Approach to dizziness in the emergency department

Jung, Inhwa; Kim, Ji-Soo

doi:10.15441/ceem.15.026

Cited by 23 publications

(29 citation statements)

References 84 publications

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“…3 Complaints of dizziness may be a sign of more serious underlying vascular pathology, including a possible transient ischaemic attack or stroke. 20 The typical clinical presentation of BPPV is a short duration of intense spinning vertigo when a patient lies down, turns the head to the side, looks up or down, or transitions upright from a supine position. 7,8 This can be easily screened for with a Dix-Hallpike test and treated with a canalith repositioning technique (e.g.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of internal carotid artery stenosis in a patient referred to a physiotherapist for dizziness

2019

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PURPOSEThe purpose of this report is to describe the diagnostic focus of the clinical decision-making process for a patient referred to a physiotherapist for treatment of persistent dizziness, who was subsequently diagnosed with severe stenosis of the internal carotid arteries. CASE DESCRIPTIONThe patient was a 79-year-old man who was referred to a physiotherapist by his primary care physician for the treatment of persistent intermittent dizziness. The patient’s dizziness began 6 months prior insidiously; it was worsening over time and now interfered with activities of daily living. The patient denied cervical pain or headaches, numbness or tingling in his extremities, difficulty maintaining balance with walking, unsteadiness, muscle weakness, dysphagia, drop attacks, diplopia or dysarthria. At the physiotherapist’s initial evaluation, cervical range of motion was moderately restricted in all motions and his dizziness was elicited with changes in head position. The patient’s neurological examination was unremarkable. Due to positional complaints of dizziness, a Dix–Hallpike test was used to screen for benign paroxysmal positional vertigo, which was positive for symptoms reproduction; however, no nystagmus was noted. The patient also became diaphoretic and exhibited significant discoloration of his face during the test. OUTCOMESDue to concern over vascular compromise, carotid duplex ultrasonography and magnetic resonance angiography were completed and revealed near complete occlusion of the left internal carotid artery at its origin. The patient subsequently underwent a left internal carotid endarterectomy with resolution of symptoms and a return to all activities of daily living. DISCUSSIONCarotid artery stenosis, although frequently asymptomatic until severe, may manifest as complaints of dizziness that mimic peripheral vestibular dysfunction. Appropriate and prudent screening and referral is necessary if clinical symptoms suggestive of vascular compromise are present.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of internal carotid artery stenosis in a patient referred to a physiotherapist for dizziness

2019

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“…Presyncope mostly occurs as an adverse effect of medications; however, the consultation can be with a diagnosis of Parkinson disease and diabetic neuropathy disequilibrium. Psychiatric disorders such as depression, anxiety, and hyperventilation mostly define lightheadedness 15,16 .…”

Section: Discussionmentioning

confidence: 99%

“…Dizziness caused by Peripheral is the most frequent complaint in middle-aged and older adults. Among all dizziness types in various studies, BPPV takes the first place with rates of 25-50%, and it was followed by Meniere syndrome, vestibular neuronitis, vestibular migraine, and psychogenic dizziness 2,3,15,[19][20][21] . It was determined in this study that the most frequent cause of dizziness was BPPV in line with the literature.…”

Section: Discussionmentioning

confidence: 99%

Should We Look For Blood Parathormone in Patients with Vertigo?

Demirbilek¹,

Evren²

2019

Kafkas J Med Sci

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Aim: Though vertigo is a symptom which is defined by an individual as spinning of themselves or an object, it is generally defined by the patients as the sensation of falling, disequilibrium, dizziness and fainting. The main problem on the patients is the determination of the underlying illness. Most of vertigos have peripheral causes and benign paroxysmal positional vertigo takes the first place. It is followed by peripheral and central causes. Patients usually consult the policlinics of Ear, Nose and Throat, internal medicine, neurology in addition to emergency departments with balance disorders. These patients undergo examinations, screening methods, audiology and balance tests and routine blood tests. Material and Method: In this study in which 397 patients who consulted the hospital with complaints of vertigo between 2011 and 2017 evaluated retrospectively. Results: In our study, first of all peripheral causes and 44.8% of these were benign paroxysmal positional vertigo. Hyperparathyroidism was detected in 4 (1%) of the cases in our patient groups that the only complaint was dizziness and there were no other characteristics in the examinations. Parathyroid adenoma was detected in three of them and hyperplasia was detected in the other. In the ones who had adenoma after parathyroidectomy and in the other case after bisphosphonate treatment, both parathormone levels decreased to normal and vertigo complaints totally disappeared. Conclusion: It is recommended that parathormone values should be taken into account in the blood tests during the process of diagnosis in vertigo patients.

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“…Vertigo is a common cause for referring patients to emergency centers and its consequences are in a wide range; on the one hand, they affect life-threatening conditions and on the other hand, they affect normal physiological response [2-4]. Treatment of patients has been often symptomatic and different drug groups are used to control it.…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis of vertigo is vital for various reasons; first of all, the vertigo can be appeared as a life-threatening situation to a normal physiological response and secondly, there is no definitive diagnostic tool for the detection of its reasons [2]. Therefore, proper management of these patients in health centers is always challenging.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of the Effects and Side Effects of Oral Betahistine with Injectable Promethazine in the Treatment of Acute Peripheral Vertigo in Emergency

Motamed¹,

Moezzi²,

Rooyfard³

et al. 2017

J Clin Med Res

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BackgroundVertigo is an illusion of rotation that is caused by the asymmetry of neurological function of the right and left vestibular nuclei. The aim of this study was to compare the efficacy and side effects of oral betahistine with injectable promethazine in treatment of acute peripheral vertigo.MethodsIn this double-blind clinical trial study, the patients with acute peripheral vertigo were assigned in the two groups: receiving promethazine intramuscularly at a dose of 25 mg (group A) and receiving 8 mg betahistine tablets (group B) and the severity of their vertigo was evaluated on the visual analog scale (VAS) scoring system. In addition, adverse events in both groups of patients were compared and evaluated.ResultsA total of 162 patients (82 subjects in group A) participated in this study. The mean age, gender distribution, intensity and symptoms of vertigo were similar in both groups before the intervention. At 2 and 3 h after the intervention, the score of VAS in patients taking betahistine was significantly higher than promethazine. In addition, the clinical symptoms after taking betahistine were significantly less. Side effects seen in patients taking the promethazine include mainly drowsiness. After taking betahistine, the most common complication was abdominal problems (nausea and vomiting).ConclusionThe results of this study show that betahistine is a safe and effective drug in controlling patients with acute vertigo and its impact is more than promethazine.

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Approach to dizziness in the emergency department

Cited by 23 publications

References 84 publications

Diagnosis of internal carotid artery stenosis in a patient referred to a physiotherapist for dizziness

Diagnosis of internal carotid artery stenosis in a patient referred to a physiotherapist for dizziness

Should We Look For Blood Parathormone in Patients with Vertigo?

A Comparison of the Effects and Side Effects of Oral Betahistine with Injectable Promethazine in the Treatment of Acute Peripheral Vertigo in Emergency

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