Dizziness

Differential diagnosis

  • Includes a variety of sx. Disequilibrium: sense of imbalance, gait disturbance; vertigo: perception of spinning; near syncope: lightheadedness due to cerebral hypoperfusion.
  • Vertigo Ddx:
    • Peripheral
      • BPPV: dislodged canaliths in semicircular canal; episodic rotatory vertigo (<1 min episodes), triggered by changes in position; Rx: Epley/BBQ roll maneuver
      • Meniere’s disease: ↑ endolymphatic pressure in inner ear; episodic rotatory vertigo (min-hrs), N/V, aural fullness, hearing loss, tinnitus; Rx: diuretics, ↓ salt
      • Vestibular neuritis: sudden-onset w/ gait ataxia; if w/ hearing loss = labyrinthitis
    • Central
      • Posterior circulation stroke/TIA: “5 Ds” of dizziness, diplopia, dysphagia, dystaxia; sudden onset (resolves after mins in TIA, persists in stroke)