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
- Distinguish between positional vertigo and postural presyncope
- 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