Once you feel that you have a solid grasp on the timing, triggers and quality of the “Dizzy” complaint, you should inquire about other symptoms associated with vestibular disease and health conditions that may lead to pre-syncope or dysequlibrium.
Associated Symptoms
Symptoms such as tinnitus, hearing loss, otalgia, or aural fullness, particularly unilateral complaints, suggest the probability of peripheral vestibular disease. Symptoms such as slurred speech, inability to walk, difficulty swallowing, syncope or presyncope, numbness or tingling of the face or extremities, headache, or visual disturbance while stationary suggest a more central etiology.
General Health Status
Patients with advanced diabetes may exhibit dysequilibrium and postural instability secondary to peripheral neuropathy or may experience orthostatic hypotension secondary to autonomic neuropathy. Patients with a history of cardiovascular disease may experience reduced blood volume to the brain with exertion. Patients with a history or family history of classic migraine headaches are prone to vestibular migraine. Patients with cerebro-vascular disease often have impaired cerebellar function.
Medications
A review of the patient’s current and past medications is useful in the case history interview. Not only does this provide the examiner insight as to possible medication-related dizziness or vertigo, it also provides a second chance to review any health conditions that the patient may have omitted from the history interview.
Next week, we wrap up this series on the meaning of the word “Dizzy” with a reprint of the MOTT list. The MOTT list is a condensed list of general rules to aid in the diagnosis of the patient presenting with dizziness, vertigo or imbalance.
