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Approach to Dizziness

Understanding Vertigo

  • Clinical presentation
    • Typically presents as room spinning, although this is not a unreliable sign
    • Clinical features of vertigo
      • Duration: vertigo typically subsides over the span of several weeks; it is never a continuous problem
      • Provocation: change in position
        • Distinguish between positional vertigo and postural presyncope
          • In both cases, standing up causes dizziness
          • Distinguish between the two by asking if head movements alone cause the dizziness (i.e. maneuvers that do not affect blood pressure)
          • Head movements ALONE make the dizziness worse
      • Nystagmus: ellicited on the Dix-Hallpike maneuver
      • Hearing loss: can be examined quickly in office through history and through finger rubbing next to ears
  • Treatment
    • Epley maneuver
    • Betahistine (24 mg twice daily for one week)

Understanding Presyncope