Dizziness

What does the patient mean by dizziness?

• Vertigo
• Impending feint
• Loss of balance
• Lightheadedness

Does the patient have falls?

• Stokes-Adams attacks
• Vertebrobasilar insufficiency
• Akinetic type of minor epilepsy

Causes of syncope

• Cardiac
  • • • Stokes-Adams attacks
      • Myocardial infarction
      • Aortic stenosis
      • Pulmonary stenosis
• Vasomotor
  • • • Simple faint (vasovagal attack)
      • Prolonged standing
      • Hypotensive drugs
• Cough and micturition syncope
• Hypoglycaemia
• Subclavian steal syndrome

Causes of lightheadedness

• Cerebrovascular insufficiency
• Anaemia
• Post-tussive dizziness and syncope
• Anxiety
• Hyperventilation

Causes of vertigo

• Vertebrobasilar insufficiency/cervical spondylosis
• Meniere’s disease (vertigo/tinnitus/deafness)
• Middle ear disease
• Vestibular neuronitis
• Benign positional vertigo
• Drug therapy
  • • • Salicylates
      • Phenytoin
      • Quinine
      • Gentamycin

10-minute consultation: Vertigo J Kanagalingam, D Hajioff, S Bennetthttp://bmj.com/cgi/content/full/330/7490/523?etoc

Rinne and Weber tests

Disease	Weber	Rinne
Middle ear	Better affected side	Bone > air
Inner ear	Better on normal side	Air > bone (both reduced)

Vertigo (2009)

An approach to the evaluation and management of syncope in adults (2010)

Syncope

Investigations?

Treatment?

Prevention?