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Practical Neurology Jun 2010Patients with chronic dizziness pose a particular challenge to the clinician, partly because their symptoms correlate poorly with standard vestibular tests; so a 'test... (Review)
Review
Patients with chronic dizziness pose a particular challenge to the clinician, partly because their symptoms correlate poorly with standard vestibular tests; so a 'test and think later' approach is likely to lead to diagnostic confusion rather than clarity. Rather, a meticulous clinical assessment is required. Here our approach to the chronic dizzy patient is described with an emphasis on treating the patient's symptoms.
Topics: Chronic Disease; Dizziness; Humans; Neurologic Examination; Reflex, Vestibulo-Ocular; Vertigo; Vestibular Diseases
PubMed: 20498184
DOI: 10.1136/jnnp.2010.211607 -
Journal of the American Geriatrics... Jul 1992Patients use the term dizziness to describe a sensation of altered orientation in space. Because visual, proprioceptive, somatosensory and vestibular signals provide the... (Review)
Review
Patients use the term dizziness to describe a sensation of altered orientation in space. Because visual, proprioceptive, somatosensory and vestibular signals provide the main information about the position of the head and body in space, damage to any of these systems can lead to a complaint of dizziness. Changes in the brain centers that integrate these orienting signals can also result in a sensation of dizziness. This review focuses on the pathophysiology, diagnosis, and management of the common causes of dizziness in older people.
Topics: Accidental Falls; Age Factors; Aged; Aging; Causality; Clinical Protocols; Decision Trees; Diagnosis, Differential; Dizziness; Gait; Humans; Vertigo
PubMed: 1607589
DOI: 10.1111/j.1532-5415.1992.tb01966.x -
Irish Journal of Medical Science Feb 2022International studies show that dizziness and vertigo are a significant burden on the general population, with 20-30% experiencing symptoms over a lifetime. There are no... (Review)
Review
BACKGROUND
International studies show that dizziness and vertigo are a significant burden on the general population, with 20-30% experiencing symptoms over a lifetime. There are no Irish studies indicating prevalence. The aim of this study was to review primary care referrals for patients with dizziness and vertigo to an otolaryngology tertiary centre.
METHODS
A review of an out-patient department waiting list was performed on primary care referrals for dizziness and vertigo to an otolaryngology tertiary centre. Demographic information was recorded on all patients referred between May 2017 and August 2019.
RESULTS
Two hundred fifteen patients out of 901 patients (24%) referred to an otologist between May 2017 and August 2019 were referred with dizziness as a presenting complaint. The average age was 51 years. F/M ratio was 3:2. The average waiting time was 441 days. The most common associated otological symptom was tinnitus (42%). Relevant comorbidities included anxiety, depression, migraine/headaches and cardiac disease.
CONCLUSION
This study demonstrates that a significant number of patients referred to an otologist from primary care are referred with dizziness and vertigo and supports the need for the establishment of multi-disciplinary vestibular/balance centres to address and manage these patients.
Topics: Dizziness; Humans; Middle Aged; Prevalence; Primary Health Care; Referral and Consultation; Vertigo
PubMed: 33675015
DOI: 10.1007/s11845-021-02575-6 -
Seminars in Neurology Dec 2021The evaluation of the dizzy patient is complicated by many common pitfalls. The patient's description of symptoms and the standard neurologic examination are often...
The evaluation of the dizzy patient is complicated by many common pitfalls. The patient's description of symptoms and the standard neurologic examination are often nonspecific or unrevealing, and neuroimaging is most often normal. Over the past several years, research has demonstrated that a refocusing of history taking results in more reliable and diagnostically helpful information. This can guide a targeted expansion of the exam, often with an emphasis on eye movements.
Topics: Dizziness; Eye Movements; Humans; Neurologic Examination; Outpatients; Vertigo
PubMed: 34826878
DOI: 10.1055/s-0041-1726369 -
Deutsche Medizinische Wochenschrift... Jun 2019Dizziness is most frequently caused by blood pressure dysregulation comprising a broad spectrum from constitutional and orthostatic hypotension to severe conditions like...
Dizziness is most frequently caused by blood pressure dysregulation comprising a broad spectrum from constitutional and orthostatic hypotension to severe conditions like endocrinopathies and neurodegenerative diseases with autonomic dysfunction like in multiple system atrophy.
Topics: Autonomic Nervous System; Blood Pressure; Dizziness; Female; Humans; Hypertension; Hypotension, Orthostatic; Middle Aged; Multiple System Atrophy; Vertigo
PubMed: 31212322
DOI: 10.1055/a-0873-2423 -
Clinics in Geriatric Medicine Feb 2013Dizziness affects one in five people over the age of 65 years and is associated with substantial healthcare costs. Serious causes of dizziness are found in 20% of... (Review)
Review
Dizziness affects one in five people over the age of 65 years and is associated with substantial healthcare costs. Serious causes of dizziness are found in 20% of patients over 50 years. The approach to the patient with dizziness is challenging as physical exam and diagnostic tests have suboptimal sensitivities. The risk of vascular events is higher in the first 30 days than after, suggesting some missed diagnoses. Medications and vestibular rehabilitation may serve as treatment options for dizziness, but data on their efficacy in older patients is lacking.
Topics: Aged; Aged, 80 and over; Aging; Dizziness; Emergency Service, Hospital; Emergency Treatment; Geriatric Assessment; Geriatrics; Humans; Medical History Taking; Middle Aged; Physical Examination; Risk Factors; Vertigo; Vestibular Diseases
PubMed: 23177607
DOI: 10.1016/j.cger.2012.10.004 -
Current Opinion in Neurology Feb 2017Functional dizziness is the new term for somatoform or psychogenic dizziness. The aim of this study is to review arguments for the new nomenclature, clinical features,... (Review)
Review
PURPOSE OF REVIEW
Functional dizziness is the new term for somatoform or psychogenic dizziness. The aim of this study is to review arguments for the new nomenclature, clinical features, possible pathomechanisms, and comorbidities of functional dizziness.
RECENT FINDINGS
The prevalence of functional dizziness as a primary cause of vestibular symptoms amounts to 10% in neuro-otology centers. Rates of psychiatric comorbidity in patients with structural vestibular syndromes are much higher with nearly 50% and with highest rates in patients with vestibular migraine, vestibular paroxysmia, and Ménière's disease. Pathophysiologic processes seem to include precipitating events that trigger anxiety-related changes in postural strategies with an increased attention to head and body motion and a cocontraction of leg muscles. Personality traits with high levels of neuroticism and low levels of extraversion appear as risk factors for anxiety and depressive disorders and increased morbidity in functional disorders.
SUMMARY
Correct and early diagnosis of functional dizziness, as primary cause or secondary disorder after a structural vestibular syndrome, is very important to prevent further chronification and enable adequate treatment. Treatment plans that include patient education, vestibular rehabilitation, cognitive and behavioral therapies, and medications substantially reduce morbidity and offer the potential for sustained remission when applied systematically.
Topics: Dizziness; Humans; Somatoform Disorders; Vertigo
PubMed: 28002123
DOI: 10.1097/WCO.0000000000000417 -
Neurologic Clinics Aug 2015Dizziness is a common symptom in emergency departments, general practice, and outpatient clinics. Faced with an acutely dizzy patient, the frontline physician must... (Review)
Review
Dizziness is a common symptom in emergency departments, general practice, and outpatient clinics. Faced with an acutely dizzy patient, the frontline physician must determine whether or not the symptoms are vestibular in origin and, if they are, which vestibular disorder they best fit. A focused history provides useful clues to the likely cause of dizziness, yet it is the clinical examination that yields the final answer. This article summarizes history and examination techniques that are useful in the assessment of acutely dizzy patients and discusses oculomotor signs that accompany common vestibular disorders.
Topics: Acute Disease; Dizziness; Humans; Meniere Disease; Migraine Disorders; Nystagmus, Pathologic; Vertigo
PubMed: 26231271
DOI: 10.1016/j.ncl.2015.04.001 -
Journal of Neurologic Physical Therapy... Apr 2019Eye movements may be adversely affected after mild traumatic brain injury (mTBI) and should be examined. The purpose of this topical review is to provide the clinician... (Review)
Review
BACKGROUND AND PURPOSE
Eye movements may be adversely affected after mild traumatic brain injury (mTBI) and should be examined. The purpose of this topical review is to provide the clinician with the most up-to-date knowledge related to eye movement abnormalities, screening measures, and evidence related to exercise interventions that are designed to enhance outcomes in persons after mTBI.
SUMMARY OF KEY POINTS
Presence of eye misalignment such as tropias or phoria or symptoms with head/eye movements such as vestibulo-ocular reflex (VOR) × 1, saccades, or smooth pursuits may slow the person's recovery. Tools such as the Convergence Insufficiency Symptom Survey, the Vestibular/Ocular Motor Screening, the Pediatric Vestibular Symptom Questionnaire, and the Pediatric Visually Induced Dizziness questionnaire may aid in identifying visual concerns to target in the physical therapy intervention program. There is emerging evidence that vestibular rehabilitation enhances recovery in persons after mTBI.
RECOMMENDATIONS FOR CLINICAL PRACTICE
A thorough eye examination is highly recommended after mTBI to identify targeted areas for intervention.
Topics: Brain Concussion; Dizziness; Eye Movements; Humans; Vertigo
PubMed: 30883491
DOI: 10.1097/NPT.0000000000000272 -
Emergency Medicine Clinics of North... Feb 2009Understanding three peripheral vestibular disorders--vestibular neuritis, benign paroxysmal positional vertigo, and Meniere's disease--is the key to the evaluation and... (Review)
Review
Understanding three peripheral vestibular disorders--vestibular neuritis, benign paroxysmal positional vertigo, and Meniere's disease--is the key to the evaluation and management of vertigo and dizziness presentations in the emergency department. Each of these benign disorders is a common cause of a broad category of dizziness presentation. In addition, each of these disorders has characteristic features that allow for a bedside diagnosis. An effective strategy for "ruling-out" a serious disorder, such as stroke, is "ruling-in" a peripheral vestibular disorder. In this article a focus is on the key features of these disorders.
Topics: Dizziness; Emergency Service, Hospital; Humans; Meniere Disease; Neurologic Examination; Nystagmus, Pathologic; Vertigo; Vestibular Neuronitis
PubMed: 19218018
DOI: 10.1016/j.emc.2008.09.002