2. There can be no physician so
dedicated to their art that they do
experience a slight decline of the
spirits when they learn that their
patients chief complaint is of
dizziness
3. • History
– “head rush” or
– “like being on a roundabout”
– Other focal neurological features
– Hearing loss
– If episodic – duration of episodes and provoking features
– If chronic – variability ?
4. • Acute
– Vestibular neuronitis
• Single acute attack of continuous
vertigo often with nausea and
vomiting for several days
• Positive head impulse test,
unidirectional nystagmus
horizontal and rotational
• No other neurological deficit,
furniture walking
• Rx – bed rest, antiemetics for 3
days only and strong
encouragement to mobilise
• Gradual recovery over weeks but
50% will have canal paresis
detectable on vestibular function
testing at 1 year
Head Impulse Test
5. • Red flags (for posterior circulation stroke)
– Normal head impulse
– Can’t walk
– Focal neurological signs
– Hearing loss, abnormal otoscopy
– New headache
6. • Recurrent episodic
– NOT vestibular neuronitis
– BPPV
• Attacks lasting seconds to a
minute
• Positional, turning over in bed
– Migraine
• Attacks lasting 10-30 minutes to
a minute with associated migraine
features
• The commonest cause of
recurrent dizziness we see
– Menieres
• Attacks lasting minutes to several
hours with roaring tinnitus, ear
fullness and unilateral deafness
7. • Dizziness: A practical approach to
diagnosis and management. Bronstein
and Lempert.
8. • Epley (following a positive Dix-Hallpike)
– Youtube (accurate and safe)
