Taking a history from a patient with dizziness

• the following points are important when taking a history from a patient with dizziness since dizziness is a highly subjective symptom
  • different patients may describe dizziness in different ways
  • objective questions must attempt to differentiate vertigo from other forms of dizziness
  • clues as to the different types of dizziness should be looked for in the history (1)
    • vertigo
      • do you get the feeling of rotation?
      • does the surroundings spin around?
      • is there a tendency to fall to one side?
    • dysequilibrium
      • are you having a feeling of unsteadiness?
    • presyncope
      • do you feel faintish?
    • light headedness
      • do you feel lightheaded?
• onset and duration of the symptoms: (2)
  • provide information concerning the likely pathological processes
    • causes of episode lasting only a few seconds include:
      • peripheral cause like
        • unilateral loss of vestibular function, acute vestibular neuronitis, Meniere's disease
    • causes of episodes lasting for several seconds to a few minutes include:
      • benign paroxysmal positional vertigo, perilymphatic fistula
    • causes of episodes lasting for several minutes to one hour include:
      • transient ischemic attack, perilymphatic fistula
    • causes of episodes lasting for several hours include
      • Meniere's disease, perilymphatic fistula, migraine, acoustic neuroma
    • causes of episodes lasting for days include
      • early acute vestibular neuronitis, CVA, migraine, multiple sclerosis
• precipitating factors (2)
  • causes precipitating spontaneous episodes are
    • acute vestibular neuronitis; cerebrovascular disease, Meniere's disease, migraine, multiple sclerosis
  • changes in position of the head
    • acute labyrinthitis, benign positional paroxysmal vertigo, perilymphatic fistula, cerebellopontine angle tumour, multiple sclerosis
  • standing up - suggesting of postural hypotension
• associated symptoms, including:
  • deafness
  • tinnitus
  • otalgia
  • a feeling of fullness in the ear
  • discharge from the ear
  • neurological symptoms
• any other medical problems:
  • vascular disease
  • multiple sclerosis
  • drug history, especially ototoxic drugs
  • cardiac disease, especially arrhythmias

Reference:

1. J Kanagalingam et al. Vertigo, BMJ, Mar 2005; 330:523
2. Ronald H. Labuguen Initial Evaluation of Vertigo. American Family Physician ,Vol. 73/No. 2 (January 15, 2006)