Dizziness resident survival guide: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
 
(28 intermediate revisions by 3 users not shown)
Line 1: Line 1:
{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;
|-
! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Dizziness Resident Survival Guide Microchapters}}
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Dizziness resident survival guide#Overview|Overview]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Dizziness resident survival guide#Causes|Causes]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Dizziness resident survival guide#Diagnosis|Diagnosis]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Dizziness resident survival guide#Treatment|Treatment]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Dizziness resident survival guide#Do's|Do's]]
|-
! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Dizziness resident survival guide#Don'ts|Don'ts]]
|}
__NOTOC__
{{CMG}}; {{AE}}[[User:MoisesRomo|Moises Romo M.D.]]
{{CMG}}; {{AE}}[[User:MoisesRomo|Moises Romo M.D.]]
<br />
 
'''''Synonyms and Keywords:''''' a''pproach to dizziness, dizziness workup, dizziness management, approach to vertigo, vertigo workup''
==Overview==
==Overview==
[[Dizziness]] is a complex and subjective complaint that encompasses a wide [[spectrum]] of [[symptomatology]]. It is one of the most common presenting [[symptoms]] among patients seen by emergency medical [[physicians]], [[primary care]] physicians, [[neurologists]], and [[otolaryngologists]]. It can be caused by a disturbance in nearly any system of the body.
[[Dizziness]] is a complex and subjective complaint that encompasses a wide [[spectrum]] of [[symptomatology]]. It is one of the most common presenting [[symptoms]] among patients seen by emergency medical [[physicians]], [[primary care]] physicians, [[neurologists]], and [[otolaryngologists]]. It can be caused by a disturbance in nearly any system of the body.
Line 6: Line 26:
===Life Threatening Causes===
===Life Threatening Causes===


* Life-threatening causes include conditions that may result in [[death]] or permanent [[disability]] within 24 hours if left untreated.
*Life-threatening causes include conditions that may result in [[death]] or permanent [[disability]] within 24 hours if left untreated.
 
**[[Electrolyte imbalance]]
**[[Electrolyte imbalance]]
**[[Traumatic brain injury]]
**[[Traumatic brain injury]]
Line 25: Line 44:


==Diagnosis==
==Diagnosis==
Shown below is an [[algorithm]] summarizing the [[diagnosis]] of [[dizziness]] according to the American Academy of Neurology guidelines:<ref name="Eggers2009">{{cite journal|last1=Eggers|first1=S. D.Z.|title=DIZZINESS: A PRACTICAL APPROACH TO DIAGNOSIS AND MANAGEMENT|journal=Neurology|volume=72|issue=24|year=2009|pages=2139–2139|issn=0028-3878|doi=10.1212/WNL.0b013e3181aa53ec}}</ref><ref name="KerberBaloh2011">{{cite journal|last1=Kerber|first1=K. A.|last2=Baloh|first2=R. W.|title=The evaluation of a patient with dizziness|journal=Neurology: Clinical Practice|volume=1|issue=1|year=2011|pages=24–33|issn=2163-0402|doi=10.1212/CPJ.0b013e31823d07b6}}</ref>


* Shown below is an [[algorithm]] summarizing the [[diagnosis]] of [[dizziness]] according to the American Academy of Neurology guidelines:<ref name="urlDIZZINESS: A PRACTICAL APPROACH TO DIAGNOSIS AND MANAGEMENT | Neurology">{{cite web |url=https://n.neurology.org/content/72/24/2139 |title=DIZZINESS: A PRACTICAL APPROACH TO DIAGNOSIS AND MANAGEMENT &#124; Neurology |format= |work= |accessdate=}}</ref><ref name="pmid28145669">{{cite journal |vauthors=Muncie HL, Sirmans SM, James E |title=Dizziness: Approach to Evaluation and Management |journal=Am Fam Physician |volume=95 |issue=3 |pages=154–162 |date=February 2017 |pmid=28145669 |doi= |url=}}</ref><ref name="urlThe evaluation of a patient with dizziness | Neurology Clinical Practice">{{cite web |url=https://cp.neurology.org/content/1/1/24 |title=The evaluation of a patient with dizziness &#124; Neurology Clinical Practice |format= |work= |accessdate=}}</ref>


{{familytree/start |summary=PE diagnosis Algorithm.}}  
{{familytree/start |summary=PE diagnosis Algorithm.}}  
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | A01 |A01= Patient with [[dizziness]]s}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | A01 |A01= [[Patient]] with [[dizziness]]s}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | |!| }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | |!| }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | A01 |A01= Presentation [[periodical]] or [[sustained]]?}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | A01 |A01= Presentation [[periodical]] or [[sustained]]?}}
{{familytree | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | }}
{{familytree | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|-|-|.| | | | | | | | | | }}
{{familytree | | | | | | | | | | | F01 | | | | | | | | | | | | | | | | | | | | | | | | | | F02 |F01= [[Periodical]]|F02= [[Sustained]]}}
{{familytree | | | | | | | | | | | F01 | | | | | | | | | | | | | | | | | | | | | | F02 |F01= [[Periodical]]|F02= [[Sustained]]}}
{{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | |!| }}
{{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | |!| }}
{{familytree | | | | | | | | | | | F01 | | | | | | | | | | | | | | | | | | | | | | | | | | F02 |F01= Provoked or unprovoked?|F02= History of [[intoxication]] or [[trauma]], or unknown?}}
{{familytree | | | | | | | | | | | F01 | | | | | | | | | | | | | | | | | | | | | | F02 |F01= Provoked or unprovoked?|F02= History of [[intoxication]] or [[trauma]], or unknown?}}
{{familytree | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | | | }}
{{familytree | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | | | }}
{{familytree | | | | | F01 | | | | | | | | | | F02 | | | | | | | | | | | | | | | | F03 | | | | | | F04 | | |F01= Provoked |F02= Unprovoked |F03= History of [[intoxication]] |F04= Unknown }}
{{familytree | | | | | F01 | | | | | | | | | | F02 | | | | | | | | | | | | F03 | | | | | | F04 | | |F01= Provoked |F02= Unprovoked |F03= History of [[intoxication]] |F04= Unknown }}
{{familytree | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | | |!| | | | | | | |!| | | | }}
{{familytree | | | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | |!| | | | | | | |!| | | | }}
{{familytree | | | | | F01 | | | | | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | | |,|-|-|^|-|-|.| | | | F02 | | |F01= Apply [[Dix-Hallpike]] maneuver |F02= [[Physical examination]] }}
{{familytree | | | | | F01 | | | | | |,|-|-|-|-|+|-|-|-|-|.| | | | | |,|-|-|^|-|-|.| | | | F02 | | |F01= Apply [[Dix-Hallpike]] maneuver |F02= [[Physical examination]] }}
{{familytree | | | | | |!| | | | | | F01 | | | F02 | | | F03 | | | | | | | | F04 | | | | F05 | | | |!| |F01= [[Deafness]] |F02= Headache |F03= [[Psychiatric]] symptoms |F04= Barotrauma  |F05= Drugs }}
{{familytree | | | | | |!| | | | | | F01 | | | F02 | | | F03 | | | | F04 | | | | F05 | | | |!| |F01= [[Deafness]] |F02= [[Headache]] |F03= [[Psychiatric]] [[symptoms]] |F04= Barotrauma  |F05= [[Drugs]] }}
{{familytree | | |,|-|-|^|-|-|.| | | |!| | | | |!| | | | |!| | | | | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| }}
{{familytree | | |,|-|-|^|-|-|.| | | |!| | | | |!| | | | |!| | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| }}
{{familytree | | F01 | | | | F02 | | F03 | | | F04 | | | F05 | | | | | | | | | | | | | | | F06 | | | | | | F07 | | | |F01= Positive |F02= Negative |F03= [[Meniere disease]] |F04= Vestibular migraine|F05= [[Panic attack]], [[psychiatric]] condition |F06= [[Nistagmus]] dominantly horizontal, direction-fixed, [[saccade]] present |F07= [[Nistagmus]] dominantly vertical, no [[saccade]], torsion or [[gaze]] evoked bidirectionaly }}
{{familytree | | F01 | | | | F02 | | F03 | | | F04 | | | F05 | | | | | | | | | | | F06 | | | | | | F07 | | | |F01= Positive |F02= Negative |F03= [[Meniere Disease|Meniere disease]] |F04= Vestibular migraine|F05= [[Panic attack]], [[psychiatric]] condition |F06= [[Nistagmus]] dominantly horizontal, direction-fixed, [[saccade]] present |F07= [[Nistagmus]] dominantly vertical, no [[saccade]], torsion or [[gaze]] evoked bidirectionaly }}
{{familytree | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | |!| }}
{{familytree | | |!| | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | |!| }}
{{familytree | | F01 | | | | F02 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | F03 | | | | | | F04 | | | |F01= [[Benign paroxysmal positional vertigo]] |F02= [[Orthostatic hypotension]] |F03= [[Vestibular neuritis]] |F04= [[Stroke]], [[transient ischemic attack]] }}
{{familytree | | F01 | | | | F02 | | | | | | | | | | | | | | | | | | | | | | | | | F03 | | | | | | F04 | | | |F01= [[Benign paroxysmal positional vertigo]] |F02= [[Orthostatic hypotension]] |F03= [[Vestibular neuritis]] |F04= [[Stroke]], [[transient ischemic attack]] }}
{{familytree/end}}  
{{familytree/end}}


*<br />The [[clinical]] [[diagnosis]] of [[benign paroxysmal positional vertigo]] according to The American Academy of Otolaryngology is as follows:<ref name="BhattacharyyaGubbels2017">{{cite journal|last1=Bhattacharyya|first1=Neil|last2=Gubbels|first2=Samuel P.|last3=Schwartz|first3=Seth R.|last4=Edlow|first4=Jonathan A.|last5=El-Kashlan|first5=Hussam|last6=Fife|first6=Terry|last7=Holmberg|first7=Janene M.|last8=Mahoney|first8=Kathryn|last9=Hollingsworth|first9=Deena B.|last10=Roberts|first10=Richard|last11=Seidman|first11=Michael D.|last12=Steiner|first12=Robert W. Prasaad|last13=Do|first13=Betty Tsai|last14=Voelker|first14=Courtney C. J.|last15=Waguespack|first15=Richard W.|last16=Corrigan|first16=Maureen D.|title=Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)|journal=Otolaryngology–Head and Neck Surgery|volume=156|issue=3_suppl|year=2017|pages=S1–S47|issn=0194-5998|doi=10.1177/0194599816689667}}</ref>
{| class="wikitable"
|+Diagnosis of benign paroxysmal positional vertigo (BPPV)
! rowspan="4" |Presence of all the following criteria
|Continuous periods of [[vertigo]] triggered by changes in [[head]] position.
|-
|[[Vertigo]] related with twisting, positive [[nystagmus]] is triggered by the [[Dix-Hallpike test|Dix-Hallpike]] maneuver.
|-
|Presence of a quiescence period between the execution of the [[Dix-Hallpike test|Dix-Hallpike maneuver]] and the beginning of [[vertigo]] and [[nystagmus]].
|-
|The triggered [[vertigo]] and [[nystagmus]] rises and then solves within 60 seconds from the onset.
|}
Adapted from The American Academy of Otolaryngology guidelines for benign paroxysmal positional vertigo (DO NOT EDIT).<ref name="BhattacharyyaGubbels2017" />
==Treatment==
Treat the underlying [[Causes|cause]].
*To view the [[treatment]] of [[benign paroxysmal positional vertigo]] [[Benign paroxysmal positional vertigo medical therapy|click here]].
*To view the [[treatment]] of [[Ménière's disease|Meniere disease]] [[Meniere Disease#Treatment|click here]].
*To view the [[treatment]] of [[orthostatic hypotension]] [[Orthostatic hypotension#Treatment|click here]].
*To view the [[treatment]] of [[panic attack]] [[Panic attack#Treatment|click here]].
*To view the [[treatment]] of [[transient ischemic attack]] [[transient ischemic attack medical therapy|click here]].
*To view the [[treatment]] of [[stroke]] [[Stroke medical therapy|click here]].
*To view the [[treatment]] of [[Migraine|vestibular migraine]] [[Migraine medical therapy|click here]].


==Do's==
==Do's==


*Always ask the patient what do they mean by [[dizziness]]. [[Dizziness]] may have a different meaning among patients; while [[vertigo]] may represent a [[Vestibular function|vestibular]] condition, [[presyncope]] directs to a [[cardiovascular]] problem, or [[disequilibrium]] a [[neurological]] or [[Psychiatric Disorders|psychiatric]] one.
*Always ask the [[patient]] what do they mean by [[dizziness]]. [[Dizziness]] may have a different meaning among [[patients]]; while [[vertigo]] may represent a [[Vestibular function|vestibular]] [[condition]], [[presyncope]] directs to a [[cardiovascular]] problem, or [[disequilibrium]] a [[neurological]] or [[Psychiatric Disorders|psychiatric]] one.
*Intentionally ask for any history of possible [[intoxication,]] medications used, and exposures. A full history review may disclose [[dizziness]] due to [[trauma]] or an [[intoxication]].<ref name="pmid29395695">{{cite journal |vauthors=Edlow JA, Gurley KL, Newman-Toker DE |title=A New Diagnostic Approach to the Adult Patient with Acute Dizziness |journal=J Emerg Med |volume=54 |issue=4 |pages=469–483 |date=April 2018 |pmid=29395695 |pmc=6049818 |doi=10.1016/j.jemermed.2017.12.024 |url=}}</ref>
*Intentionally ask for any history of possible [[intoxication,]] [[medications]] used, and exposures. A full history review may disclose [[dizziness]] due to [[trauma]] or an [[intoxication]].<ref name="pmid29395695">{{cite journal |vauthors=Edlow JA, Gurley KL, Newman-Toker DE |title=A New Diagnostic Approach to the Adult Patient with Acute Dizziness |journal=J Emerg Med |volume=54 |issue=4 |pages=469–483 |date=April 2018 |pmid=29395695 |pmc=6049818 |doi=10.1016/j.jemermed.2017.12.024 |url=}}</ref>
*Ask for any eliciting or exacerbating features. [[Dix-Hallpike test|Dix-Hallpike]] maneuver may easily detect a [[benign paroxysmal positional vertigo]] (BPPV) and differentiate it from an [[orthostatic hypotension]].<ref name="pmid15791890">{{cite journal |vauthors=Swartz R, Longwell P |title=Treatment of vertigo |journal=Am Fam Physician |volume=71 |issue=6 |pages=1115–22 |date=March 2005 |pmid=15791890 |doi= |url=}}</ref>
*Ask for any eliciting or exacerbating features. [[Dix-Hallpike test|Dix-Hallpike]] maneuver may easily detect a [[benign paroxysmal positional vertigo]] (BPPV) and differentiate it from an [[orthostatic hypotension]].
*Perform a full [[neurological examination]]. A head-impulse, [[nystagmus]], test of skew (HINTS) can differentiate between a central from a peripheral cause.
*Perform a full [[neurological examination]]. A head-impulse, [[nystagmus]], test of skew (HINTS) can differentiate between a central from a peripheral [[Causes|cause]].
*When taking [[vital signs]], remember to measure [[blood pressure]] in standing and [[supine position]].<ref name="pmid19762709">{{cite journal |vauthors=Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE |title=HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging |journal=Stroke |volume=40 |issue=11 |pages=3504–10 |date=November 2009 |pmid=19762709 |pmc=4593511 |doi=10.1161/STROKEAHA.109.551234 |url=}}</ref>
*When taking [[vital signs]], remember to measure [[blood pressure]] in standing and [[supine position]].<ref name="pmid19762709">{{cite journal |vauthors=Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE |title=HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging |journal=Stroke |volume=40 |issue=11 |pages=3504–10 |date=November 2009 |pmid=19762709 |pmc=4593511 |doi=10.1161/STROKEAHA.109.551234 |url=}}</ref>
*Perform a [[Romberg's test|Romberg test]]. A positive [[Romberg's test|Romberg test]] may disclose a peripheral etiology.<ref name="pmid1443950">{{cite journal |vauthors=Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers JE, Wehrle PA, Boggi JO |title=Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care |journal=Ann. Intern. Med. |volume=117 |issue=11 |pages=898–904 |date=December 1992 |pmid=1443950 |doi=10.7326/0003-4819-117-11-898 |url=}}</ref>
*Perform a [[Romberg's test|Romberg test]]. A positive [[Romberg test]] may disclose a peripheral etiology.<ref name="pmid1443950">{{cite journal |vauthors=Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers JE, Wehrle PA, Boggi JO |title=Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care |journal=Ann. Intern. Med. |volume=117 |issue=11 |pages=898–904 |date=December 1992 |pmid=1443950 |doi=10.7326/0003-4819-117-11-898 |url=}}</ref>
*


==Don'ts==
==Don'ts==
Line 66: Line 111:
*Do not give any kind of [[pharmacologic]] treatment for [[Benign paroxysmal positional vertigo|BPPV]].<ref name="pmid29395695">{{cite journal |vauthors=Edlow JA, Gurley KL, Newman-Toker DE |title=A New Diagnostic Approach to the Adult Patient with Acute Dizziness |journal=J Emerg Med |volume=54 |issue=4 |pages=469–483 |date=April 2018 |pmid=29395695 |pmc=6049818 |doi=10.1016/j.jemermed.2017.12.024 |url=}}</ref>
*Do not give any kind of [[pharmacologic]] treatment for [[Benign paroxysmal positional vertigo|BPPV]].<ref name="pmid29395695">{{cite journal |vauthors=Edlow JA, Gurley KL, Newman-Toker DE |title=A New Diagnostic Approach to the Adult Patient with Acute Dizziness |journal=J Emerg Med |volume=54 |issue=4 |pages=469–483 |date=April 2018 |pmid=29395695 |pmc=6049818 |doi=10.1016/j.jemermed.2017.12.024 |url=}}</ref>


<br />
==References==
==References==
{{Reflist|2}} {{WikiDoc Help Menu}} {{WikiDoc Sources}}
{{Reflist|2}}  
<references />
<references />
[[Category:Primary care]]
[[Category:Resident survival guide]]
[[Category:Up-To-Date]]

Latest revision as of 01:29, 12 December 2020

Dizziness Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D.

Synonyms and Keywords: approach to dizziness, dizziness workup, dizziness management, approach to vertigo, vertigo workup

Overview

Dizziness is a complex and subjective complaint that encompasses a wide spectrum of symptomatology. It is one of the most common presenting symptoms among patients seen by emergency medical physicians, primary care physicians, neurologists, and otolaryngologists. It can be caused by a disturbance in nearly any system of the body.

Causes

Life Threatening Causes

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of dizziness according to the American Academy of Neurology guidelines:[1][2]


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patient with dizzinesss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presentation periodical or sustained?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Periodical
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sustained
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Provoked or unprovoked?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History of intoxication or trauma, or unknown?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Provoked
 
 
 
 
 
 
 
 
 
Unprovoked
 
 
 
 
 
 
 
 
 
 
 
History of intoxication
 
 
 
 
 
Unknown
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Apply Dix-Hallpike maneuver
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physical examination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Deafness
 
 
Headache
 
 
Psychiatric symptoms
 
 
 
Barotrauma
 
 
 
Drugs
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive
 
 
 
Negative
 
Meniere disease
 
 
Vestibular migraine
 
 
Panic attack, psychiatric condition
 
 
 
 
 
 
 
 
 
 
Nistagmus dominantly horizontal, direction-fixed, saccade present
 
 
 
 
 
Nistagmus dominantly vertical, no saccade, torsion or gaze evoked bidirectionaly
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Benign paroxysmal positional vertigo
 
 
 
Orthostatic hypotension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Vestibular neuritis
 
 
 
 
 
Stroke, transient ischemic attack
 
 
 
Diagnosis of benign paroxysmal positional vertigo (BPPV)
Presence of all the following criteria Continuous periods of vertigo triggered by changes in head position.
Vertigo related with twisting, positive nystagmus is triggered by the Dix-Hallpike maneuver.
Presence of a quiescence period between the execution of the Dix-Hallpike maneuver and the beginning of vertigo and nystagmus.
The triggered vertigo and nystagmus rises and then solves within 60 seconds from the onset.

Adapted from The American Academy of Otolaryngology guidelines for benign paroxysmal positional vertigo (DO NOT EDIT).[3]

Treatment

Treat the underlying cause.

Do's

Don'ts


References

  1. Eggers, S. D.Z. (2009). "DIZZINESS: A PRACTICAL APPROACH TO DIAGNOSIS AND MANAGEMENT". Neurology. 72 (24): 2139–2139. doi:10.1212/WNL.0b013e3181aa53ec. ISSN 0028-3878.
  2. Kerber, K. A.; Baloh, R. W. (2011). "The evaluation of a patient with dizziness". Neurology: Clinical Practice. 1 (1): 24–33. doi:10.1212/CPJ.0b013e31823d07b6. ISSN 2163-0402.
  3. 3.0 3.1 Bhattacharyya, Neil; Gubbels, Samuel P.; Schwartz, Seth R.; Edlow, Jonathan A.; El-Kashlan, Hussam; Fife, Terry; Holmberg, Janene M.; Mahoney, Kathryn; Hollingsworth, Deena B.; Roberts, Richard; Seidman, Michael D.; Steiner, Robert W. Prasaad; Do, Betty Tsai; Voelker, Courtney C. J.; Waguespack, Richard W.; Corrigan, Maureen D. (2017). "Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)". Otolaryngology–Head and Neck Surgery. 156 (3_suppl): S1–S47. doi:10.1177/0194599816689667. ISSN 0194-5998.
  4. 4.0 4.1 Edlow JA, Gurley KL, Newman-Toker DE (April 2018). "A New Diagnostic Approach to the Adult Patient with Acute Dizziness". J Emerg Med. 54 (4): 469–483. doi:10.1016/j.jemermed.2017.12.024. PMC 6049818. PMID 29395695.
  5. Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE (November 2009). "HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging". Stroke. 40 (11): 3504–10. doi:10.1161/STROKEAHA.109.551234. PMC 4593511. PMID 19762709.
  6. 6.0 6.1 Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers JE, Wehrle PA, Boggi JO (December 1992). "Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care". Ann. Intern. Med. 117 (11): 898–904. doi:10.7326/0003-4819-117-11-898. PMID 1443950.
  7. Muncie HL, Sirmans SM, James E (February 2017). "Dizziness: Approach to Evaluation and Management". Am Fam Physician. 95 (3): 154–162. PMID 28145669.
  8. Savitz SI, Caplan LR (June 2005). "Vertebrobasilar disease". N. Engl. J. Med. 352 (25): 2618–26. doi:10.1056/NEJMra041544. PMID 15972868.
  9. Hilton M, Pinder D (2004). "The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo". Cochrane Database Syst Rev (2): CD003162. doi:10.1002/14651858.CD003162.pub2. PMID 15106194.