Geriatrics, Gerontology & Elderly Care

Introduction: Dizziness is the most common condition or symptom to be present in Emergency departments or rooms in most of the part of the world. It can easily be miss- diagnosed as Central verses Peripheral Vertigo if not deal with proper history and examination in EDs by Emergency Physicians or clinicians. Dizziness cane be defined as ‘’Spinning movement in surroundings’’ or whirlpool like feeling. Dizziness is common among elderly age with many different reasons apart from Peripheral or Central causes of Vertigo which includes Risk of Fall, Trauma, Dietary intake, Walking aids, Organic diseases, Vision problems etc. My presentation will focus on new method of Diagnosing Dizziness in Emergency Departments as quick and easy three steps which includes Three clinical tests which are 1. Nystagmus, 2. Skew test and 3. Head thrust test. 40 years old female known case of I.H.D, HTN and DM presented with moderate dizziness which is since one month and gradually increasing, associated with nausea, vomiting and headache. She also fell down twice in this month. She doesn’t use walking aids. She lives alone. On multiple medications for her comorbidities. She was at the shopping mall and suddenly felt quite dizzy and became better but not settled and now in E.D.

History of fall: If yes then preceding symptoms, clear cause of fall etc. Palpitation, use of medications which can cause dizziness, consumption of alcohol, walking aids, previous episodes. Different meaning for the different patient- Some describe as Disequilibrium, Light headedness, etc. Vertigo: Sensation of disorientation in space with the hallucination of movement. BPPV: Most commonly recognized form of vertigo. Attributed to calcium debris within the semicircular canal (canalithiasis).I feel like the room is spinning when I turn my head Lasts seconds, but may feel destabilized for hours after an attack. No ear pain, tinnitus, or hearing loss.

Diagnosis usually made by history:

• Dix Hallpikemaneuver

• Positive in 50-80% of patients

• Canalithrepositioning maneuvers

Medical therapy usually not helpful due to transient symptoms

Meniere’s disease:

• Excess endolymphaticfluid pressure

• Episodic, acute vertigo lasts minutes to hours

• Unilateral tinnitus, hearing loss, ear fullness