00:01
In this lecture,
we're going to talk about
an introduction to dizziness.
00:05
Before we dive into the
specific causes of dizziness,
it's important to have
some way of thinking about
how to approach these patients.
00:13
So let's start with a case.
00:15
This is a 34-year-old woman
who presents to clinic urgently
for evaluation of dizziness.
00:21
The patient reports
that she awoke this morning
and suddenly felt very dizzy
while sitting up in the bed.
00:27
She was unable to stand and walk
due to severe dizziness.
00:31
Her son escorted her downstairs
where they telephoned.
00:35
In the office, the patient
is lying on the exam table
uncomfortable and still.
00:40
She says that her dizziness
feels like the room is spinning.
00:44
Her eyes are closed.
00:45
She is freely able to report
the history from this morning
without confusion,
aphasia, or dysarthria.
00:53
She was able to walk into the clinic
and denies any problems
with weakness, numbness,
or tingling.
00:59
She has a history of
borderline hypertension,
which he is managing with
diet and lifestyle at this time.
01:05
She is on a multivitamin only.
01:06
She has no allergies,
and denies personal
or family history of symptoms,
which prompted her presentation.
01:13
So how would you categorize
this patient's dizziness?
Well, let's start with the case.
01:18
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.
01:26
It helps us to categorize
the type of problem
we're going to focus on.
01:30
And here
this patient presented suddenly
with acute onset of symptoms.
01:35
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.
01:44
The second feature
are propagating factors
or provoking signs.
01:49
Here this patient's dizziness
was provoked
when she was sitting up in the bed,
or potentially turning her head.
01:55
And those provoking factors
are important
for driving us towards certain
diagnostic possibilities.
02:02
The last is
the patient's description.
02:05
When we're evaluating dizziness,
we're putting the history
and the physical exam together.
02:10
But the history is really important
for beginning our search
for what the cause
of this dizziness is.
02:15
And here this patient describes
the room as spinning.
02:19
And that will be important
for labeling this problem
for categorizing her symptom
and ultimately arriving
at the diagnosis.
02:27
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.
02:40
Dysequilibrium is imbalanced
or incoordinations.
02:43
Problems with
ataxia or dysmetria on exams.
02:46
Cerebellar findings
we see on exam
and none of those
are reported, or found,
or described in this patient.
02:53
So this is an inconsistent
presentation for dysequilibrium.
02:58
The patient's description is
also inconsistent with syncope.
03:02
Syncope or presyncope
is a feeling of fainting
or near fainting.
03:06
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.
03:21
Nonspecific dizziness
is a diagnosis of exclusion.
03:25
And this patient's presentation
is really consistent with vertigo.
03:28
So here are the correct answer,
the categorization of this
patient's problem is vertigo.
03:34
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.