Dizziness

Dizziness can come in different forms: vertigo, lightheadedness, disequilibrium.

Vertigo:  False movement, room spinning.  Feels as if you are moving when you are not.  

Benign Paroxysmal Positional Vertigo:  acute, occurs with certain movements, lasts seconds to minutes

Dix-Hallpike to diagnose 

Vestibular rehab/physical therapy to treat - Epley Maneuver

Meniere’s Disease: vertigo, with hearing loss and ringing in ears

Labyrinthitis

Central vertigo: can be more worrisome, exam looks for signs of stroke or other pathology. May need brain imaging. 

Lightheadedness: feeling like one could pass out, pre-syncope

Cardiac causes: arrhythmias, valve disease

Orthostatic hypotension

Disequilibrium: sense of imbalance

Changes in nerve sensation can contribute: peripheral neuropathy, knee replacements

Vision and auditory impairment can also contribute

Diagnosis: monofilament testing, vibration sensory testing, gait speed, get up and go test, Romberg test all help evaluate

Treatable causes: B12 deficiency, thyroid disease, uncontrolled diabetes, medications that can be stopped (older anti-histamines)

Treatment: Adaptations (change in glasses, hearing aids), practice balance - physical therapy, strengthening

Persistent Postural Perceptual Dizziness (PPPD): persistent dizziness that worsens with motion or upright position, present > 3 months

Often follows BPPV or labyrinthitis

Anxiety, depression often present concomitantly

Treatment: Evaluate medications, consider medication to help with anxiety, depression

Health Pearl: For people who have been fully vaccinated for COVID-19, we discuss CDC guidelines and ways to safely expand activities. 

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