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Aids to Diagnosis - Dizziness

Dizziness, giddiness and whooziness (amongst others) are words used by patients to describe a variety of experiences, from vertigo (a sensation of motion) to light-headedness to weak legs.  Whilst most causes are benign, on occasion the cause is sinister.  The most important part of the diagnostic process is to interrogate the patient about the symptom.  The nature of the sensation, the duration and the precipitating circumstances are all things that help to gain the precision necessary to formulate a diagnosis. 

70% of vertigo is caused by the following four syndromes:

 

Benign paroxysmal positional vertigo

BPPV causes brief (up to one minute) attacks of vertigo and vomiting triggered by an alteration in head position (for example turning the head on the pillow or lifting the head from the pillow).  The Dix-Hallpike manoeuvre is the standard diagnostic test. Many web pages show how to perform and interpret the manoeuvre.  One important feature of BPPV is of compensation - in true BPPV the test stops being positive after two or three repeat manoeuvres.  Patients with BPPV can be referred to members of the trust Vestibular disorder therapy team.

Name Site Contact Number
Julie Shepherd CGH 08454 223 040
Allysun Hope CGH 08454 223 040
Sue Atkinson GRH 08454 228 302
Clare Gardner GRH 08454 228 302
Claire Hunt GRH 08454 228 302
Christine Beadle Lydney 01594 598 235
Linda Pritchard Tewkesbury 01684 853 933
Gloria Sim Cirencester 01285 655 711
Sarah James Bourton-on-the-Water 01451 823 723

 

Vestibular neuritis

Here vertigo typically develops over a period of hours, is severe for a few days, and then subsides over the course of a few weeks. Some patients can have residual non-specific dizziness and imbalance that lasts for months. The condition is thought to result from a selective inflammation of the vestibular nerve, presumably of viral origin.

 

Meniere's disease

The characteristic triad is of vertigo, tinnitus and deafness lasting hours at a time.

 

Phobic vertigo

Characterised by a vague sensation of unsteadiness, often fluctuating.

 

Who do we want to see?

In neurology we are particularly concerned with central (ie within the brain or brainstem) causes.  The vestibular nucleii lie in the brainstem, close to many important structures.  The features that lead to a suspicion of a central cause are:

1. Symptoms and signs of brainstem dysfunction:

These might include facial weakness, diplopia, ataxia, cranial nerve or limb deficits.  It is important to quickly examine the cranial nerves, particularly hearing and corneal reflexes

2.  Sustained (ie days or weeks) vertigo, with or without response to change in head position.

Vertebrobasilar ischaemia may be an overdiagnosed explanation for brief attacks of dizziness and loss of consciousness in the elderly.  The theory,  that neck movement interferes with vertebral blood flow and that causes loss of consciousness, is unproven. 

There are however a great many other important causes of loss of consciousness in the elderly (eg carotid sinus sensitivity, cardiac arrhythmia and epilepsy), and we are happy to see and advise or refer on for investigation.