The Rational Clinical Examination
David L. Simel, Drummond Rennie
Vertigo
David A. Froehling, Marc D. Silverstein, David N. Mohr, Charles W. Beatty
Patients with vestibular neuronitis (also called labyrinthitis), benign paroxysmal positional...
Topics Discussed:
benign positional vertigo, diagnostic process, dix-hallpike maneuver, dizziness, hearing tests, neurologic examination, pathologic nystagmus, vertigo
Excerpt:
"Patients often have difficulty describing symptoms of dizziness,
and even those who have disorders that produce vertigo may not clearly
describe a hallucination of movement. As Olsson and Atkins16 pointed
out, "A person is so rarely conscious of his own vestibular
system, he has a great deal of trouble describing his symptoms to
a doctor." Thus, clues must be gathered from the medical history
and physical examination to classify the dizziness properly.It is probably more important to ask a patient about the circumstances
in which the dizziness occurs than to ask for a description of the
dizziness. Dizziness related to early-morning activities is somewhat
helpful in distinguishing between peripheral and central vertigo.
Matutinal vertigo (vertigo on first arising in the morning) is usually due
to a peripheral vestibular disorder.19Look for cranial nerve palsies, weakness, reflex changes, ataxia,
decreased sensation in the feet, and abnormalities of gait and station.
Vertical nystagmus is associated with lesions of the vestibular nuclei
or of the cerebellar vermis.13 Neurologic findings
other than pathologic nystagmus suggest that the lesion is central...."
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