Dizziness
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Contents |
More Specific Terms
- disequilibrium in the elderly
- labyrinthitis
- light-headedness
- presyncope; near-syncope
- vertigo
- vestibular neuronitis
Introduction
- Defined as a disturbed state of spatial awareness.
Etiology
- ( differential diagnosis)
- multisensory dizziness
- common in elderly, especially diabetics [6]
- may be some overlap with disequilibrium
- disequilibrium (5%, more common in elderly) {perhaps most common [5]})
- CNS lesions
- hydrocephalus
- cerebellar dysfunction
- vertigo (50%)
- presyncopal lightheadedness (25%)
- psychophysiologic dizziness
- acute or chronic anxiety
- agoraphobia
- depression
- somatoform disorder
- ocular dizziness
- high magnification & lens implant
- imbalance in extraocular muscles
- oscillopsia
- physiologic dizziness
- motion sickness
- space sickness
- height vertigo
- migraine
- transient ischemic attack, stroke
- idiopathic dizziness (20%)
- acoustic neuroma [3]
- pharmaceutical agents
- use of 4 or more medications
- SSRI
- cholinesterase inhibitors
- risk factors (in elderly) [4]
- anxiety
- depression
- impaired hearing [6]
- impaired balance
- past myocardial infarction
Epidemiology
- 0.8% of outpatient visits
- more prevalent in the elderly
- 29% of individuals > 72 years of age
Clinical-manifestations
- may persist for 6 months or longer
- examine for nystagmus
- head shaking nysatgmus
- close eyes
- shake head horizontally for 10 seconds
- open eyes
- vertical nystagmus or torsional nystagmus associated with a single episode of protracted dizziness suggests a central condition [7]
- Rhomberg test may be positive
- fear of falling, especially elderly
Laboratory
- complete blood count ( CBC)
- serum electrolytes
- serum creatinine
- serum glucose
- serum thyroid-stimulating hormone ( serum TSH)
- specific tests for specific etiologies
Complications
- increased risk of falls
- social isolation
- diminished quality of life
- risk of vascular event after presenting with an episode of dizziness is low ( stroke within 1 month < 1 in 500) [8]
Management
- fall precautions (also see falls in the elderly)
- vestibular rehabilitation
- even simple exercises challenging the vestibular system of benefit [5]
- Epley maneuver for benign positional vertigo
- see specific etiology
- prognosis:
- dizziness in the elderly NOT associated with increased mortality or risk of hospitalization
More General Terms
Additional Terms
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1013-15
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 649
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
- Journal Watch 20(7):56, 2000 Tinetti et al Ann Inten Med 132:337, 2000 Drachman An Intern Med 132:403, 2000
- Journal Watch 24(24):188, 2004 Yardley L, Donovan-Hall M, Smith HE, Walsh BM, Mullee M, Bronstein AM. Effectiveness of primary care-based vestibular rehabilitation for chronic dizziness. Ann Intern Med. 2004 Oct 19;141(8):598-605. PMID: [1]
- Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004; 7th edition, 2010
- Stanton VA et al, Overreliance on symptom quality in diagnosing dizziness: results of a multicenter survey of emergency physicians. Mayo Clin Proc 2007, 82:1319 PMID: [2]
- Kim AS et al. Risk of vascular events in emergency department patients discharged home with diagnosis of dizziness or vertigo. Ann Emerg Med 2011 Jan; 57:34 PMID: [3]
- Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- NIH Institute & Center Resources: Dizziness & Vertigo [4]
- NIDCD Balance, Dizziness and You [5]
