00:01 In this lecture, we're going to talk about an introduction to dizziness. 00:05 Before we dive into the specific causes of dizziness, it's important to have some way of thinking about how to approach these patients. 00:13 So let's start with a case. 00:15 This is a 34-year-old woman who presents to clinic urgently for evaluation of dizziness. 00:21 The patient reports that she awoke this morning and suddenly felt very dizzy while sitting up in the bed. 00:27 She was unable to stand and walk due to severe dizziness. 00:31 Her son escorted her downstairs where they telephoned. 00:35 In the office, the patient is lying on the exam table uncomfortable and still. 00:40 She says that her dizziness feels like the room is spinning. 00:44 Her eyes are closed. 00:45 She is freely able to report the history from this morning without confusion, aphasia, or dysarthria. 00:53 She was able to walk into the clinic and denies any problems with weakness, numbness, or tingling. 00:59 She has a history of borderline hypertension, which he is managing with diet and lifestyle at this time. 01:05 She is on a multivitamin only. 01:06 She has no allergies, and denies personal or family history of symptoms, which prompted her presentation. 01:13 So how would you categorize this patient's dizziness? Well, let's start with the case. 01:18 What are the key features that we look at in patients who are presenting with dizziness? The first is the timeline of onset. This is critical. 01:26 It helps us to categorize the type of problem we're going to focus on. 01:30 And here this patient presented suddenly with acute onset of symptoms. 01:35 Not a chronic onset, which would point us in a certain direction, but acute onset of her symptoms, and that will be important when we're evaluating this patient. 01:44 The second feature are propagating factors or provoking signs. 01:49 Here this patient's dizziness was provoked when she was sitting up in the bed, or potentially turning her head. 01:55 And those provoking factors are important for driving us towards certain diagnostic possibilities. 02:02 The last is the patient's description. 02:05 When we're evaluating dizziness, we're putting the history and the physical exam together. 02:10 But the history is really important for beginning our search for what the cause of this dizziness is. 02:15 And here this patient describes the room as spinning. 02:19 And that will be important for labeling this problem for categorizing her symptom and ultimately arriving at the diagnosis. 02:27 So how would you categorize this patient's dizziness? Is it vertigo, dysequilibrium, syncope, or nonspecific dizziness? Well, the clinical description doesn't sound like dysequilibrium. 02:40 Dysequilibrium is imbalanced or incoordinations. 02:43 Problems with ataxia or dysmetria on exams. 02:46 Cerebellar findings we see on exam and none of those are reported, or found, or described in this patient. 02:53 So this is an inconsistent presentation for dysequilibrium. 02:58 The patient's description is also inconsistent with syncope. 03:02 Syncope or presyncope is a feeling of fainting or near fainting. 03:06 Typically, when patients stand up in the situation of orthostatic presyncope or syncope, and there's no indication of cardiac dysrhythmias, which would tip us off to a cardiac concern that would precipitate a syncopal event. 03:21 Nonspecific dizziness is a diagnosis of exclusion. 03:25 And this patient's presentation is really consistent with vertigo. 03:28 So here are the correct answer, the categorization of this patient's problem is vertigo. 03:34 The patient describes room spinning, provoked with head turning or sitting up in bed, and those are common descriptions for patients who are suffering from vertigo.
The lecture Case: 34-year-old Woman with Severe Dizziness by Roy Strowd, MD is from the course Vertigo, Dizziness, and Disorders of Balance.
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