Posted by e-Medical PPT
Is the dizziness is vertiginous in nature, or more suggestive of near-syncope or non-vestibular dizziness
Is the dizziness is affected by movements of the head, if so it suggests a peripheral vertigo
·a patient with peripheral acute vertigo often prefers to sit upright and not lie down, or prefers to lie still with the unaffected ear undermost; and the patient also prefers to avoid any sudden head movements
·a patient with central vertigo often has a lesser degree of dizziness, which is less affected by head movements and not specifically related to a particular head position
Dizziness – is it vertigo ?
Dizziness and head movement
Vertigo lasting seconds, which is only precipitated by sudden movements of the head (looking up, suddenly twisting the head, suddenly getting up from a supine position or when suddenly rolling over in bed) suggests benign positional vertigo
·a patient with benign positional vertigo may be able to identify a particular movement or position of the head that precipitates vertigo, which usually occurs after a latent period of 10 - 20 seconds
·patients with BPV may complain of non-specific nausea, dysequilibrium and dizziness between attacks

Dizziness – duration assists differential diagnosis
The duration of the vertigo provides useful information
·vertigo lasting seconds suggests benign paroxysmal positional vertigo
·vertigo lasting minutes suggests transient cerebrovascular ischaemia (posterior circulation TIA)
·vertigo lasting hours suggests Meniere's syndrome
·vertigo lasting hours-days suggests vestibular neuronitis or posterior circulation strokes

Dizziness and otological symptoms
Deafness and/or tinnitus suggests peripheral vertigo
·Many patients with vestibular neuronitis have a history of a recent viral illness in the past few weeks. Otological symptoms in a patient with acute vestibular neuronitis suggests acute (serous) labyrinthitis
·Recent severe earache +/- ear discharge +/- fever suggests a middle ear infection and a possible acute (purulent) labyrinthitis
·Recent head trauma, sudden coughing/sneezing + sudden 'pop' in the ear, or recent scuba diving suggests a possible peri-lymphatic fistula (vertiginous symptoms may also be exacerbated by valsalva-type maneuvers or a loud noise)

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