fistula, migraine, acoustic neuroma
- causes of episodes lasting
for days include
- early acute vestibular neuronitis, CVA, migraine, multiple sclerosis
- causes of episode lasting
only a few seconds include:
- precipitating factors (2)
- causes precipitating spontaneous episodes are
- acute vestibular neuronitis; cerebrovascular disease, Meniere's disease,migraine, multiple sclerosis
- changes
in position of the head
- acute labyrinthitis,benign positional paroxysmal vertigo,perilymphatic fistula cerebellopontine angle tumor,multiple sclerosis
- standing up - suggesting of postural hypotension
- associated symptoms, including:
- deafness
- tinnitus
- otalgia
- a feeling of fullness in the ear
- discharge from the ear
- neurological symptoms
- any other medical problems:
- vascular disease
- multiple sclerosis
- drug history, especially ototoxic drugs
- cardiac disease, especially arrhythmias
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