NEURO-OTOLOGIC HISTORY
Section snippets
DEFINITION OF TERMS: VERTIGO, VISUAL DISORIENTATION, LIGHTHEADEDNESS, AND IMBALANCE
For nearly every disease considered in this issue, patients likely present complaining of dizziness. Webster's Ninth New Collegiate Dictionary includes “a whirling sensation in the head,” “mentally confused,” and “giddy” in its definition of dizzy. Obviously this covers a broad range of neurologic and nonneurologic symptoms and it serves for most patients as a general purpose term for sensory disorientation or imbalance. Similar common but relatively useless terms include woozy, spacey, and
PRECIPITATING FACTORS: POSITIONAL, MOVEMENT RELATED, STRESS, AND HYPERVENTILATION
For most patients, vestibular symptoms are episodic and not continuous. The factors that initiate or predispose the patient to develop symptoms may provide important clues as to the cause of the attacks. Certain positions or position changes are particularly common as precipitating events. Vertigo brought on by lying supine and turning to one side is typical of BPPV. Other typical precipitating positions for BPPV include looking underneath a low object (like a sink), or reaching up to a high
DURATION OF SYMPTOMS
Once the symptom of dizziness has been confirmed by history to be vertigo, the duration of attacks can indicate the diagnosis. For any chief complaint the duration of symptoms is important, but the authors find this is particularly the case for vertigo. At issue here is the duration of individual episodes and not the time since the first attack. Because many patients develop a baseline level of imbalance or discomfort onto which the attacks of vertigo are superimposed, it is important to
ASSOCIATED OTOLOGIC COMPLAINTS
Otologic complaints, such as hearing loss, tinnitus, or ear fullness, provide important clues as to the location of a lesion. Hearing loss accompanies peripheral, not central, disease. Auditory pathways become bilateral after the first synapse in the cochlear nucleus. Because of the crossing and recrossing of auditory projections, central lesions rarely cause unilateral hearing loss. Central lesions at the root entry zone of the auditory nerve are the principal exception, and these are rare.21
VISUAL FUNCTION
Other sensory information also can be extremely important in the maintenance of balance and one's sense of stability. All sensory information (other than taste and smell) can be used to give information about position and velocity relative to the surround. At times different senses can give contradictory information even in normal day to day circumstances. For example, while sitting in a car that is not moving somatosensory and vestibular information tells one that the world is stable. If out
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Cited by (12)
Imprecision in patient reports of dizziness symptom quality: A cross-sectional study conducted in an acute care setting
2007, Mayo Clinic ProceedingsCitation Excerpt :Furthermore, evidence indicates considerable confusion among physicians about terms and diagnostic implications of qualitative categories. Although the term light-headed is considered by some authors7,11,15,18,35–39 and many clinicians13 to indicate a mild version of presyncope, others adopt the traditional stance that light-headedness is distinctly separate from near faint,16,19,20 and yet others deliberately avoid the term.21,27 Some authors point to the presence or absence of true vertigo as the most important qualitative distinction to make in evaluating dizziness in a patient.30,40,41
Overreliance on symptom quality in diagnosing dizziness: Results of a multicenter survey of emergency physicians
2007, Mayo Clinic ProceedingsDo central vestibular findings predict abnormal findings on magnetic resonance imaging?
2019, Journal of Laryngology and OtologyDoes my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome
2011, CMAJ. Canadian Medical Association JournalCitation Excerpt :Various findings on clinical examination and results of specific tests have been used to distinguish between peripheral and central causes of acute vestibular syndrome. The presence of general neurologic findings has occasionally been touted by authors as a key feature distinguishing peripheral and central causes of acute vestibular syndrome.81,82 The true prevalence of focal neurologic signs in patients with acute vestibular syndrome is difficult to estimate, because symptoms or signs suggesting a central disorder influence patient selection in most studies.
Perception of verticality in the post-COVID-19 condition correlates to infection severity
2023, Journal of Central Nervous System DiseaseIncidence and predicting factors of cerebellar stroke in patients with acute vestibular syndrome in songklanagarind emergency department: A preliminary study
2018, Journal of the Medical Association of Thailand
Address reprint requests to Michael L. Rosenberg, MD, New Jersey Neuroscience Institute, 65 James Street, Edison, NJ 08818
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New Jersey Neuroscience Institute, Edison, New Jersey