Vertigo
A. Dx
1. “Dizziness”: Ask if the feeling is of spinning, and in the feet vs. the head, may distinguish between vertigo (illusion of movement), lightheadedness (a feeling that one might faint), and poor balance—all of which pts may call “dizziness.”
2. Other: Sudden onset, HA, tinnitus, hearing decrease, other cranial nerves, gait, trouble controlling limbs, length of episode, LOC, change in vision, N/V, worse when lay down/stand/stoop/turn neck, h/o trauma, anxiety, hypo- or hyperglycemia, or hypertension. Orthostatic BPs, bruits, hearing (q.v. p. 54), eye exam, tympanic membranes; consider Romberg, postural reflexes, hyperventilation × 3 minutes, calorics (q.v. p. 222).
3. Bárány’s test: On a stretcher, bring pt suddenly back from a seated position to supine with pt’s head turned fully to the right and eyes open. Watch for nystagmus and vertigo for at least 1 min. Repeat with head to the left. Have a bucket handy in case of vomit.
B. DDx
R/o dizziness from cardiac problem, bleed, panic, hypoglycemia; poor balance from movement disorder, sensory deficits, or weakness.
1. Central vertigo:
a. H&P: Usually less sudden onset (or if sudden, with HA), less nausea, continuous sx indep. of posture, usually no hearing loss.
1) Nystagmus: All varieties of nystagmus including vertical.
2) Side of sxRelated posts:
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