Dizziness

https://www.bernardshevlin.com/dizziness/Dizziness as a Presenting Complaint

(also articulated as “giddiness”, “vertigo”. “having a funny turn”, “coming over queer”, “going mazey” “having the falling about disease” and all the “iddies, izzies and oozies” you can think of!)

Common things are common:

Infection – esp “sinusitis”

Drug Side-Effects “Any Drug can cause anything in anybody anytime – especially in the elderly”

Pychiatry: Do a Nejmegan Questionnaire? (For hyperventilation)

 

Dangerous to Miss:

Rare Otological Emergencies (ruptured round window, post-stapedectomy, advancing cholesteatoma.

DVT and/or PE: do a Wells Score. (+ u/s and d-dimer?)

Silent MI: (Diabetic, the Elderly, previous cardiac surgery), Critical Aortic Stenosis.

Congenital Cardiac: esp HOCUM and Brugada’s.  Cardiac Dizziness – especially dizziness (+/- palpitation +/- chest pain) on effort.

Long QT: QT should be less than 50% of RR. Congenital or acquired: Many drugs can cause long QT.

Occult bleed.

Dangerous Infections – esp meningitis. Time Frame: up to 6 hours non specific. 8 hours limb pain, cold extremities, pale or mottled skin are early warning of septicaemia. 13-24 hours: non blanching rash (tumbler test), neck stiffness, Kernig’s, Brudzinski’s signs, impaired mental state.

 

Good Diagnoses:

The vertiginous patient is terrified; give them a diagnosis whether you know it or not!

(The more scary the vertigo the more confident you can be that it is totally benign)

Remember BPPV (Benign Paroxysmal Positional Vertigo) Cawthorne-Hallpike Test and Epley’s manoeuvre.

Meniere’s: episodic dizziness, deafness and dinnitus.

TIAs don’t cause syncope.

 

 

Bernard Shevlin.                                         B.shevlin02@gmail.com

 

 

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