Case: 34-year-old Woman with Severe Dizziness

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.