The Dizzy Patient

Department of Otolaryngology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9035, USA.
The Medical clinics of North America (Impact Factor: 2.61). 09/2010; 94(5):989-1002. DOI: 10.1016/j.mcna.2010.05.011
Source: PubMed


The dizzy patient often presents a challenge to the physician. The history is the most important component of the evaluation of the dizzy patient and often allows the cause of the dizziness to be categorized as peripheral or central. Peripheral causes include benign paroxysmal positional vertigo, Meniere's disease, and vestibular neuritis. Central causes include migraine-associated dizziness, postconcussion syndromes, cerebrovascular disease, and multiple sclerosis. Treatment depends on the cause of the dizziness and may include dietary modifications, diuretics, vestibular suppressants, vestibular rehabilitation, or surgical intervention.

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    • "On distingue classiquement les vertiges centraux et périphériques. Le vertige périphérique par rapport au vertige central aura typiquement une illusion de mouvement plus importante, avec davantage de nausées, une absence de signe neurologique associé, une ataxie modérée (plus importante dans les causes centrales), un « head impulse test » positif (voir plus loin), un nystagmus horizonto-rotatoire (le nystagmus central pourra être horizontal, vertical ou rotatoire pur, changeant de direction , non aboli par la fixation) et une récupération plus courte que les vertiges centraux [3] [5]. Concernant le sens du nystagmus, la perte d'activité unilatérale du système vestibulaire entraînera un nystagmus dont la phase lente sera dirigée vers ce système déficient, alors que la secousse rapide (qui définit le sens du nystagmus) sera dirigée dans l'autre sens. "
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    ABSTRACT: Vertigo and dysequilibrium are a frequent cause of medical consultation. Clinical evaluation is essential. Some cases of vertigo are diagnosed clinically while others require imaging, sometimes emergently (suspected stroke). MRI is the imaging modality of choice to assess the labyrinth (labyrinthitis? labyrinthine hemorrhage?), internal auditory canal (vestibular schwannoma? other tumor?…) and brain parenchyma including all structures of the auditory pathways: vestibular nuclei, vestibulocerebellar tract, tracts involved with ocular motricity, vestibular cortex… Multiple central etiologies exist: stroke, multiple sclerosis, tumor… However, some etiologies are best depicted with CT, especially lesions of the labyrinth: cholesteatoma, trauma, suspected dehiscence of the superior semicircular canal, suspected labyrinthine fistula… Finally, imaging may be negative (Benign Paroxysmal Positional Vertigo, Meniere's disease, vestibular neuritis, migraine…), merely reducing the differential diagnosis.
    Journal de Radiologie 11/2011; 92(11). DOI:10.1016/j.jradio.2011.09.001 · 0.57 Impact Factor
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    ABSTRACT: Dizziness is a common presenting concern in primary care practice. The most useful diagnostic approach in distinguishing different types of dizziness is a thorough history and physical examination; additional tests are rarely necessary. Effective treatments exist for many causes of dizziness, and these treatments are often accomplished in the clinic or at home without the need for medication.
    The Medical clinics of North America 05/2014; 98(3):583-596. DOI:10.1016/j.mcna.2014.01.014 · 2.61 Impact Factor