Dizziness

Karl Abi Aad

22 y/o F
presenting to
the ED for
dizziness

T: 37 degree Celsius
BP:115/80
P:90
RR:16
According to nurse Triage: no PMHx, PSHx

Dizziness could be

Open ended question: Tell me more about this dizziness of

yours?
Patient: Its been ongoing for a while, with several episode of
spinning.

Ver..?

SOCRATES

Continuous >month VS Episodic 1-2 week

Sx of Anxiety?
Acute Prolonged VS Reccurent Spontaneous
Provoking? Positional?

Associated Symptoms

Hearing loss and duration of symptoms help

narrow the differential diagnosis further in
patients with vertigo.
with
hearing
loss

Meniere disease
Labyrinthitis

without
hearing
loss

BPPV
Vestibular neuritis

Episodic
vertigo

BPPV
Meniere disease

Persistent
vertigo

vestibular neuritis
labyrinthitis

Otologic or vestibular causes of vertigo are the most common

causes of dizziness

Include:
1-Benign Paroxysmal Positional Vertigo (BPPV)
2-Vestibular neuritis (viral infection of the vestibular nerve)
3-Labyrinthitis (infection of the labyrinthine organs)
4-Menieres disease (increased endolymphatic fluid in the inner ear)

Migrainous vertigo ( AKA Vestibular Migraine) is another

underlying cause of vertigo that affects about 3 % of the
general population and about 10 % of persons with
migraine.

One of the following symptoms during at least two episodes of

vertigo:
1.
2.
3.
4.

migraine headache
Photophobia
Phonophobia
aura

Head Impulse Test

DIX-HALLPIKE MANEUVER

Patient reports recovery of URI 3 days ago

Treatment:
H1 blocker
Anticholinergic
Steroids
Acyclovir
IV Hydration