Approach to giddiness and vertigo (lecture)

**As with any symptom, ask for the DETAILS. E.g. how long already, how long each episode, pre and post, aggravating and
relieving factors, describe the nature, any vertigo, associated symptoms such as n/v, etc.
Common causes of giddinessalways think of:
(1) PMH + Drugs
Especially elderly
HTN: ACE-inhibitors/ARBs, diuretics (can cause postural hypotension)
DM: long acting sulfonylureas (hypoglycemia)
OA: NSAIDs (GI bleedanemia)
(2) Autonomic neuropathy
Postural hypotension
Nocturnal diarrhea
Gastroparesis
Urinary incontinence
Erectile dysfunction
Abnormal sweating patterns (sweat in cold, shiver in hot)
ECG rhythm leadloss of RR variability, especially with valsalva manouvre (loss of reflex tachycardia)
(3) TIAs/VBI
Assess cranial nerves! (blood supply is from VBAs)
3,4,6: diplopia
5: numbness
7: droop
8: deafness, tinnitus, vertigo
9, 10: dysphagia, dysarthria, dysphonia
12: tongue
(4) Anemia
NSAIDs, fibroids, CRC
Common causes of vertigo:
(1) BPPV (benign paroxysmal positional vertigo)
Most common cause of vertigo
Always precipitated by change of head position!
Can usually be remembered and described very clearly
Do you have milder attacks frequently? (usually yes)
(2) Vestibular problem
Cant focus on snellens chart (loss of visual acuity/VOR) when moving head left and right/up and down
But NOT when rotating head! (can be used to pick out malingerers)
For any syncope:
*Always rule out seizures!
Atonic seizures can mimic vasovagal
Ask for post-ictal drowsiness/tiredness