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
www.bernardshevlin.com 01538 722678 (home office)