Muhammad Hammad
Mediclinic Welfare Hospital, UAE
Title: New approach to dizziness with clinical method
Biography
Biography: Muhammad Hammad
Abstract
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
Vestibular Neuritis:
• Viral or post viral inflammatory disorder.
• Rapid onset of severe persistent vertigo with nausea, vomiting, ataxia.
• Sometimes combined with unilateral hearing loss (labyrinthitis)
• Steroid taper.
• Dramamine, meclizine (H1 blockers), benzodiazepines
Labryinthine Concussion:
• Traumatic vestibular injury following head trauma
• Transverse fractures of the temporal bone
Acute Vestibular Syndrome: Acute vestibular syndrome (AVS) is characterized by the rapid onset (over seconds to hours) of vertigo, nausea/ vomiting, and gait unsteadiness in association with head motion intolerance and nystagmuslasting days to weeks. Of the 2.6 million emergency department visits for dizziness or vertigo annually in the United States, APV is diagnosed in nearly 150 000. Small observational studies suggest perhaps 25% of acute vestibular syndrome presentations to the emergency department represent posterior circulation infarctions.CT scans have low sensitivity (approximately 16%) for acute infarction, particularly in the posterior fossa, and brain MRI is not always readily available. Studies also suggest that false-negative MRI can occur with acute vertebrobasilar strokes.