Dizziness

Dizziness may mean one thing to a patient but another to clinician.  It may even mean different things between clinicians!  It is important to clarify the exact symptom being described.

History

  • Wash hands, introduce self, check patient name and DOB, build rapport and gain consent
  • PC
    • Ask the patient to describe what they mean (without using the word dizziness/dizzy).  Do they feel spinning? light headed? nauseous? like they are about to collapse/fall? floating? etc etc
  • HxPC
    • If it is true vertigo, how long does it last?
      • If seconds and associated with head positional change- likely BPPV
      • If hours-days, more likely to Meniere’s (+ ear fullness/tinnitus/hearing loss – sickness) or vestibular neuronitis (- ear fullness) or labyrinthitis (+ hearing problems etc) (+sickness)
      • If sudden onset, lasting minutes, you can consider central causes too (specifically vascular problems if risk factors are present) as well as vestibular neuronitis/labyrinthitis
        • Usually this will be present with other neurological signs e.g. dysarthria/dysphasia, diplopia, ataxia (and inability to mobilise properly), dysdiadochokinesis, weakness etc
    • Is it associated with anything else?
      • Migraines?
      • Autoimmune conditions?
    • If it is light-headedness- are there possible CVS risk factors? e.g. high/low BP, orthostatic BP problems, history of heart failure
  • In other aspects of the history, you need to explore
    • PMHx and RHx
      • Particularly polypharmacy and heart problems, but also diabetes, epilepsy, cancers (brain mets?) and any other significant conditions and/or drug therapies
    • SHx
      • Alcohol intake is particularly important here
      • Effect on life is important and you should always ask every patient about what their main concerns are
      • Travel Hx

Examination

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