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Dizziness approach (Spinning sensation (Vertigo (區分 Central and peripheral…

- - - - 發作時間持續數分鐘到小時
        
        思考 Meniere disease, migraine, VBI
        
        持續超過數小時且伴隨聽力損失、耳鳴等狀況
        
        Probable Meniere disease
        
        No significant tinnitus or ear symptoms
        
        Possible VBI, migraine
      - 發作持續數天
        
        Sustained vertigo
        
        Vestibular neuritis VS CVA, MS, migraine, other CNS disorder
        
        If there are any following
        
        skew deviation
        
        direction change nystagmus
        
        normal head thrust
        
        Yes
        
        Consider CVA, MS, or other CNS disorder
        
        No
        
        Probable vestibular neuritis
      - 發作時間持續小於一分鐘且無伴隨動作誘發的聽力喪失或耳鳴
        
        較懷疑BPPV (benign paroxysmal positional vertigo)
- - - - Normal
        
        Consider multiple sensory deficits
      - Abnormal gait
        
        Shuffling gait
        
        Parkinson’s disease
        
        Wide base gait
        
        Cerebellar disorder, normal pressure hydrocephalus
      - Cranial neuropathy
        
        Consider CVD, MS, posterior fossa tumor
      - Abnormal sensory exam
        
        Loss of proprioception
        
        Consider posterior column disease, B12 deficiency, tabes dorsalis, compressive spinal lesion
        
        Stocking glove neuropathy
        
        Consider neuropathy
- - - - differential diagnosis:
        
        CVA, VBI
        
        cerebellar hemorrhage
        
        CNS tumor
        
        MS
        
        vestibular migraine
    - - Meneire disease
        
        labyrinth infarction
        
        labyrinthitis
        
        CPA tumors
    - - orthostatic hypotension
    - - psychiatric disorder such as depression or anxiety