Case: 34-year-old Woman with Severe Dizziness

by Roy Strowd, MD

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    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.

    About the Lecture

    The lecture Case: 34-year-old Woman with Severe Dizziness by Roy Strowd, MD is from the course Vertigo, Dizziness, and Disorders of Balance.

    Included Quiz Questions

    1. Vertigo may be provoked by head turning.
    2. The timeline of a dizziness episode is rarely helpful in diagnosis.
    3. "Dizzy" and "lightheaded" are medical terms having the same meaning.
    4. Patients experiencing disequilibrium often feel that the room is spinning.
    5. When describing their symptoms, patients always accurately differentiate between vertigo and presyncope.

    Author of lecture Case: 34-year-old Woman with Severe Dizziness

     Roy Strowd, MD

    Roy Strowd, MD

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