What do you mean when you say Dizzy ? – Part VIII


           (General rules to aid in the dizziness diagnosis)

  •  A complaint of Vertigo MOTT indicates a peripheral vestibular asymmetry, but can mean Migraine or Infarct
  • A complaint of Lightheadedness, Faintness MOTT is not vestibular.
  • Vertigo, of less than 1 minute duration when lying down or tilting head MOTT indicates BPPV.
  • Pre-syncope and/or transient loss of balance, of less than one minute after rising MOTT indicates Orthostatic Hypotension.
  • Symptoms lasting minutes to hours MOTT indicates vestibular or vascular etiology.
  • Vertigo lasting hours with gradual decrease MOTT indicates unilateral vestibular pathology.
  • Vertigo lasting for 48 hours or more with no improvement MOTT indicates CNS or psychiatric etiology.
  • Symptoms that increase with eyes closed or with a change in head position MOTT indicates vestibular etiology.
  • Symptoms noted only while standing MOTT are related to vascular or orthopedic disease.
  • Associated symptoms such as unilateral tinnitus and/or hearing loss, particularly at the time of the dizziness, MOTT indicates vestibular etiology.
  • Symptoms such as syncope, numbness, tingling, confusion, slurred speech MOTT indicate CNS disease.
  • Nystagmus that are conjugate, diminish with visual fixation, and/or are direction fixed MOTT are of peripheral vestibular origin.
  • Nystagmus that are vertical, disconjugate or direction changing without change in head position are MOTT due to CNS disease.
  • Nystagmus that increase when gaze is directed toward the fast phase, and decrease when gaze is directed toward the slow phase are MOTT a sign of acute peripheral vestibular asymmetry.








About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.