In this lecture, we're going to talk about
an introduction to dizziness.
Before we dive into the specific causes of dizziness,
it's important to have some way of thinking about
how to approach these patients.
So let's start with a case.
This is a 34-year-old woman who presents to clinic urgently
for evaluation of dizziness.
The patient reports that she awoke this morning
and suddenly felt very dizzy while sitting up in the bed.
She was unable to stand and walk due to severe dizziness.
Her son escorted her downstairs where they telephoned.
In the office, the patient is lying on the exam table
uncomfortable and still.
She says that her dizziness feels like the room is spinning.
Her eyes are closed.
She is freely able to report the history from this morning
without confusion, aphasia, or dysarthria.
She was able to walk into the clinic and denies any problems
with weakness, numbness, or tingling.
She has a history of borderline hypertension,
which he is managing with diet and lifestyle at this time.
She is on a multivitamin only.
She has no allergies,
and denies personal or family history of symptoms,
which prompted her presentation.
So how would you categorize this patient's dizziness?
Well, let's start with the case.
What are the key features that we look at
in patients who are presenting with dizziness?
The first is the timeline of onset. This is critical.
It helps us to categorize the type of problem
we're going to focus on.
And here this patient presented suddenly
with acute onset of symptoms.
Not a chronic onset, which would point us in a certain direction,
but acute onset of her symptoms,
and that will be important when we're evaluating this patient.
The second feature are propagating factors
or provoking signs.
Here this patient's dizziness was provoked
when she was sitting up in the bed, or potentially turning her head.
And those provoking factors are important
for driving us towards certain diagnostic possibilities.
The last is the patient's description.
When we're evaluating dizziness,
we're putting the history and the physical exam together.
But the history is really important
for beginning our search for what the cause
of this dizziness is.
And here this patient describes the room as spinning.
And that will be important for labeling this problem
for categorizing her symptom
and ultimately arriving at the diagnosis.
So how would you categorize this patient's dizziness?
Is it vertigo, dysequilibrium, syncope, or nonspecific dizziness?
Well, the clinical description doesn't sound like dysequilibrium.
Dysequilibrium is imbalanced or incoordinations.
Problems with ataxia or dysmetria on exams.
Cerebellar findings we see on exam
and none of those are reported, or found,
or described in this patient.
So this is an inconsistent presentation for dysequilibrium.
The patient's description is also inconsistent with syncope.
Syncope or presyncope
is a feeling of fainting or near fainting.
Typically, when patients stand up
in the situation of orthostatic presyncope or syncope,
and there's no indication of cardiac dysrhythmias,
which would tip us off to a cardiac concern
that would precipitate a syncopal event.
Nonspecific dizziness is a diagnosis of exclusion.
And this patient's presentation is really consistent with vertigo.
So here are the correct answer,
the categorization of this patient's problem is vertigo.
The patient describes room spinning,
provoked with head turning or sitting up in bed,
and those are common descriptions
for patients who are suffering from vertigo.