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Vertigo

  • Common ddx

    • BPPV (positional), meniere's disease (tinnitus, hearing loss), otitis (earache), labyrinthitis
    • EtOH, drugs, meds
    • herpes zoster (Bell's palsy, otalgia)
    • migraines
    • hypoglycemia (insulin usage), hypotension (BP med overdose)
    • seizure (syncope, postictal)
  • Serious ddx

    • stroke, TIA (unilateral weakness)
    • concussion (headache)
    • arrhythmia
    • acoustic neuroma (unilateral hearing loss)
    • MS (vision loss, paresis, paresthesia)
  • Labs

    • CT if suspect tumor or stroke
    • MRI if suspect MS
    • audiology referal if hearing loss
    • holter moniter if suspect arrhythmia
  • Other ddx

    • vestibular neuronitis, vertebrobasilar insufficiency, panic attack, TMJ syndrome, barotrauma
  • Definition

    • spinning sensation
  • HPI

    • onset
    • triggering events: anxiety, activities
    • severity
    • aggravates: movement, position
    • alleviates
    • currently symptomatic vs symptoms resolved
  • ROS

    • fever, recent infection
    • head trauma, headache, syncope
    • vision loss
    • ENT: earache, hearing loss, tinnitus
    • cardio: chest pain, palpitations
    • pulm: dyspnea, cough
    • neuro: paresis
  • PMH

    • diabetes
    • stroke, afib, arrhythmia
    • HTN
    • migraines
    • MS
    • NF2
  • FH

  • SH

    • EtOH, tobacco, illicit drugs
  • Meds

    • insulin usage
    • blood pressure meds
    • new meds, overdosing on meds
  • Allergies

  • Px

    • vitals
    • gen impression
    • head: trauma
    • eye: nystagmus, unequal pupils, papilledema
    • ENT: gross hearing, otoscope
    • cardio: bruits, murmurs, gallops, arrhythmia
    • pulm
    • abd
    • neuro: unilateral weakness, facial droop, finger-to-nose, gait
    • dix-hallpike if suspect BPPV
  • Tx

    • canalith repositioning exercises for BPPV

  • Print | Citations

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