Dizziness/Vertigo

INTRODUCTION

The term ‘dizziness’ is generally used collectively to describe all types of equilibrium disorders and, for convenience, can be classified as shown in Figure D9.

VERTIGO

Vertigo is defined as an episodic sudden sensation of circular motion of the body or of its surroundings or an illusion of motion (a rotatory sensation).

GIDDINESS

Giddiness is a sensation of uncertainty or ill-defined lightheadedness. It is a typical psychoneurotic symptom.

SYNCOPAL EPISODES

Syncope may present as a variety of dizziness or lightheadedness in which there is a sensation of impending fainting or loss of consciousness. Common causes are cardiogenic disorders and postural hypotension, which are usually drug-induced. Consider postural orthostatic tachycardia syndrome (POTS) with hypotension if adolescent onset.

DISEQUILIBRIUM

Disequilibrium implies a condition in which there is a loss of balance or instability while walking, without any associated sensations of spinning. It is often described as ‘like standing on a rocking boat’ where the feeling underneath the feet is unsteady.

SPECIFIC CAUSES OF DIZZINESS

Drugs

Drugs usually affect the vestibular nerve rather than the labyrinth. The causes, which are numerous, include antibiotics, esp. the mycins and tetracyclines, anticonvulsants, cardiogenic drugs and salicylates.

Cervical spine dysfunction

It is not uncommon to observe vertigo in patients with cervical spondylosis or postcervical spinal injury. It has been postulated that this may be caused by the generation of abnormal impulses from proprioceptors in the upper cervical spine. Some instances of benign positional vertigo are associated with disorders of the cervical spine.

Acute vestibulopathy (vestibular failure)

This term covers both vestibular neuritis and labyrinthitis, which are considered to be a viral infection of the vestibular nerve and labyrinth respectively, causing a prolonged attack of vertigo that can last for several days, especially if labyrinthitis. It is also caused by a stroke of the inferior cerebellar arteries.

Main features

• Often follows a ‘flu-like’ illness

• Mainly affects young adults and middle-aged

• Generally lasts days to weeks

• Nausea and vomiting

• No hearing loss or tinnitus

• Horizontal nystagmus (in acute phase)

Treatment

• Rest in bed, lying very still

• Gaze in the direction that eases symptoms

• Drugs to lessen vertigo

The following drugs can be used:

• promethazine 10–25 mg IM or IV (slow) then 10–25 mg (ο) for 48 hrs or

• prochlorperazine (Stemetil) 12.5 mg IM (if severe vomiting) or 5–10 mg (o) 6–8 hrly or

• ondansetron 4.8 mg (o) 2–3 hrly (recommended)

• diazepam (which ...