Dizziness Archives - Emergency Medicine Kenya Foundation

Dizziness…the good and the ugly…

15 October, 202129 December, 2021 EMKF

The differential diagnosis of vertigo can be broken into peripheral and central causes. It is imperative the Emergency Physician consider central causes of vertigo.

Signs/ Symptoms Differentiating Peripheral and Central Vertigo

	Peripheral	Central
Onset	Sudden or Insidious	Sudden
Severity of Vertigo	Intense Spinning	Ill-defined, may be severe or less intense
Prodromal Dizziness	Occurs in up to 25%, often single episode	Occurs in up to 25%, recurrent episodes suggest TIA’s
Intolerant of head movements/Dix-Hallpike Maneuver	Yes	Varies, but often intolerant
Associated Nausea/Diaphoresis	Frequent	Variable, but often frequent
Auditory Symptoms	Points to peripheral causes	May be present
Proportionality of Symptoms	Usually proportional	Often disproportionate
Headache/Neck Pain	Unusual	More likely
CNS signs/symptoms	Absent	Usually present
Head Impulse Test	Abnormal	Often normal
Nystagmus	Horizontal	Vertical/direction-changing
HINTS Testing	Negative	Abnormal in at least 1 out of 3 tests

Myths In Emergency Medicine Diagnostic Imaging For Dizziness

23 March, 201511 July, 2021 EMKF

“Doctor, I’m feeling dizzy…” What you need to know:

CT is worthless and expensive in the evaluation of dizziness.
MRI has much better utility but is often unnecessary for the complaint of dizziness.
Nystagmus is an unreliable sign and does not differentiate serious neurological disease from other causes of dizziness.
Gait instability or imbalance, other subtle neurological findings, and age >60 years are predictors of stroke or other serious neurological diseases causing dizziness – Do an MRI NOT CT
Isolated dizziness is very unlikely to be serious or to require an extensive diagnostic evaluation.

Acute Ataxia In The ED Highlights

9 March, 201511 July, 2021 EMKF

The word “ataxia”, comes from the Greek word, ” a taxis” meaning “without order or incoordination”. Learn how to evaluate acute ataxia in the ED

Evaluating the dizzy patient…not everyone needs imaging (and a brain tumour in the long run)

20 February, 201511 July, 2021 EMKF

Head CT is poor screening tool for ED

15 January, 201511 July, 2021 EMKF

“Our results suggest that most patients presenting with syncope or dizziness to the emergency department may not benefit from head CT unless they are older, have a focal neurologic deficit, or have a history of recent head trauma,”

Epley’s Maneuver

30 December, 201321 July, 2021 EMKF

Benign paroxysmal positional vertigo (BPPV) is the likely cause in patients reporting brief recurrent attacks of dizziness triggered by changes in head position. It is important to recognize this cause because it can be readily treated at the bedside and because identification of the key features is the most effective way to exclude a central nervous system cause of positional dizziness. Important points about BPPV are that; a) the dizziness episodes last < 1 minute – Sometimes nausea or a mild light headedness can persist longer than 1 minute, but any patient reporting positional dizziness lasting longer than 1 minute should be carefully scrutinized for other potential causes. b) patients are normal in between episodes The Epley manoeuvre, a curative bedside manoeuvre, can then be used to reposition the debris in the semicircular cannals that is responsible for BPPV.